Experts alarmed at a possible figure of a million people with uncontrolled asthma have proposed major structural changes to the way asthma medicines are handled, including OTC preventers and restricting the OTC sale of relievers without preventers.
Tunn Ren Tay, Michael J Abramson and Mark Hew write in MJA Insight that the results of an asthma survey, recently published in the MJA, are “disappointing and disquieting,” with a quarter of respondents not regularly using preventers, despite having uncontrolled disease.
Of significant concern was the lack of regular preventer use, with patients apparently preferring immediate symptom relief to long term disease control.
“Ironically, the present dispensing system reinforces such behaviour,” the authors write.
“Relievers are readily available over the counter, but preventers require prescriptions, necessitating additional effort, time and expense.
“The logical solution to this problem is to re-design access to asthma medications. Preventers must be made more accessible.
They also suggested a measure be implemented “to detect and attempt to reduce the high volume dispensing of relievers without adequate concomitant preventers, because this pattern of medication use is implicated in asthma deaths.
“Such a move would require electronic coordination across pharmacies, with the ability to trigger referral for asthma review.”
They also suggest increasing the rebate for asthma reviews in general practice.
Jenny Gowan, the pharmacist member on the National Asthma Council Australia Guidelines Committee, told the AJP that she is not convinced the first two recommendations would be of benefit.
“I think it’s an advantage to have Ventolin available without a prescription, but it must be with adequate, compassionate counselling by the pharmacist,” she says. “This needs to be thoughtful counselling, not accusative counselling.
“When they ask for Ventolin, I immediately get it off the shelf so they know they’re going to get it, and ask a question: how’s your asthma been with all these changes in the weather? How does sport affect your asthma?
“It’s a conversation, which opens up a dialogue, and then we can actually do some constructive counselling about how many puffs, and techniques, and then explain why it’s necessary to give a preventer.
“I don’t believe we should have preventers available over the counter unless you have people that are trained and prepared to spend the time in developing a proper asthma plan.”
She says that allowing OTC preventer sales could also play a role in other lung conditions remaining undiagnosed, as buying preventers would then cut out the GP.
“I want to have a diagnosis,” Gowan told the AJP. “I want to know whether they’ve got asthma or not, and I think a full history-taking exercise needs to be done, with family history, triggers and a full asthma plan.
“Pharmacists could do it, but it would need to be a specialist consultation, like a health destination pharmacy, and some sort of certification or competency achieved.
“I’d also like an improvement in the MBS for the doctors: for years it’s been a poorly funded area. They get a lot more from diabetes than asthma.
“It’s not just about the rebate, though; there needs to be increased remuneration as a priority.”