HEALTH SCREENING SERVICES

INTRODUCTION

Health screening is a process used to identify unrecognized diseases or conditions in apparently healthy individuals before symptoms appear.

Screening involves the use of rapid tests or examinations to identify people who may have a disease so that early treatment can be started and disease progression can be prevented.

Early screening leads to early diagnosis and treatment, resulting in a better prognosis. For example, early control of hyperglycemia and hypertension can prevent complications.

Health screening services are healthcare services provided by healthcare professionals to the public and patients. Examples include:

• Blood glucose measurement using a glucometer
• Blood pressure measurement using a sphygmomanometer

SCOPE OF HEALTH SCREENING SERVICES

A person trained in health screening services can:

1. Work in hospitals
2. Work in pathology laboratories
3. Work in hospital and community pharmacies
4. Run their own laboratory
5. Join companies providing door-to-door health screening services
6. Provide services during disaster management
7. Provide services during pandemics and public health emergencies

IMPORTANCE OF HEALTH SCREENING SERVICES

• Helps identify diseases at an early stage
• Reduces mortality rate
• Reduces severity of disease
• Increases effectiveness of treatment
• Reduces treatment cost
• Provides peace of mind
• Prevents occurrence of high-risk diseases
• Saves patients’ time
• Helps avoid chronic complications through early detection
• Prevents adverse effects by early referral of undiagnosed cases

HEALTH SCREENING SERVICES FOR ROUTINE MONITORING

Health screening services help in routine monitoring and early detection of diseases.

Examples of Routine Health Screening

1. Blood Pressure Screening

Regular blood pressure monitoring helps detect hypertension, a major risk factor for:

• Heart disease
• Stroke
• Kidney disease

Early detection helps initiate treatment and lifestyle modifications.

2. Cholesterol Testing

Helps assess risk of cardiovascular diseases, especially in individuals with:

• Family history of heart disease
• Obesity
• Diabetes
• Smoking habits

3. Blood Glucose Monitoring

Important in diabetic patients to:

• Monitor glucose levels
• Adjust therapy
• Prevent complications such as:
• Neuropathy
• Nephropathy
• Retinopathy

4. Body Mass Index (BMI) Screening

Helps determine whether an individual is:

• Underweight
• Normal weight
• Overweight
• Obese

Useful in preventing obesity-related disorders.

5. Immunization

Vaccination protects individuals from infectious diseases such as:

• Influenza
• Pneumonia
• Shingles

MEASUREMENT OF BLOOD PRESSURE

A person is considered hypertensive if, on two or more consecutive measurements:

• Systolic Blood Pressure (SBP) ≥ 140 mmHg
• Diastolic Blood Pressure (DBP) ≥ 90 mmHg

Poor blood pressure control may cause:

• Cardiac damage
• Cerebrovascular damage
• Renal damage
• Ocular damage

These complications may lead to death.

Instrument Used

Sphygmomanometer

CLASSIFICATION OF BLOOD PRESSURE (JNC 7)

Category	SBP (mmHg)	DBP (mmHg)
Normal	<120	<80
Prehypertension	120–139	80–89
Hypertension Stage 1	140–159	90–99
Hypertension Stage 2	≥160	≥100

ROLE OF PHARMACISTS IN BLOOD PRESSURE SCREENING

Pharmacists can:

• Detect new hypertensive patients
• Help patients monitor BP regularly
• Improve medication adherence
• Prevent complications of hypertension
• Reduce workload on physicians

GUIDELINES FOR ACCURATE BLOOD PRESSURE MEASUREMENT

1. Patient should sit quietly for at least 5 minutes.
2. Back should be supported and arm kept at heart level.
3. Avoid smoking or caffeine 30 minutes before measurement.
4. Use an appropriate cuff size.
5. Place stethoscope over the brachial artery.
6. Inflate cuff to 30 mmHg above palpated SBP.
7. Deflate cuff at 2–3 mmHg/second.
8. First Korotkoff sound = SBP.
9. Disappearance of sound = DBP.
10. Take two readings 2 minutes apart and average them.
11. Confirm elevated BP on repeated visits before diagnosing hypertension.
12. Provide results verbally and in written form.
13. Refer patients with high BP to a physician.

MEASUREMENT OF CAPILLARY BLOOD GLUCOSE (CBG)

Capillary blood glucose monitoring helps identify abnormal glucose levels.

It is useful for:

• Patients with diabetes
• Individuals unable to monitor glucose themselves
• Detecting new diabetic cases

Pharmacists should not independently alter treatment based on readings. Results should be referred to a physician.

GLUCOMETER

A glucometer is a small electronic device used to measure capillary blood glucose.

Principle

Works on the colorimetric principle.

Procedure

1. Insert the test strip into the glucometer.
2. Ensure strip code matches machine code.
3. Clean finger using antiseptic/alcohol swab.
4. Prick finger using sterile lancet.
5. Place blood drop on test strip.
6. Result appears within 5–30 seconds.

INDICATIONS FOR BLOOD GLUCOSE SCREENING

Screening is useful in:

• Individuals anxious about diabetes
• Patients controlled by diet or oral hypoglycemic drugs
• Diabetic patients requiring monitoring
• Individuals with symptoms such as:
• Polyuria
• Polyphagia
• Weight loss
• Fatigue

BLOOD GLUCOSE SCREENING SHOULD NOT BE DONE IN

• Persons below 18 years unless prescribed by a doctor
• Persons with finger/nail infections
• Immunocompromised individuals
• Patients on immunosuppressant drugs

BLOOD GLUCOSE VALUES

Test	Normal Value
Fasting CBG	70–100 mg/dL
Postprandial CBG	110–150 mg/dL
Random CBG	100–150 mg/dL

BLOOD GLUCOSE INTERPRETATION

Category	Result (mg/dL)	Interpretation
Non-diabetic fasting	<80	Diabetes unlikely
Non-diabetic random	<99	Diabetes unlikely
Non-diabetic random	99–138	Further investigation required
Non-diabetic fasting	138–150	Refer to physician
Diabetic	>180	Needs medical attention

TECHNIQUE FOR MEASURING BLOOD GLUCOSE

1. Sterilize finger using alcohol swab.
2. Pierce skin using disposable lancet.
3. Apply blood drop onto test strip.
4. Glucometer detects glucose calorimetrically.
5. Reading appears within about 5 seconds.

Types of measurements:

• Fasting Blood Glucose (FBG)
• Random Blood Sugar (RBS)
• Postprandial Blood Sugar (PPBS)

Results should be communicated verbally and in written form, and patients with abnormal readings should be referred to a physician.

SCREENING OF LUNG FUNCTION – Corrected Notes

INTRODUCTION

Screening of lung function in community pharmacies can mainly be performed using:

1. Peak Flow Meter – measures Peak Expiratory Flow Rate (PEFR)
2. Spirometer – performs spirometry tests

These tests help assess respiratory function in diseases such as:

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)

1. MEASUREMENT OF PEAK EXPIRATORY FLOW RATE (PEFR)

During asthma and COPD, airway narrowing due to bronchoconstriction reduces airflow.

Peak Expiratory Flow Rate (PEFR) is used to assess lung function and airway obstruction.

It also helps:

• Monitor effectiveness of bronchodilators
• Assess severity of respiratory disease
• Guide treatment decisions

PEAK FLOW METER

A Peak Flow Meter is a small handheld device used to measure the maximum speed of expiration.

PEFR readings help determine:

• Lung functionality
• Severity of asthma symptoms
• Degree of airway obstruction
• Response to treatment

TECHNIQUE FOR MEASURING PEFR

1. Ensure the pointer is set to zero.
2. Ask the patient to stand or sit upright comfortably.
3. Hold the peak flow meter horizontally.
4. Keep fingers away from the pointer.
5. Ask the patient to take a deep breath.
6. Close lips tightly around the mouthpiece.
7. Blow out as hard and as fast as possible in a single breath.
8. Note the reading indicated by the pointer.
9. Reset the pointer to zero.
10. Repeat the procedure three times.
11. Record the highest reading.

INTERPRETATION OF PEFR VALUES

PEFR Value	Interpretation
80–100%	Airways normal; patient relatively symptom-free
50–80%	Caution required; condition worsening
<50%	Severe airway obstruction; emergency condition

Important Points

• Higher PEFR values indicate better airway function.
• Lower PEFR values indicate airway constriction.

PULMONARY FUNCTION TESTS (PFTs)

Various tests used to assess lung function include:

1. Spirometry
2. Body plethysmography and lung volume studies
3. Diffusion capacity tests
4. Airway reactivity tests
5. Six-minute walk test

In community pharmacies, the commonly used tests are:

• PEFR measurement
• Spirometry

2. SPIROMETRY

DEFINITION

Spirometry is a Pulmonary Function Test (PFT) used to assess respiratory function.

It helps:

• Diagnose lung diseases
• Monitor response to treatment
• Assess disease progression
• Guide treatment decisions

Spirometry measures all lung volumes except Residual Volume (RV).

INDICATIONS OF SPIROMETRY

Spirometry is indicated for:

1. Investigation of Respiratory Symptoms

Patients with:

• Cough
• Wheezing
• Breathlessness
• Crackles
• Abnormal chest X-ray findings

2. Monitoring Pulmonary Diseases

Such as:

• COPD
• Asthma
• Interstitial fibrosis
• Pulmonary vascular disease

3. Evaluation of Diseases with Respiratory Complications

Examples:

• Connective tissue disorders
• Neuromuscular diseases

4. Preoperative Evaluation

Before:

• Lung resection surgery
• Abdominal surgery
• Cardiothoracic surgery

5. Assessment of Individuals at Risk

Exposure to:

• Radiation
• Drugs/medications
• Occupational or environmental toxins

6. Post-Lung Transplant Monitoring

To assess:

• Acute rejection
• Infection
• Obliterative bronchiolitis

CALIBRATION OF SPIROMETER

1. Spirometers should be calibrated or calibration checked before use.
2. Calibration procedures vary with device type.
3. Follow manufacturer instructions carefully.
4. Some devices require manufacturer servicing if calibration is inaccurate.
5. Weekly biological control testing using a healthy individual is recommended.

TECHNIQUE/PROCEDURE OF SPIROMETRY

1. Patient takes a deep maximal inspiration.
2. Patient exhales:
• As hard as possible
• As fast as possible
3. Exhalation should continue until no air remains.
4. Encouragement improves test performance.
5. Patients with obstructive diseases may find forced expiration difficult.
6. Peak Expiratory Flow (PEF) is obtained from the FEV₁ and FVC maneuver.

SPIROMETRY MEASUREMENTS

Spirometry helps calculate:

1. Vital Capacity (VC)
2. Forced Expiratory Volume (FEV)
3. Forced Expiratory Flow (FEF)

1. VITAL CAPACITY (VC)

Vital Capacity includes:

a) Forced Vital Capacity (FVC)

• Total volume of air exhaled forcefully and rapidly after maximum inhalation
• Measured using dynamic spirometry

b) Slow Vital Capacity (SVC)

• Total volume of air exhaled slowly after maximum inhalation
• Measured using static spirometry

Clinical Importance

• In normal individuals, FVC and SVC are usually similar.
• In early COPD, FVC decreases before SVC.

2. FORCED EXPIRATORY VOLUME (FEV)

DEFINITION

FEV measures the amount of air exhaled during forced expiration over a specified time.

Measurements include:

• FEV₀.₅ → in 0.5 seconds
• FEV₁ → in 1 second (most clinically significant)
• FEV₃ → in 3 seconds
• FEV₆ → in 6 seconds

FEV₁/FVC RATIO

Used to assess airway obstruction.

Normal Individuals

Approximate exhalation:

• 50% of FVC in first 0.5 seconds
• 80% in first second
• 98% in 3 seconds

Obstructive Lung Disease

FEV₁/FVC ratio decreases depending on severity of obstruction.

COPD DIAGNOSIS AND SEVERITY (ATS/ERS/GOLD GUIDELINES)

Diagnosis

Indicates chronic airway obstruction.

Severity Grading

FEV₁ Value	Severity
≥80%	Mild
50–80%	Moderate
30–50%	Severe
<30%	Very severe/Respiratory failure

3. FORCED EXPIRATORY FLOW (FEF)

DEFINITION

FEF measures airflow rate during forced expiration.

Uses

·        Evaluates airflow in:

• Medium airways
• Small airways
• Bronchioles
• Terminal bronchioles

·        Detects obstruction in small airways, especially in:

• Acute severe asthma

CHOLESTEROL TESTING

DEFINITION

Cholesterol testing, also called a Lipid Profile Test, measures:

• Cholesterol levels
• Triglyceride levels

Cholesterol is essential for normal body function, but elevated levels increase the risk of:

• Heart disease
• Stroke

IMPORTANCE OF CHOLESTEROL TESTING

1. Heart Health Assessment

Helps assess cardiovascular risk.

2. Preventive Healthcare

Early detection helps prevent heart disease.

3. Treatment Monitoring

Monitors effectiveness of:

• Lifestyle changes
• Cholesterol-lowering medications

4. Identification of Associated Disorders

High cholesterol may indicate:

• Diabetes mellitus
• Hypothyroidism
• Liver disease

METHODS OF CHOLESTEROL TESTING

1. Blood Test (Lipid Profile)

Measures:

• Total cholesterol
• LDL cholesterol (“bad cholesterol”)
• HDL cholesterol (“good cholesterol”)
• Triglycerides

Blood may be collected:

• From a finger prick
• From a vein in the arm

2. Non-Fasting Lipid Profile

Patient does not need fasting before the test.

Advantages:

• Convenient
• Useful for routine screening

3. Point-of-Care Testing

Performed in pharmacies using portable devices.

Advantages:

• Quick results
• Immediate counseling possible

INTERPRETATION OF CHOLESTEROL VALUES

Parameter	Unit	Optimal / Heart-Healthy	Intermediate / At-Risk	High / Dangerous
Total Cholesterol	mg/dL	< 200	200 – 239	> 239
	mmol/L	< 5.2	5.2 – 6.2	> 6.2
LDL Cholesterol (calculated)	mg/dL	< 130	130 – 159	> 159
	mmol/L	< 3.36	3.36 – 4.11	> 4.11
HDL Cholesterol	mg/dL	> 60	40 – 60	< 40
	mmol/L	> 1.55	1.03 – 1.55	< 1.03
Triglycerides	mg/dL	< 150	150 – 199	> 199
	mmol/L	< 1.69	1.69 – 2.25	> 2.25
Non-HDL-C (calculated)	mg/dL	< 130	130 – 159	> 159
	mmol/L	< 3.3	3.3 – 4.1	> 4.1
TG : HDL Ratio (calculated)	Ratio	< 3	3 – 3.8	> 3.8
	mmol/L	< 1.33	1.33 – 1.68	> 1.68

Cholesterol Levels

Category	Total Cholesterol	LDL Cholesterol	HDL Cholesterol
🔴 Dangerous	240 and higher	160 and higher	Under 40 (male) / Under 50 (female)
🟠 At-Risk	200 – 239	100 – 159	40 – 59 (male) / 50 – 59 (female)
🟢 Heart-Healthy	Under 200	Under 100	60 and higher

COUNSELING AND FOLLOW-UP

Healthcare providers and pharmacists should provide:

·        Lifestyle counseling:

• Healthy diet
• Exercise
• Smoking cessation

·        Referral to physician when needed

·        Education on cardiovascular health

CONCLUSION

Lung function screening and cholesterol testing are important preventive healthcare services.

These tests help:

• Detect diseases early
• Monitor treatment response
• Reduce complications
• Improve patient outcomes

Community pharmacy-based screening services improve accessibility to preventive healthcare and contribute significantly to public health.