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Changes to inhaled asthma treatment


By Darush Attar-Zadeh

11 May 2020

How do I go about changing people’s inhaled treatment if there are stock shortages?

Pharmacist and Primary Care Respiratory Society (PCRS) executive committee member Darush Attar-Zadeh gives advice on asthma-related pharmacy queries during the coronavirus pandemic.

We have seen some significant respiratory device shortages during the Covid-19 emergency period, and it may sometimes be necessary to switch patients from one inhaled product to another suitable product.

If prescribers are issuing alternative treatments, then it is important that this is done in parallel with a patient’s personal asthma action plan (PAAP) and a shared decision-making approach is used to identify what is the most suitable alternative for them.

These two links may be useful support for patients and parents of a child with asthma:

Your asthma action plan

Your child’s asthma action plan

GP practices should not change their repeat prescription durations or support patients trying to stockpile. These actions may put a strain on the supply chain and exacerbate any potential shortages. Practices should consider putting all suitable patients on electronic repeat dispensing as soon as possible. The whole repeatable prescription can be valid for a year, but each repeat should be for no longer than the patient has now.

Inhaler technique coaching

If there is no alternative but to change the device a patient is using, for whatever reason – or if a patient appears unclear on how to use their usual prescribed device – then it is important that inhaler technique is coached. This is best done via a video link, rather than by telephone.

The virtual asthma review can be done on the phone or by video. The Covid-19 pandemic has meant that this is done more often and will probably continue for the foreseeable future. Home monitoring of peak flow is possible, however, tests such as spirometry, FeNO (exhaled Nitric Oxide) and Carbon Monoxide (CO) monitoring are on hold to stop the possible spread of coronavirus.

The obvious challenge for telephone consultations is watching a person show you their inhaler technique and for the clinician to demonstrate.

Video consultations are not so different from a face to face session but there are some considerations, such as:

  • Technical issues
  • Clinicians surroundings need to be uncluttered e.g, no patient identifiable information, no pets or children running around
  • Wearing appropriate clothing (as professional as possible)
  • Patient confidentiality. 

The training is best supplemented with a video to reinforce understanding. The following resources are free to use for patients, carers, parents and clinicians, and include tutorial videos and supplementary information:

https://www.rightbreathe.com

https://www.asthma.org.uk/advice/inhaler-videos/

Several studies show that approximately 10% of health care professionals (including doctors, nurses and pharmacists) demonstrate correct metered dose inhaler (pMDI) technique to patients. We must do what we can during the pandemic to keep people safe.

Good technique is of paramount importance because the way a patient uses a device is proportional to the amount of drug they will deposit in their lungs, which in turn has a direct correlation with emergency attendance at the hospital and poor respiratory disease control. Introducing a spacer to the pMDI and teaching on technique should improve lung deposition if used optimally.


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