Asthma is a chronic and common disease, affecting one in 10 people in Australia, writes Leanne Philpott.
It’s a significant cause of illness and poor quality of life and yet of all healthcare professionals, pharmacists are in a prime position to offer asthma care and self-management techniques.
Woolcock Institute inhaler specialist (and pharmacist) Associate Professor Sinthia Bosnic-Anticevich says, “It is astonishing that despite the high level of asthma awareness in the community, so many people are compromising their well-being through inappropriate use of asthma medicines.
“Pharmacists play a critical role in identifying the barriers to asthma medicine use and helping patients optimise the benefits to be gained from appropriate medicine use.”
Research conducted by the Woolcock Institute has revealed that while most people think they’re using their medication effectively, they’re in fact making multiple errors.
She says, “Recent Australian research indicates that of those people with asthma prescribed regular asthma medication, only 12% have well-controlled asthma. Almost half of those with uncontrolled asthma believed their asthma was well controlled.
“Of those with uncontrolled asthma, 27.5% were at high risk for future exacerbation. While 49% of patients reported having a diagnosis of allergic rhinitis, 90% reported mild (38%) to moderate-severe (52%) symptoms.
“Only 40.5% reported regular preventer use, and 77.5% experienced at least one side effect from preventer medication. All patients demonstrated sub-optimal inhaler technique, with 95% not having their inhaler technique checked in the previous year.
“Used correctly, inhalers have the power to effectively manage even persistent asthma but so many people aren’t doing so. In many cases there’s been decades of incorrect use, simply because the person has never been shown how to use it properly,” says Bosnic-Anticevich.
She adds, “Talking about it is not enough. Physical demonstrations are needed with a placebo inhaler to ensure that they really understand. Without it, a patient will not be getting the full benefit of their medications and this is extremely important with regards to controlling their asthma long term.”
Amy Edmonds, registered pharmacist at Jetty Village Pharmacy, NSW, says pharmacists should educate patients on inhaler technique as well as the use of a spacer where appropriate.
“This can be done at the dispensing stage by having a tag or note placed in the basket with the patient’s asthma medication simply asking ‘does this patient need a spacer?’
“I always advise the use of a spacer in any age group, but obviously a larger emphasis is placed on spacer use amongst children. In most cases spacers are recommended to patients by their doctor, however, many people don’t understand why they are in fact so critical in the management of moderate to severe asthma.
“I believe there is a big misconception among people that spacers are simply for those who do not know how to use their inhaler correctly and this can turn people off wanting to include a spacer in their daily routine, especially among adults.
“I emphasise to patients that a person may have very good inhaler technique but it has still been shown that by using a spacer the amount of medication we’re actually receiving into the lungs can be vastly different and therefore the effectiveness altered.
“In cases where a spacer is not used, either because a patient chooses not to or it is not possible with the device, having the patient demonstrate their technique is a beneficial way of identifying any issues,” says Edmonds.
Edmonds reiterates that a tag or trigger card placed with asthma medication scripts at the dispensing stage is an opportune way to prompt the discussion of how a patient’s asthma is being managed.
“With the large number of new medications and devices becoming available on the PBS, we as pharmacists have seen patient’s trialling a number of different medications and confusion growing.
“For example, I had a patient who had been using Spiriva capsules for a long period of time but the doctor had prescribed him the new Spiriva respimat device to switch over to.
“The number one issue I addressed for this patient was that Spiriva needed to be in fact ceased and this new device was replacing their current medication. This was not something they were aware of and so that avoided potential overdose.
“To help the patient, I set up the device in front of them as it does need to be put together, to ensure they had the correct technique for next time. The patient very much appreciated the help with their new device,” she says.
Community pharmacist Amanda Elaro has a keen interest in enhancing the communication behaviour and management practices of community pharmacists with a specific focus on paediatric asthma.
She reminds pharmacists that asthma is one of the most common chronic conditions in children in Australia. It is estimated that 11.3% of children aged 0 to 15 years have a current asthma diagnosis.
“Community pharmacists may assist in the identification of undiagnosed asthma by referring children to the general practitioner if they detect that the child has had a history of recurrent or persistent wheeze along with allergies or a family history of asthma and allergies.
“Pharmacists may have the opportunity to identify this group of children by engaging with parents who come to the community pharmacy and frequently request cough medicines for their child.”
Elaro says, “Pharmacists are in an opportune position to provide self-management education to the parent and child with asthma. Pharmacists can promote better management of paediatric asthma by:
- Identifying parents who do not possess a Written Asthma Action Plan and referring them to the general practitioner so that they can develop an asthma action plan with their doctor.
- Providing adequate medicine information and support to parents. It is important that any concerns parents have around their child’s use of asthma medicines are addressed. Pharmacists should also ensure parents have a good understanding of the differences between different asthma medicines (i.e.‘releivers’ and ‘preventers’). These activities may maximise adherence.
- Ensuring parents and child receive adequate training relating to the correct use of inhaler devices and spacers.
by Leanne Philpott