Community pharmacists' readiness to support quality care in chronic obstructive pulmonary disease management

Community pharmacists’ readiness to support quality care in chronic obstructive pulmonary disease management Jeton Mucaj1, Beti Djurdjic1, Zorica Naumovska1, Kristina Mladenovska1, Maja Simonoska Crcarevska1 1 Faculty of Pharmacy, Ss Cyril and Methodius University in Skopje, 1000 Skopje, Republic of North Macedonia Corresponding author: Maja Simonoska Crcarevska (m[email protected].mk) Received 11 August 2025♦ Accepted 5 November 2025♦ Published 24 November 2025 Citation: Mucaj J, Djurdjic B, Naumovska Z, Mladenovska K, Simonoska Crcarevska M (2025) Community pharmacists’ readiness to support quality care in chronic obstructive pulmonary disease management. Pharmacia 72: 1–9. https://doi.org/10.3897/pharmacia.72.e168446 Abstract Chronic obstructive pulmonary disease (COPD) requires ongoing care, and community pharmacists (CPs) play a key role in its management. This study assessed CPs’ knowledge, confidence, and practices related to COPD in Kosovo. A cross-sectional survey of registered CPs evaluated their knowledge and practices concerning COPD, covering general, pharmacological, and non-pharmacological aspects. Data analysis involved cross-tabulations and chi-square tests (p < 0.05). The sample represented 9.5% of Kosovo’s CPs (mean age = 39.1 years; 63.2% female). Most participants (88.8%) lacked formal COPD training. While 84% dispensed COPD medications, only 57.6% felt confident managing the condition. Knowledge scores revealed gaps: general knowledge (mean = 3.3/8), pharmacological (1.42/5), and non-pharmacological (2.59/5). Pharmacological knowledge was weakest, with 60% scoring low. Education level correlated with general knowledge (p = 0.011), and confidence was linked to knowledge (p = 0.0004) and dispensing (p = 0.0003). Substantial COPD knowledge gaps among CPs in Kosovo underscore the need for targeted education and system-level support to optimize patient care. Keywords Chronic obstructive pulmonary disease, community pharmacy services, education, health knowledge and practice, quality of health care Introduction Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, affecting nearly 300 million people, with prevalence increasing significantly after age 40 (Olortegui-Rodriguez et al. 2022; GOLD 2023; WHO 2023). It includes chronic bronchitis, emphysema, and obstructive asthma, marked by airflow limitation, inflammation, excess mucus, and reduced lung elasticity (ALA 2023). Common symptoms—dyspnea, chronic cough, sputum production, and fatigue— progressively impair patients’ functional capacity and quality of life. Major risk factors include smoking, occupational exposures, and indoor air pollution, especially in lowand middle-income countries (WHO 2023). Without adequate management, COPD can cause serious complications, including infections, cardiovascular and metabolic conditions, psychiatric disorders, and Copyright Mucaj J et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pharmacia 72: 1–9 DOI 10.3897/pharmacia.72.e168446 Research Article Mucaj J et al.: Pharmacists’ readiness to deliver quality COPD care2 malignancies. International guidelines recommend combining pharmacological treatments (e.g., bronchodilators, corticosteroids, and PDE4 inhibitors) with non-pharmacological interventions such as smoking cessation, vaccination, and pulmonary rehabilitation. High-quality COPD care requires a multidisciplinary approach. Community pharmacists (CPs), due to their accessibility, are increasingly recognized as valuable contributors to prevention, early detection, patient education, and long-term management. Studies show that pharmacist-led interventions can improve medication adherence, inhaler technique, smoking cessation, and vaccination uptake (Van Der Molen et al. 2017; Karle et al. 2020; Condinho et al. 2021). However, poor adherence and incorrect inhaler use remain common, with up to 60% of patients not following treatment recommendations (Krigsman et al. 2007; Sanduzzi et al. 2014; WHO 2015; Newman 2017; Świątoniowska et al. 2020; Homętowska et al. 2022). These gaps highlight the importance of CPs’ engagement in patient-centered care. Pharmacist-led programs have positively impacted treatment quality and outcomes (FIP 2019). Pharmacists also help manage polypharmacy, promote guideline-based therapies, and support smoking cessation and influenza vaccination (Klassing et al. 2018; Hudd 2020). Despite growing evidence, CPs’ readiness to provide COPD care remains underexplored, especially in resource-limited regions. Understanding their knowledge, practices, and barriers is essential for improving care delivery and outcomes. This study aims to evaluate the knowledge, experiences, and practices of CPs in Kosovo regarding COPD management. It explores the extent of their clinical preparedness, the availability of COPD-related services, and their willingness to engage in pharmaceutical care. The study seeks to answer: How well are pharmacists equipped to support high-quality COPD care, and what factors limit their involvement in effective management strategies? Methods Research design A voluntary cross-sectional survey, using a structured questionnaire, was conducted to assess community pharmacists’ knowledge of COPD management and related professional practices in Kosovo. The questionnaire, originally developed by Hu et al. (2020), was translated into the local language and adapted by adding context-specific questions to suit the study setting. It contained 34 items, including eight demographic questions and 26 assessing knowledge and willingness to provide quality pharmaceutical care in COPD management. A focus group refined the questionnaire for clarity and relevance (expert review by a panel of pharmacy professionals). In July 2024, a pilot study with 10 CPs evaluated comprehension, acceptability, and completion time. Participants provided feedback that helped improve the final anonymous questionnaire. This stepwise development ensured that the questionnaire appropriately captured the intended knowledge domains and was suitable and reliable for use in the target population. The finalized survey was distributed with support from the Chamber of Pharmacists of Kosovo via email and closed social media groups, reaching CPs across the country. Ethics approval Ethical approval for the study was obtained from the Ethics Committee of the Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, North Macedonia (No. 02-284/3, dated 29 April 2024), where the idea for the study originated. Subsequent approval was granted by the Ethics Committee of the Chamber of Pharmacists of Kosovo (No. 142, dated 1 July 2024). Data collection and analysis Data were collected via Google Forms (3 September to 30 November 2024). Participants could optionally submit email addresses for follow-up, with initial responses remaining anonymous. The survey spanned all regions of Kosovo to capture diverse socioeconomic contexts. Data were exported to Excel for cleaning and then analyzed descriptively using Statgraphics Centurion XIX (trial version). Knowledge assessment covered COPD general knowledge (risk factors, symptoms, diagnosis, treatment guidelines) (questions 15–19; maximum score: 8), pharmacological treatment (questions 20–24; maximum score: 5), and non-pharmacological treatment (questions 25–27; maximum score: 5). Scores were calculated by assigning +1 for correct answers and −1 for incorrect ones, except for question 27, where responses were scored as “Yes” (+1), “No” (−1), and “Sometimes” (0). The scoring system was applied to mitigate potential inflation of knowledge scores due to random guessing, with negative points for incorrect answers ensuring a more accurate representation of respondents’ true knowledge by balancing correct and incorrect responses and distinguishing informed understanding from chance-based selections. To explore factors influencing scores, cross-tabulation analysis was conducted, and statistical significance was assessed using the chi-square test, with p < 0.05 considered significant. Results Overview of socio-demographic data of the participants Understanding the socio-demographic profile of CPs in Kosovo is essential for interpreting survey findings on COPD care management, as variables such as age, experience, and professional setting provide vital context. Pharmacia 72: 1–9 3 The EU average for community pharmacies (CPharm) is approximately 32 per 100,000 people (GP 2024). As of January 2022, Kosovo had 832 licensed CPharms, or 52.44 per 100,000 population, indicating higher-than-average accessibility. Regarding CPs, most EU countries report between 58 and 123 per 100,000 people (Eurostat 2024). By September 2024, Kosovo had 1,478 registered pharmacists, including 1,321 in CPharm, corresponding to 83.26 per 100,000—placing Kosovo within the EU mid-range. The final study sample included 125 CPs (9.5% of the target population). The mean participant age was 39.09 years (SD = 10.22), with an average of 13.8 years (SD = 9.09) of professional experience and 11.61 years (SD = 7.91) in CPharm practice. Full socio-demographic characteristics are shown in Table 1. Table 1. Socio-demographic characteristics of CPs participating in the COPD survey (n = 125). Characteristic Category Percentage (%) from surveyed population 95% confidence interval (CI%) Gender Male 36.8 28.3–45.3 Female 63.2 54.7–71.7 Age 20–30 years 20 13.0–27.0 31–40 years 37.6 29.1–46.1 41–50 years 29.6 21.6–37.6 51–60 years 7.2 2.7–11.7 61+ years 4 0.6–7.4 Geographical distribution Prishtina 48.8 40.0–57.6 Prizren 20.0 13.0–27.0 Ferizaj 11.2 5.7–16.7 Peja 5.6 1.6–9.6 Mitrovica 4.0 0.6–7.4 Gjakova 7.2 2.7–11.7 Gjilan Others 1.6 1.6 0–3.8 0–3.8 Education level Master of pharmacy 84.8 78.5–91.1 Master of science in pharmacy 8.0 3.2–12.8 PhD 5.6 1.6–9.6 Specialist degree 1.6 0–3.8 Work experience 1–10 years 39.2 30.6–47.8 11–20 years 40.8 32.2–49.4 21–30 years 9.6 4.4–14.8 31–40 years 5.6 1.6–9.6 41–50 years 1.6 0–3.8 Community pharmacy experience 1–10 years 49.6 40.8–58.4 11–20 years 37.6 29.1–46.1 21–30 years 8.0 3.2–12.8 31–40 years 3.2 0.1–6.3 Weekly working hours 1–16 hours 3.2 0.1–6.3 17–32 hours 4.8 1.1–8.5 33–40 hours 38.4 29.9–46.9 41–48 hours 33.6 25.3–41.9 49+ hours 19.2 12.3–26.1 Type of pharmacy Independent pharmacy 75.2 67.6–82.8 Small chain pharmacy 13.6 7.6–19.6 Large chain pharmacy 9.6 4.4–14.8 Females comprised 63.2%, highlighting their expanding role in CPharm care. Most were aged 31–40 (37.6%) or 41–50 (29.6%), reflecting mid-career professionals. Younger pharmacists (20–30, 20%) contributed fresh knowledge, while those 51+ (11.2%) offered expertise. Experience was balanced: 40.8% had 11–20 years of professional experience, and 49.6% had 1–10 years in CPharm, suggesting a dynamic early-career cohort driving change. Education levels were high: 84.8% held a Master of Pharmacy degree, and 15.2% had postgraduate degrees, reinforcing strong qualifications and commitment to COPD care development. Professional experience rose steadily with age—from 3.32 years (SD = 3.59) among those aged 21–30 to 30.25 years (SD = 3.47) among those aged 61+, underscoring accumulated expertise. Geographically, nearly half of respondents were from the capital, with smaller shares from other major cities, while one region showed low participation, indicating regional disparities. Mucaj J et al.: Pharmacists’ readiness to deliver quality COPD care4 Most respondents (75.2%) worked in independent pharmacies. Common work hours were 33–40 (34.04%) and 41–48 (34.04%), with 25.5% working over 49 hours. Only 9.6% worked in large chains (mostly 33–40 hours); none worked under 16 or over 48. Small chains accounted for 13.6%, mainly working 33–40 hours (47.06%). Overall, 33–40 hours were most common (38.4%), while longer hours (41–48, 33.6%; ≥ 49, 19.2%) were typical in independents, likely due to patient or business demands. Community pharmacists` involvement in COPD care A majority of respondents (57.6%) reported being familiar with COPD, with 11.2% very familiar, 20% somewhat familiar, and 8.8% unfamiliar. Most community pharmacies (84%) provided COPD medications, while 11.2% did not, and 4% were unsure whether these medications were stocked. Comparative data show that the availability of COPD medications in Kosovo (84%) is higher than in China (66.7%) (Hu et al. 2020) but lower than in North Macedonia (96.62%) (Bozhinovska et al. 2022). The proportion of pharmacists not dispensing or unsure about COPD medications in Kosovo (15.2%) is lower than in China (33.3%) (Hu et al. 2020) but higher than in North Macedonia (3.38%) (Bozhinovska et al. 2022). Regarding services, 47% reported offering or expressing interest in expanding COPD services, including inhaler technique instruction, medication counseling, smoking cessation, infection prevention, therapy monitoring, and pulmonologist referrals. Some CPs suggested advanced services such as telepharmacy, group education, and peak flow meter use. Education-related findings revealed that 88.8% of respondents did not receive COPD-related training during formal education, while only 11.2% had. Similarly, 78.4% had no COPD-related training during professional practice, while 20.8% had. Willingness to engage in COPD pharmaceutical care was high: 49.6% were willing if training was provided, 32.8% expressed willingness without training, 14.4% were unsure, and 2.4% were unwilling. These findings are comparable to Bozhinovska et al. (2022), where 57.43% were willing after training, 34.46% without training, and 1.35% were unwilling. In Hu et al. (2020), 91% supported pharmacist involvement regardless of training, while 2.3% were unwilling. General knowledge about COPD Fig. 1 shows CPs’ knowledge of COPD risk factors, symptoms, and airflow limitation reversibility. Most respondents correctly identified smoking, lung infections, air pollution, and dust as key risk factors, but nearly half wrongly included allergic reactions. Only 11.2% recognized parasympathetic hyperactivity as a risk factor, though this group also mistakenly included allergic reactions. About 22.8% correctly identified three of four risk factors without errors, while 1.42% identified only one. No respondent identified all risk factors correctly. For comparison, Bozhinovska et al. (2022) reported 24.32% recognition of parasympathetic hyperactivity, with 80% also incorrect on allergic reactions; Hu et al. (2020) reported 4% correct identification of all risk factors. Regarding symptoms, 96% identified chronic cough, sputum, dyspnea, and chest tightness correctly, consistent with Hu et al. (2020) and Bozhinovska et al. (2022). However, nearly half incorrectly believed airflow limitation is reversible, similar to Bozhinovska et al. (2022) and higher than Hu et al. (2020) (33.3%), while only ~20% acknowledged its irreversibility. On diagnostics, 67.28% incorrectly thought an FEV/ FVC ratio below 90% diagnoses COPD; only 32.74% correctly rejected this, knowing the cutoff is < 70% (GOLD 2023). Bozhinovska et al. (2022) and Hu et al. (2020) reported lower correct answers (18.24% and 13%, respectively). Meanwhile, 91.45% recognized GOLD guidelines for COPD treatment, similar to Bozhinovska et al. (2022) (96%) but much higher than Hu et al. (2020) (27.1%). Graphical representation of the responses for risk factors, symptoms (chronic cough, sputum production, dyspnea, and chest tightness), and reversibility of airflow limitation in COPD, *correct answers; **wrong answer. Pharmacological treatment of COPD Fig. 2 shows CPs’ knowledge of COPD pharmacological treatment. A large majority (80.67%) mistakenly identified SABAs as first-line treatment, with only 19.33% correctly recognizing that SABAs are not recommended for chronic use. This aligns with previous studies reporting 9.6% (Hu et al. 2020) and 17.57% (Bozhinovska et al. 2022) correct responses. However, 88.3% correctly identified SABAs’ role in acute exacerbations, similar to Hu et al. (2020) (74.6%) and Bozhinovska et al. (2022) (95.95%). Regarding inhaled corticosteroids (ICS), 47.11% recognized their role in COPD management, comparable to Bozhinovska et al. (2022) (54%), while 52.9% incorrectly believed ICS are avoided due to severe side effects. This is better than Hu et al. (2020) but indicates misunderstanding. Most pharmacists (88.89%) correctly acknowledged the use of short-acting oral glucocorticoids in managing exacerbations, consistent with Hu et al. (2020) (79.7%) and Bozhinovska et al. (2022) (93.24%), while 11.11% responded incorrectly. Regarding side effects of theophylline and related drugs, 74.17% correctly identified common adverse effects such as nausea, vomiting, diarrhea, regurgitation, and headaches, with 25.83% incorrect. These results are similar to Hu et al. (2020) (79.7%) and Bozhinovska et al. (2022) (76.35%). Pharmacia 72: 1–9 5 Figure 1. Graphical representation of the responses for risk factors, symptoms (chronic cough, sputum production, dyspnea, and chest tightness), and reversibility of airflow limitation in COPD, *correct answers; **wrong answer. Figure 2. CPs’ knowledge about pharmacological treatment of COPD. Mucaj J et al.: Pharmacists’ readiness to deliver quality COPD care6 Non-pharmacological treatment and nicotine replacement therapy CPs recognized smoking cessation as crucial in COPD management, with 93.6% acknowledging its role in slowing disease progression. Despite this, only 28.1% regularly recommend nicotine replacement therapy (NRT), 39.67% recommend it occasionally, and 32.23% do not recommend it at all. Regarding other non-pharmacological interventions, 72.0% recommend seasonal flu vaccination, 62.4% encourage increased physical activity, and 33.6% suggest reducing salt intake. Pulmonary rehabilitation centers were acknowledged by 87.07% of pharmacists. In comparison, 20.5% of pharmacists selected all three key non-pharmacological interventions (smoking cessation, flu vaccination, physical activity), compared to 6.8% in Hu et al. (2020). Salt intake reduction was noted by 44.6% in Bozhinovska et al. (2022). Pulmonary rehabilitation awareness was similar to Hu et al. (2020) (87.6%) and Bozhinovska et al. (2022) (96.62%). Evaluation of general knowledge, pharmacological, and non-pharmacological treatment of COPD Regarding the participants’ general knowledge, the average score was 3.3 (SD = 1.87), with a range from -1 to 7 (maximum possible score 8). The average score for pharmacological treatment was 1.42 (SD = 1.89; range -2 to 4) and 2.59 (SD = 1.37; range -1 to 5) for non-pharmacological treatment (max score: 5 for both). For the general knowledge domain, scores ≤ 2 were ranked as low, scores between 3 and 5 as moderate, and scores ≥ 6 as high. In addition, for pharmacological and non-pharmacological treatment knowledge domains, the ranking was scores ≤ 1 as low, scores between 2 and 3 as moderate, and scores ≥ 4 as high. CPs’ knowledge varied across three domains: general, pharmacological, and non-pharmacological treatment (Fig. 3). Moderate general knowledge was found in 49.6% of CPs, while 37.6% had low and 12.8% high general knowledge. Pharmacological treatment knowledge was the weakest, with 60% showing low, 32% moderate, and only 8% high proficiency. Conversely, non-pharmacological treatment knowledge was stronger: 28% had high, 51.2% moderate, and 20.8% low knowledge. Education level was significantly associated with general knowledge (χ² = 16.566, p = 0.011), with MSc holders more likely to have high general knowledge, while Cramer’s V = 0.2574 indicated moderate association. No significant association was found between education and pharmacological or non-pharmacological knowledge. Pharmaceutical care practices for COPD: patient monitoring, counseling, and adherence A large majority (87.71%) of respondents reported lacking tools or methods to continuously monitor COPD patients. The average comfort score for counseling COPD patients was 2.98 (SD = 2.05) (scale 1 to 6), with 55.5% reporting low comfort, 14.4% moderate, and 30.4% high comfort (categorized as low (≤2), moderate (3–4), and high (≥5)). CPs’ comfort with counseling varied by medication type: 47.15% felt comfortable with short-acting bronchodilators, 37.6% with long-acting, 24.8% with both, 38.2% with combination inhalers, 29.3% with inhaled corticosteroids, and only 5.7% with phosphodiesterase-4 inhibitors. About 25.2% felt comfortable with all COPD medications. Cross-tabulation revealed a significant association between comfort and general COPD knowledge (χ² = 20.674, p = 0.0004). Cramer’s V (0.2876) indicated a moderate association. Similarly, comfort level correlated with pharmacological knowledge (χ² = 14.407, p = 0.0061). Cramer’s V (0.2401) suggested a moderate association. In summary, while both general and pharmacological knowledge were statistically related to comfort, the predictive power was weak, with other factors likely influencing comfort levels in counseling COPD patients. Confidence in teaching inhalation technique was “very confident” in 43.09%, “confident” in 44.72%, “somewhat confident” in 8.94%, and “not very confident” in 3.25%. Confidence did not significantly correlate with knowledge domains but was moderately associated with dispensing COPD medications (χ² = 36.128, p = 0.0003). Cramer’s V (0.3104) and the contingency coefficient (0.4735) indicated a moderate association between the two variables. However, Lambda (0.0571) suggested weak predictive power, indicating that other factors may also influence the relationship between medication dispensing and inhalation technique confidence. Adherence awareness was positive: 43.8% rated patients as very cooperative, 44.63% as moderately, 6.61% as poorly, and 4.96% did not counsel on adherence. Phone contact frequency with patients was occasional (64.46%), often (10.74%), always (1.65%), and no contact at 23.14%. About 46% responded to challenges in COPD care, citing patient education/compliance, patient behavior, trust/communication gaps, and systemic barriers such as medication shortages and limited staffing. Figure 3. Distribution of CPs’ knowledge levels across general, pharmacological, and non-pharmacological treatment domains of COPD. Pharmacia 72: 1–9 7 Nearly half (48.8%) expressed willingness to continue in future project phases, showing strong interest and potential for deeper involvement with further support for quality COPD care. Strengths and limitations This study is among the first to assess COPD-related competencies of CPs in Kosovo, a region with limited published data on the quality of primary care in respiratory diseases. It provides insight into real-world practice and reveals gaps that hinder optimal care. The sample, while representing 9.5% of the CP population, was drawn through voluntary participation and may be subject to selection and response bias. Recruitment via the Chamber of Pharmacists and social media could limit generalizability. Despite this, the findings offer important insight into systemic barriers affecting the quality of care in COPD management. Discussion CPs in Kosovo demonstrated a foundational understanding of COPD, including symptom recognition and awareness of treatment guidelines. However, significant knowledge gaps persist, particularly in pharmacotherapy, diagnostic criteria, and spirometry interpretation. While most CPs expressed motivation to engage in care, few had received formal or structured training. Availability of COPD medications was inconsistent, with 15.2% either not stocking them or unaware of their availability, potentially hindering access and continuity of care. Limited confidence in managing complex therapies and low access to monitoring tools reflect broader system constraints. Although CPs generally support non-pharmacological measures such as smoking cessation and vaccination, misconceptions about risk factors and treatment strategies remain. Lack of formal training and monitoring tools limits their ability to provide consistent, high-quality care. Nonetheless, over 80% expressed willingness to engage in COPD care, revealing untapped potential within the profession. Compared to similar studies, CPs in Kosovo demonstrated knowledge and engagement levels between those reported in China (Hu et al. 2020) and North Macedonia (Bozhinovska et al. 2022). The availability of COPD medications is higher than in China but lower than in North Macedonia, reflecting regional disparities in pharmaceutical infrastructure and healthcare organization. The lack of formal training among most CPs mirrors findings from other lowand middle-income countries, where continuing professional development remains fragmented (Hu et al. 2020, Bozhinovska et al. 2022). Although willingness to engage was highest in China (Hu et al. 2020), similarly strong responses in Kosovo and North Macedonia (Bozhinovska et al. 2022) suggest a broadly favorable attitude, implying that systemic and educational barriers may be more limiting than motivation. Recognition of non-pharmacological measures such as smoking cessation, vaccination, and pulmonary rehabilitation aligns with international priorities (Au et al. 2009; Tønnesen 2013; Ellerbeck et al. 2018; Kopsaftis et al. 2018; Arnold et al. 2020; Doo et al. 2023). However, recurring misconceptions such as incorrect identification of first-line therapies, misunderstanding of ICS, and misinterpretation of diagnostic criteria highlight gaps in clinical knowledge (Hu et al. 2020; Bozhinovska et al. 2022; GOLD 2023). These findings underscore the need for structured, guideline-based education aligned with GOLD recommendations (GOLD 2023). Strengthening CPs’ competencies could improve care consistency and quality, reduce disparities, and lead to better outcomes for patients with chronic respiratory diseases. Building on this, aligning professional development and practice standards with the WHO (FIP/WHO 2011) and FIP Community Pharmacy Section (CPS) (FIP 2020) frameworks would further strengthen pharmacists’ roles in COPD care. These frameworks highlight pharmacists’ key roles in optimizing medicine use, advancing patient-centered care, and contributing to public health, aligning with the CPS Mission and Vision 2020 call to strengthen pharmacists’ competencies and integrate community pharmacy into primary healthcare systems. The identified knowledge gaps and limited access to diagnostic tools in Kosovo highlight areas where these global objectives are not yet fully achieved. However, the strong willingness of CPs to engage in COPD care aligns with FIP’s strategic aims to advance community pharmacy practice through professional development, improved communication, and collaboration within healthcare teams. Aligning national policies and educational initiatives with these WHO/FIP frameworks could therefore enhance the quality, consistency, and sustainability of COPD-related pharmaceutical care, enabling pharmacists in Kosovo to fulfill their full public health and clinical roles as envisioned by the international pharmacy community. Based on the findings, improving COPD care quality in Kosovo requires a coordinated, multi-level approach. National policies should formally integrate CPs into chronic care pathways, supported by standardized training focused on spirometry, pharmacotherapy, and patient counseling. Infrastructure upgrades such as access to monitoring tools, inventory systems, and telehealth are also essential for consistent, high-quality service delivery. Variation in COPD services across CPharm highlights the need for national protocols to reduce care disparities. Given CPs’ strong willingness to engage, investing in structured training and support programs could quickly expand their role in respiratory care. Future research should focus on piloting scalable educational and practice models to enhance clinical competence and improve patient outcomes. Insights from these pilot projects can guide the design of continuous education programs with Mucaj J et al.: Pharmacists’ readiness to deliver quality COPD care8 evidence-based content that addresses identified gaps and empowers CPs to overcome specific practical challenges through the proactive integration of knowledge and skills into their daily practice. These efforts are essential for convincing policymakers, service payers, and other stakeholders to integrate these services into the national healthcare system, support workforce planning, and develop policies and guidelines aimed at minimizing medication errors and improving patient outcomes. They will assist professional bodies in advocating for this expanded scope of practice and ensure that policies are tailored to the resources and needs of the country’s population with COPD and its healthcare system. To ensure these initiatives translate into consistent, high-quality practice, subsequent guideline development should follow a structured, evidence-based process that actively involves pharmacists, clinicians, and policymakers as key stakeholders. Clearly defining objectives, target populations, and outcomes—supported by systematic evidence appraisal and transparent grading of recommendations—would help ensure rigor and credibility (Dixon et al. 2023). Including diverse professional and patient perspectives, along with mechanisms for regular review and timely updates, would further enhance relevance, adaptability, and sustainability within Kosovo’s healthcare context. Conclusion CPs in the country have the motivation and basic knowledge to take a greater role in COPD care but are limited by gaps in training and resources. Targeted educational interventions, system integration, and policy support are critical to empowering pharmacists as active contributors to chronic disease management. Strengthening their role is essential to improving the quality and equity of COPD care in Kosovo and across similar health systems. Implications Improving COPD care requires a coordinated national approach that formally integrates CPs into chronic care through standardized training in key areas. Infrastructure upgrades, such as monitoring tools and telehealth, are essential. Variations in services highlight the need for national protocols to reduce disparities. With CPs willing to engage, investing in training can expand their role. Future research should pilot scalable education and practice models to enhance competence and outcomes. Building on these efforts, the findings can guide the development of local pharmacy practice guidelines aligned with GOLD and WHO/FIP frameworks. Implementing such guidelines would help standardize COPD care across community pharmacies and strengthen pharmacists’ roles in chronic disease management. Additional information Conflict of interest The authors have declared that no competing interests exist. Ethical statements The authors declared that no clinical trials were used in the present study. The authors declared that no experiments on humans or human tissues were performed for the present study. The authors declared that no informed consent was obtained from the humans, donors or donors’ representatives participating in the study. The authors declared that no experiments on animals were performed for the present study. The authors declared that no commercially available immortalised human and animal cell lines were used in the present study. Use of AI No use of AI was reported. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author contributions Jeton Mucaj: Writing – original draft, Investigation, Formal analysis, Data curation; Beti Djurdjic: Writing – original draft, Writing – review and editing, Formal analysis; Zorica Naumovska: Writing – original draft, Writing – review and editing, Methodology, Formal analysis, Conceptualization; Kristina Mladenovska: Writing – original draft, Writing – review and editing, Formal analysis; Maja Simonoska Crcarevska: Writing – original draft, Writing – review and editing, Methodology, Investigation, Data curation, Formal analysis, Conceptualization, Supervision. Author ORCIDs Jeton Mucaj https://orcid.org/0009-0006-7326-7058 Beti Djurdjic https://orcid.org/0000-0003-0122-0411 Zorica Naumovska https://orcid.org/0000-0003-3491-0304 Kristina Mladenovska https://orcid.org/0000-0003-2503-4699 Maja Simonoska Crcarevska https://orcid.org/0000-00021927-7101 Data availability Data are available upon request. References ALA (2023) American Lung Association. https://lung.org [Accessed February 26, 2025] Arnold MT, Dolezal BA, Cooper CB (2020) Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Pharmacia 72: 1–9 9 Often Overlooked. Tuberculosis and Respiratory Diseases 83: 257– 267. https://doi.org/10.4046/trd.2020.0064 Au DH, Bryson CL, Chien JW, Sun H, Udris EM, Evans LE, Bradley KA (2009) The Effects of Smoking Cessation on the Risk of Chronic Obstructive Pulmonary Disease Exacerbations. 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