The Royal Pharmaceutical Society has published a briefing on medicines optimisation which focuses on asthma.
The briefing encourages pharmacists to enquire about the patient’s experience, appropriateness of the medicine and the safety and effectiveness of the medication for the patient. It details steps to take and questions to ask to ensure the patient is getting the most out of their medicine. The document also contains case studies to show how medicines optimisation can benefit patients.
Patient experience
“I want to know that you care about me and my condition. Ask me to show you how I use my inhaler, then you can check I’ve got it with me, that it’s in date and that I am using it correctly”
Evidence – is the medicine appropriate?
As a condition, you can expect asthma to change with time; peak flows and symptoms improve and worsen and you can help patients to make the right choices about their medication. BTS/ SIGN asthma guideline stepped approach adds in steroid inhalers, oral steroids and other agents as the condition worsens, then removes them as it improves. The patient is the key source of information about their symptoms, which in turn indicates what step they should be on. You should confirm that they know what each of their medicines does, and when and how to use them.
Safe and effective
Asthma is a chronic condition and it is easy to get complacent about the symptoms and put up with it not being well controlled. Patients can monitor the effectiveness of their therapy by monitoring their peak flow reading and by using validated tools such as the Royal College of Physicians ‘ 3 questions’ or the Asthma Control Test (ACT).
Lifestyle messages
Understand the risk of not controlling the asthma
The key to good health is for patients to know about their condition and have a personalised asthma action
Share tips on using medicines and devices
Encourage all patients to stay active and to lose weight if they are overweight
Offer smoking cessation advice
Emphasise to patients the importance of keeping their reliever inhalers and emergency contact details with them at all times
Recommend one-off pneumococcal vaccination and annual flu vaccination
Where’s the Evidence?
British Thoracic Society/SIGN British Guideline on the Management of Asthma
www.brit-thoracic.org.uk/guidelines-and-quality-standards/asthma-guideline
NICE www.nice.org.uk
Local asthma specialists – check your RPS networks
Talk to your local hospital colleagues – is there a respiratory pharmacist?
RPharmS Map of Evidence
Signposting patients
Asthma UK www.asthma.org.uk
including inhaler demonstration videos
www.asthma.org.uk/Sites/healthcare-professionals/pages/inhaler-demos
British Lung Foundation www.blf.org.uk/Home
Allergy UK http://allergyuk.org/
Local support groups
Local sports and leisure centres/Activity groups
Stop smoking services. Smoke free NHS https://quitnow.smokefree.nhs.uk/
NHS Choices www.nhs.uk
Royal College of Physicians ‘3 questions’
www.rcplondon.ac.uk/publications/measuring-clinical-outcome-asthma
Asthma Control Test (ACT) – adult
www.asthma.org.uk/Sites/healthcare-professionals/pages/asthma-control-test
Asthma Control Test (ACT) – childhood
www.asthma.org.uk/Sites/healthcare-professionals/pages/children-and-youngpeople-
the-childhood-asthma-control-test
Where can I learn more about this?
CPPE learning programmes www.cppe.ac.uk
The Royal Pharmaceutical Society www.rpharms.com
Clinical knowledge summaries http://cks.nice.org.uk