How does community pharmacy support patients living with asthma?
Authors: Micallef R , Bhatti H 
Published: November 2023

Abstract

Introduction
Asthma is a chronic respiratory condition that is currently an increasing issue worldwide. Particularly in the United Kingdom, 185 people are admitted to hospital because of an attack and 3 people die daily despite the National Healthcare Service (NHS) spending £1 billion on asthma care.1 Community pharmacies are taking on a more clinical role in the NHS but the extent of their role in primary care, specifically regarding helping patients living with asthma is unknown.

Aim
This study aimed to identify how community pharmacists reduced the general practitioners (GPs) workload by helping patients living with asthma.

Methods
The study used a 30-question survey to collect data from community pharmacists in North-East London boroughs (n=206 pharmacies). The survey consisted of both closed and open-ended questions, exploring the asthma interventions pharmacists conducted and the impact this had on patients, as well as the medication or devices that patients were struggling with the most and how confident pharmacists felt about all aspects of asthma. The paper-based survey was handed to each responsible pharmacist for completion. Data was input into SPSS for analysis. The study received ethical approval from Kingston University.

Results
Participants found the New Medicines Service to be the most helpful service (4.4/5) for patients living with asthma, followed by influenza vaccine (4/5), Community Pharmacy Consultation Service (CPCS) (3.8/5) and inhaler technique checks (3.8/5). The percentage of referrals to the GP that resulted from these services were 0-20% of patients in an average week. The most frequently referred medication was salbutamol (56.5%) due to its overuse or exacerbation of symptoms with Clenil® (15.2%) the second most referred medicine due to side-effects such as a sore throat. The most frequent inhaler device dispensed was the metered dose inhalers (94%), however the most troublesome inhalers were dry powder inhalers (50.8%) due to patient’s poor inhalation capacity, dexterity, inability to load the capsules and poor knowledge. Overall, pharmacists were confident in their ability to help asthma patients, however, younger pharmacists were less likely to check inhaler technique at every dispensing (p=0.016), more likely to check it only upon patient request (p=0.042) and were more likely to refer patients to the GP after consultations. Contrastingly, nearly all participants (93.2%) found their training for asthma and its services to be sufficient, with 62.5% using centre for pharmacy postgraduate education as their training provider.

Discussion/Conclusion
The results suggest that most of the time pharmacists were well trained, addressed patients concerns adequately and were able to support with adherence and usage of inhalers.2 It was clear that pharmacists do play an active role in the lives of asthma patients through the services they conduct. Their training allows pharmacists to be confident when carrying out these services so that majority of patient’s concerns are addressed within the pharmacy and only a few require GP referral. It may be beneficial to carry out technique checks more frequently, conduct asthma reviews within the pharmacy and provide additional resources to newly qualified pharmacists to aid their confidence in helping asthma patients.

References
1. PSNC. Essential facts, stats and quotes relating to asthma [Internet]. 2022 [cited 18 Mar 2023]; Available from: https://psnc.org.uk/lpcs-and-local/locally-commissioned-services/essential-facts-stats-and-quotes/asthma/
2. Al-Jahdali H, Ahmed A, Al-Harbi A, Khan M, Baharoon S, Salih S et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. All, Asth Clin Immun. 2013 Mar 06; 9(8).