Asthma management optimisation in adult patients in GP practice as a way of reducing inhaler carbon footprint and high dose inhaled corticosteroid prescribing. (ID 481)

Gabzdyl E, Meynard V

South Yorkshire Integrated Care Board, Doncaster Place; Tramways and Middlewood Medical Centres, Sheffield

Funding: None;
Access to Sentinel Plus resources was sponsored by Astra Zeneca

Abstract

The Global Initiative for Asthma (GINA) strategy recommends a new approach to asthma management, where ICS/formoterol combination inhalers can be used as both maintenance and relief. The MART strategy offers significant advantages: better asthma control, reduced risks of asthma exacerbations and simpler regimen. The aim was to implement the Doncaster asthma guideline, which closely follows the GINA strategy.
This ongoing project started at a GP practice (circa 11,000 patients) in November 2022, led by a clinical pharmacist and a GP registrar. There were two arms: a proactive search for patients with well-controlled asthma who collected inhalers regularly with less than six inhalers in twelve months. The second cohort included patients with more than six salbutamol inhalers over twelve months.
The first group was provided with information on the MART regimen and a NICE guide to ‘greener’ inhalers. Patients were asked whether they wished to try MART. An asthma management review was offered. A full inhaler review was conducted, including ACT score, inhaler technique, discussion around ‘greener’ dry powder inhalers and the MART regimen. Patients who chose to change to MART had a follow-up review four weeks after the first.
The first group included 107 patients. Thirteen declined participating. 94 had reviews. 72 patients had their inhalers changed to a MART ICS/LABA dry powder inhaler. During the follow-up review, five patients switched to pMDI, two patients had their ICS/LABA DPI inhaler changed back to ICS+SABA combination due to side effects. The second arm included reviewing patients referred by a practice nurse and who used six or more salbutamol inhalers in a 12 months period.

The ePACT data shows a sustained impact on the prescribing, reductions in pMDI prescribing, reductions in salbutamol pMDI prescribing, reductions in prescribing multiple inhalers, a lower carbon footprint and a reduction in high dose ICS prescribing.

Conflicts of interest: Ewa Gabzdyl received a payment for a talk develivered for Astra Zeneca on MART use and Sentinel Plus project.

The conference has been instigated and organised by PCRS. We are grateful to sponsors and exhibitors who have contributed funding towards this event in return for exhibition space. Neither sponsors or exhibitors have had any input into the agenda or the selection of speakers with the exception of any sponsored satellite symposia which are clearly indicated. View the full list of sponsors.