asthma stuff in the cp

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The Prescribing Community PharmacistJohnathan Laird MRPharmS (iPresc)Community pharmacist interested in asthmaPharmacyinpractice.org Twitter @johnathanlaird e-mail [email protected]

1Blog johnathanlaird.wordpress.com Twitter @johnathanlairdPharmacist Independent Prescribing in Community Pharmacy Practice

Pharmacyinpractice.org Twitter @johnathanlaird e-mail [email protected]

A patient and two journeys she may take

Ms. Laird is a single mum with two kids.She regularly uses the local community pharmacy because she feels supported there. Most of her trips to the pharmacy are to use the minor ailments scheme for her family.In the last 12 months she has ordered 24 salbutamol inhalers.


Route 1The community pharmacist is not a prescriber

Ms. Laird calls in to repeatedly collect her salbutamol.Inhaler technique is checked and is found to be poor therefore corrected.

Has the pharmacist done a good job?

Before I was a prescriber and not truly part of the multidisciplinary team I would have not been in a position to support this patient further. Pharmacyinpractice.org Twitter @johnathanlaird e-mail [email protected]

Community pharmacists can do more

As independent pharmacist prescribers we can begin to manage patients with long term conditions such as asthma.

By taking responsibility for the complete care of the patient community pharmacists can truly integrate into the multidisciplinary team and secure our future role beyond supply of medication.Pharmacyinpractice.org Twitter @johnathanlaird e-mail [email protected]

Route 2The pharmacist is a prescriber.

On clinically checking her prescription for salbutamol I noticed that she was overusing.

I noted her previous use of oral prednisolone twice recently.

I noted from my surgery search that she did not regularly attend the local respiratory clinic.

I marked her prescription so that she would receive a brief intervention on collecting her salbutamol.


Brief intervention considers the following

1.Reliever usage2.Oral steroid use3.Attendance at respiratory clinic4.Asthma control test score and symptoms5.Inhaler technique

Based on the findings and in line with SIGN 141 and NRAD 2014 recommendations patient is referred to GP, to my IP clinic or counsel and watchfully wait.


So what happened to Ms. Laird?

I referred her to my IP clinic and did a full review.Initially I coached her on technique and gave her a written asthma plan. Important to use her preventer inhaler with a spacer.

Returned still symptomatic after four weeks

I prescribed montelukast and her symptoms subsided as did her salbutamol use.

Her ACT score was initially 11. Three months after my initial contact it was 24 = control.


Care Pathway for CP PrescribingWatchful waiting Alarm symptoms Refer to GP

Brief Intervention

CP Prescribing Clinic



Pharmacyinpractice.org Twitter @johnathanlaird e-mail [email protected] Control Tests Oct-Jan 201548% Patients scoreed 20 or above26% Patients scored 15-2026% Patients scoreed below 15

52% Patients seen classed uncontrolled

How big is the problem of non-attendance?

In general practice respiratory clinics especially asthma clinics are among the worst attended.Poor attendance=Poor control=Worse OutcomesMy list is made up completely of non-attendersPharmacyinpractice.org Twitter @johnathanlaird e-mail [email protected]

Its not just the easy patients!

A patient I recently assessed...Step 4 asthmaticACT score = 7Peak flow = 190 (40% expected)Multiple inhaler types unable to use DPIUsed 42 salbutamol inhalers previous year

Patient thought he was well!


Take home message

Community pharmacist prescribers, with the correct level of competance and read/write access to the patient record can help to find the disengaged asthmatics with the highesst risk of exacerbation.


Continue the conversation and share best practice...

Twitter @johnathanlairdPharmacyinpractice.orgE-mail [email protected] Twitter @johnathanlaird e-mail [email protected]


Further reading

http://www.pharmaceutical-journal.com/opinion/column/identifying-those-with-poor-asthma-control/20069015.article

http://www.pharmaceutical-journal.com/opinion/column/a-simple-intervention-to-help-manage-asthma-patients/20200007.article

http://www.sign.ac.uk/guidelines/fulltext/141/index.html

https://www.rcplondon.ac.uk/projects/national-review-asthma-deaths

http://johnathanlaird.com/2015/10/19/community-pharmacy-prescribing-and-finding-the-asthmatics-that-need-support-most/

asthma stuff in the cp

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