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Blog series – Asthma outcomes: Community pharmacy perspective | Darush Attar-Zadeh
Friday, 7th May 2021
Darush Attar-Zadeh is a community pharmacist and Executive Committee member of the Primary Care Respiratory Society. He gives his view of how community pharmacies can have a role in improving asthma care.
There are five main areas where community pharmacy can have a role in improving asthma care in the UK:
I hope that we can tap into the expertise of the pharmacist and the pharmacy staff: pharmacy technicians, pre-reg pharmacists and the counter assistants. We should know that we are never more than 20 minutes away from a community pharmacy, with 5 years of training that the pharmacist has gone through. There is real expertise. They are real medicines experts.
When it comes to asthma basic care, Asthma UK talks about inhaler technique, the personal asthma action plan and an annual asthma review. It’s very hard to cover all of these things in a GP practice. We really should be looking at the skill mix of pharmacists and taking advantage of it.
We have the new medicine service. If a person gets a new asthma medicine (usually in an inhaler), they need to know about how to use that device, but they also need to know what’s inside the device and what that medication is for. If they know what it’s for, then they’ll be empowered and are more likely to take it. For example, it benefits the person if they take their preventer treatment.
The Pharmacy Quality Scheme is soon to be updated. This helped identify people who were getting the blue inhaler over and over again and potentially at risk. New services now include the Discharge Medicines Service (DMS) and the Community Pharmacy Consultation Service (CPCS). For example: The DMS allows hospitals to refer patients to Community Pharmacy who would benefit from extra guidance on their new medicine. This will help keep people safe who may have otherwise been confused.
Healthy living pharmacies
Pharmacies should be considered wellbeing centres. You can get to speak to somebody without having to make an appointment. That’s really important.
Smoking cessation is an offering that we’ve been able to do for many years. Very brief advice: Ask, Advise, Act, form as little as 30 seconds. It’s the number one respiratory intervention we can make in my opinion.
Whenever that blue inhaler arrives for asthma, the warning signs should be there. Knowing that each time we advise a patient that the canister with 200 puffs should really last six months. Lots of education and support is needed, and we do a lot of signposting to people who are at risk.
I like to use the Asthma RISKS acronym.
R – RATE: If you have a patient medication record, you can identify the prescribing rate of ICS and SABA, and if a person is getting less than 75% of the ICS over a 12 month period and more than 2 SABA, you know that this person needs some education and support.
I – ICS: Review ICS potency and consider step-down for people appropriately controlled
S – Smoking cessation (ICS is less effective if a person is a smoker)
K – Knowledge: National Review of Asthma Deaths identified that 73% of patients were without an asthma plan. Good news from the Asthma UK survey is that number is improving to around 50%. But there is so much more we can do to educate patients about the importance of having an asthma plan and signposting to GP practices. In North-West London, we’ve got some of the patients and pharmacies to fill out the green section and complete the rest of the plan in the GP practice.
S - Spacer & Inhaler Technique Optimisation. (During the pandemic there has been a dramatic drop in spacer use, which worries me). For people on a pMDI (sometimes called a ’puffer’) a spacer can improve lung deposition and can help improve everyday symptoms with regular preventer use.
Asthma Right Care
I’ve been working with PCRS, IPCRG and Taskforce for Lung Health around making sure that community pharmacy colleagues are not forgotten in the whole social movement towards Asthma Right Care. We need to highlight and correct any misunderstanding that the blue inhaler is not there to open up the airways prior to using ICS. We can really use the pharmacies to help patients understand that ICS regular use is important.
The asthma control test is available. We can see that person’s asthma control at that moment in time. I’m finding in the community pharmacy, we can ask our colleagues to help patients fill that out. We can explore the ideas, concerns and expectations of the patient. We can use the reliever reliance test to understand people’s beliefs about their medication and help them understand what good asthma looks like? There are so many things we can do to improve asthma management, and prevent people from doing risky behaviours.
Hopefully that gives you a top line of what pharmacy can do in the community as part of an Integrated Care System. There are many skilled Multidisciplinary Team colleagues that can support people to live better with asthma.
PCRS Produced / Collaboration