Adherence & inhaler technique

For patients using separate ICS and SABA or LABA inhalers, adherence to ICS is a common problem; research shows that only between 22-63 per cent of the population use ICS as intended. SABAs train the brain to think that this type of device is the most important inhaler as it provides immediate relief – but these inhalers do not treat the underlying inflammation.

Before any new drug treatment is initiated, adherence to existing therapies and inhaler technique should be checked. Re-check inhaler technique, ask for a spacer if applicable, and consider possible referral for temporary ICS dose step-up and adjust the PAAP if required.

The Asthma Control Test can be used by patients to provide a snapshot of the effectiveness of their asthma control. It consists of five questions and only takes around a minute to do. There is also a version for children and young people (4-11 years), which can also be found at asthmacontroltest.com/en-gb/welcome.

Through existing services, such as the NMS and MCR service, community pharmacists will play an essential role in embedding AIR and MART treatment in asthma in the coming years. The 2023 ‘A Vision for Community Pharmacy’ report by the King’s Fund and Nuffield Trust concluded that community pharmacies could directly identify and manage chronic conditions such as asthma.

This is also an obvious area for independent prescribing by community pharmacists. In some parts of the UK, asthma reviews already take place in community pharmacies. For example, in Tayside (Scotland) the service has been offered for over 10 years. (See communitypharmacy.scot.nhs.uk/media/1719/les_asthma_jan_2015_nhs_tayside_community_pharmacy_160115.pdf)

Working in partnership with local GP practices is important if AIR and MART are going to be successfully embedded in routine asthma care. Letting the practice know that you are aware of the new NICE guideline and can support both patients and the practice through the NMS and MCR service will ensure they know that you and your team will be reinforcing their prescribing.

Suggesting some criteria for when you will refer patients where there is evidence of over-reliance on SABAs and suboptimal asthma control will help to prevent patients falling through the net.

Conclusion

In conclusion, asthma continues to cause many preventable deaths in the UK. Community pharmacy teams can make a difference by spotting over-reliance on short-acting beta-agonists and referring patients to their GP, continuing to motivate patients to use their inhaled corticosteroids correctly, suggesting AIR or MART in appropriate patients, and using Asthma Right Care tools and the RightBreathe website in everyday practice.

See also ‘Further reading and useful resources’.