W 04 Asthma Flashcards
What would be patients and pharmacists’ GOAL for asthma ?
Patients goal: to get rid of this cough so he can play a good game of rugby. Sport and fitness are important to him (reduce stress levels, general wellbeing).
Pharmacist’s goals: to provide optimal pharmacotherapy with minimal or no adverse effects, support his exercise plan, find out if he needs any smoking cessation support and to find out about his mental health status.
What are the signs and symptoms of Asthma?
Cough, difficulty breathing, wheezing, breathing through the mouth, fast breathing, rapid breathing, or shortness of breath at night, Unable to communicate, chest pressure, anxiety, early awakening or throat irritation
What do you mean by severe asthma?
Your PEFR score is below 500
Your symptoms are getting severe
You are finding it hard to breath or communicate
Your reliever is not helping much
When do you think you need emergency treatment and how?
Call 111
You reliever is not working or not helping much
If you have a back pocket prednisone medication take it now
What are the classes of drugs used to treat asthma?
First line: LABA ex:Formeterol / Inhaled corticosteroids (ICS) Ex:Budesonide
Or LAB+ ICS
Or (ICS)/LABA with SABA
What are the pharmacological treatment options for asthma?
Fluticasone 125mcg 1 puff morning and night (P)
Sulbutamol 100mcg 2 puffs when required(R)
In Severe case:(back pocket)Prednisone 40 mg for 5 days
Example of LABA?
Salmeterol (Serevent Diskus)
Formoterol (Perforomist)
Example of SABA?
Salbutamol
Albuterol
Levalbuterol
What are the non-pharmacological treatment options for asthma?
Inhaler techniques Avoid dust, potential triggers Reduce stress Stop smoking Reduce Weight Light Exercise daily Swimming Meditation
What monitoring is required for asthma patients?
Medicine Compliance: patient having his inhalers regularly or not, is he compliance with his inhalers if not follow up counseling required to improve adherence
Monitor his symptoms: e.g is he still coughing and wheezing after treatment- if so, step-up therapy may be needed
PEFR: Check his peak flow reading (asthma action plan)
Smoking secession: use of nicotine patches/gum and whether or not he has had any cigarettes in that time, if he needs more supply that can be offered to aid him as
Exercise: Follow up with his asthma plan to make sure that his exercise is effective (but not too strenuous) and maintain his normal physical health.
What would be your patient counseling point for asthma?
Advice that he takes regularly: his prevention inhaler as recommended and that will therefore minimise the symptoms of his asthma during his exercising (mention that exercise can be a trigger).
Counseling how to improve compliance: Give the patients some options to help improve his compliance i.e. putting inhalers next to his bed or in the bathroom. setting reminder
Explain long term benefit: Emphasise how important it is to take every night- explain long term benefit, and prevention abilities → how this could help him on a day to day basis.
Spacer Technique: tell him how to take care of the spacer.
Smoking: Make sure it is explained to the patient WHY stopping smoking will actually make him healthier in terms of improving his asthma symptoms, rather than just advising that smoking is bad for him. Try to get the patient to understand for his own wellbeing so that he wants to try to stop.
Before exercise: Ensure he uses his inhaler before/during exercise. Avoid dust, potential triggers and avoid physically demanding exercises.
Carry inhaler: Always carry inhalers while away from home e.g. in the gym
Why does Aarav not want to use his preventer?
Misconceptions about steroids.
He does not want to take steroids as these are used by the bodybuilders
What can you do to educate Aarav and his whānau on using his inhalers?
Explain that this steroid is different from the the one that is used by bodybuilders - it is a corticosteroid so it relieves inflammation (diff group to bodybuilder steroids which are anabolic steroids)
Explain how the medicine will help improve his symptoms: if he uses it regularly, which means that he can go back to exercise sooner - i.e. he should take his preventer regularly to prevent symptoms, and take the reliever whenever his asthma symptoms worsen.
Common side effects of corticosteroids: oral thrush, hoarse voice, cough, nose bleeding, teeth staining - can reduce oral thrush by rinsing mouth or brushing teeth after using inhaler.To reassure on side effects, mention that the benefits of the medicine outweigh the risk of side effects of the medicine but these are very uncommon.
Explanation about absorption of the drug: very less absorbed systemically compared with oral dose, thus less side effects.
What will you do if a patient does not meet emergency supply criteria but the patient is in a severe asthmatic condition?
Need to use common sense - if the ambulance is far away and the patient does not meet emergency supply criteria but they are having a serious attack -> still provide medicine. Asthma can kill people, so better to supply and apologise later for not following the legislation.
What would you do if the person needed an ambulance?
call 111, and stay on the line to see if they recommend anything you can do to help while you wait. Arguably you could give the patient an inhaler as an emergency to try and control the symptoms/breathing until the ambulance arrives.
Or they hadn’t been prescribed salbutamol by a NZ prescriber?
We will Identify why. Maybe they are traveling from overseas. If they have acute asthma symptoms give the medicine- case by case basis. If able/enough time you could get them a walk in doctor’s appointment and have them hopefully quickly prescribed an inhaler that you can then dispense with prescription.
