COPD annual reviews in Primary Care: How to Improve Control and Reduce Exacerbations

• 6th February 2026

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COPD annual reviews reduce admissions by targeting inhaler technique, therapy optimisation, and self-management plans. For PCNs, a pharmacy team integrating Clinical Pharmacists and Pharmacy Technicians is the most efficient model to hit QOF indicators and support long-term condition (LTC ) management. Most gains come from a structured 20-30 minute review.

• What should a COPD annual review include?
• How do COPD annual reviews reduce exacerbations?
• The 5-Step Pharmacy Review Process
• What should a COPD self-management plan include?
• The Role of Clinical Pharmacists and Pharmacy Technicians
• The role of sustainability in COPD reviews

Key Takeaways

• Targeted intervention: Structured reviews fix the main causes of exacerbations-poor adherence and incorrect device use
• Multidisciplinary roles: Clinical Pharmacists lead therapy optimisation; Pharmacy Technicians drive technical assessments and data quality
• Risk stratification: High-risk patients (≥2 exacerbations or ≥1 hospitalisation/year) need more than annual review

What should a COPD annual review include?

A COPD annual review should cover exacerbation history, symptom assessment using the CAT score or mMRC dyspnoea scale, inhaler technique, therapy optimisation in line with GOLD guidelines, self-management planning, smoking cessation, vaccinations, and pulmonary rehabilitation eligibility. NICE NG115 underpins this structure.

Review Component	Why It Matters
Exacerbation history	Risk stratification and therapy stepping
CAT score / mMRC	Objective symptom and breathlessness assessment
Inhaler technique	Poor technique drives poor control
Therapy optimisation	Match treatment to symptoms and risk per GOLD
Self-management plan	Reduces delayed treatment and admissions
Smoking cessation	Single most important modifiable factor
Vaccinations	Basic exacerbation prevention

These elements are frequently under-recorded or reviewed in isolation in routine primary care.

How do COPD annual reviews reduce exacerbations?

COPD annual reviews reduce exacerbations by identifying and fixing modifiable problems before they escalate. The biggest levers are inhaler technique, device mismatch, and over-reliance on SABA relievers.

Pharmacy Technicians often play a vital role here by conducting initial technique screenings and identifying patients who are over-ordering rescue medication. Addressing these issues early reduces treatment delays and prevents avoidable admissions. Fixing them is often achievable within a single structured medication review.

The 5-Step Pharmacy Review Process

Inhaler optimisation means matching the device to the patient, confirming technique, and stepping therapy based on symptoms and exacerbations in line with NICE NG115.

1. Assess capability – Check dexterity, cognition, and inspiratory flow (using tools like the In-Check DIAL)
2. Simplify devices – Reduce device variety where possible to improve technique consistency
3. Observe technique – Watch the patient use their actual inhaler; do not rely on verbal confirmation
4. Review ICS indication – Clinical Pharmacists ensure inhaled corticosteroids are appropriate and step down where possible
5. Document and follow up – Record findings and schedule review within 4-12 weeks

This is where pharmacist-led reviews consistently outperform template-only reviews.

What should a COPD self-management plan include?

A COPD self-management plan should include individualised early warning signs, clear first actions, when to seek help, and rescue pack guidance where locally appropriate. Both Clinical Pharmacists and Pharmacy Technicians can support the patient in understanding these plans, ensuring the patient feels confident in managing a flare-up. The Primary Care Respiratory Society provides practical templates.

The Role of Clinical Pharmacists and Pharmacy Technicians

A collaborative pharmacy model is the gold standard for respiratory and long-term condition (LTC) care. Clinical Pharmacists bring deep medicines expertise, focusing on clinical assessment and complex therapy changes. Meanwhile, Pharmacy Technicians support the pathway by managing QOF coding, conducting smoking cessation chats, and ensuring patients are up to date with their vaccinations.

Utilising ARRS-funded pharmacy teams for these reviews releases GP capacity for acute presentations while ensuring every COPD patient receives a high-quality, proactive review.

The strongest models include:

• Structured clinical review (symptoms, exacerbations, function)
• Device and technique optimisation using CAT scores for monitoring
• Action plan creation or refresh
• Clear escalation routes to GP or respiratory services

This integrates well with respiratory care pathways.

The role of sustainability in COPD reviews

Inhaler optimisation also supports Greener NHS goals. Where clinically appropriate, switching from pressurised metered-dose inhalers (pMDIs) to dry powder inhalers (DPIs) reduces carbon footprint without compromising patient outcomes. Clinical Pharmacists are perfectly placed to lead these green switches, ensuring the patient’s inspiratory flow is sufficient for a DPI before making the change.

Structured COPD reviews are one of the clearest opportunities to reduce avoidable admissions. When the clinical pharmacy team focuses on technique, adherence, and action planning, the impact on exacerbation rates is measurable.

Adeem Azhar, Co-Founder and Chief Executive Officer – Core Prescribing Solutions

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