Systematic review and meta-analysis of pharmacist-led care in COPD
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Key Takeaway
Consider that pharmacist-led COPD care may reduce admissions and improve adherence, but evidence is heterogeneous and limited.
This systematic review and meta-analysis evaluated pharmacist-led interventions in COPD patients, pooling data from 2313 participants across included trials. The authors synthesized evidence on exacerbation-related hospital admissions, medication adherence, smoking cessation rates, health-related quality of life, COPD Assessment Test scores, and lung function.
The analysis reported a lower risk of exacerbation-related hospital admissions with pharmacist-led care (RR = 0.43; 95% CI: 0.33-0.55). Improvements were observed in medication adherence and smoking cessation rates, and health-related quality of life was reported to improve. In contrast, COPD Assessment Test scores and lung function showed non-significant effects.
The authors noted several limitations: substantial heterogeneity, variable overall study quality, many small trials, and a high risk of bias in many trials. They highlighted inconsistent effects across outcomes and concluded that the evidence is heterogeneous and limited by study quality.
In terms of practice relevance, the authors suggested that pharmacist-led interventions in COPD may improve selected medication-related and patient-centered outcomes. However, they emphasized that robust conclusions regarding clinical effectiveness and effects on COPD Assessment Test scores and objective disease measures cannot be drawn, and findings should be interpreted cautiously.
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View Original Abstract ↓
PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, and suboptimal medication management contributes to exacerbations and preventable healthcare utilization. Pharmacist-led integrated care has the potential to improve medication use and clinical outcomes. We conducted a systematic review and meta-analysis to evaluate the effects of pharmacist-led interventions in COPD.
METHODS: This systematic review and meta-analysis was conducted and reported in accordance with PRISMA 2020. We searched PubMed, Embase, and Web of Science from inception until June 23, 2025. Randomized controlled trials (RCTs) assessing the effects of pharmaceutical care on clinical outcomes in COPD patients were included. A random-effects model was used to estimate pooled relative risks (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane Risk of Bias tool.
RESULTS: A total of 11 randomized controlled trials involving 2313 participants were included. Pharmacist-led interventions were associated with a lower risk of exacerbation-related hospital admissions (RR = 0.43, 95% CI: 0.33-0.55). Improvements in medication adherence and higher smoking cessation rates were also observed. Improvements in health-related quality of life were reported; however, substantial heterogeneity was present. In contrast, effects on COPD Assessment Test scores and objective disease measures, including lung function, were non-significant. Overall study quality was variable, with many trials being small and at high risk of bias.
CONCLUSION: Pharmacist-led interventions in COPD may improve selected medication-related and patient-centered outcomes; however, the available evidence is heterogeneous and limited by study quality and inconsistent effects across outcomes. These findings should be interpreted cautiously, and well-designed, adequately powered trials with standardized outcomes are needed before robust conclusions regarding clinical effectiveness can be drawn.
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