What value does a pharmacist bring in optimising severe asthma?

The work described here was presented at the UKCPA Virtual Conference Poster Day 2021 

Clinicians must frequently rely on patient-reported adherence and technique when treating patients in outpatient settings. However, the Severe Asthma New Patient One Stop Service involves a multidisciplinary team assessment, including a specialist pharmacist review. 

Prior to the appointment the pharmacist confirms the patient’s adherence to their preventer inhaler and the annual number of prednisolone courses using community and secondary care record data. In addition, the patient is asked about their level of adherence, whilst undergoing a specialist pharmacist assessment of their inhaler technique.

We wanted to evaluate the pharmacist’s role in identifying the difference between patient-reported and confirmed adherence to inhaled therapy alongside inhaler technique. Alongside this, we explored the difference between patient-reported and pharmacy confirmed prednisolone courses over a 12-month period and its impact on treatment escalation. 

Patients were found to over-report prednisolone courses which can lead to unnecessary changes to asthma treatment.

Data from 50 new patient assessments over a three-month period were collected retrospectively. The number of prescriptions for prednisolone and preventer inhalers over the previous 12 months was confirmed with the patients’ GP, pharmacy and hospital records. Patient-reported number of prednisolone courses and adherence to inhalers were recorded at the day case appointment. 

Inhaler technique as assessed by a specialist pharmacist was recorded as poor, fair or good. Between-group differences in patient-reported and confirmed prednisolone courses and inhaler collections were assessed using a Wilcoxon signed-rank test.  

Analysis of the data showed that 84 percent (n=42) of patients reported good adherence, although this proportion was higher (92 percent) when confirmed by pharmacy pickup rates.  

Over half of patients (52 percent) had poor inhaler technique which is a similar proportion to that reported in the literature. Twelve percent had fair technique and only one-third of patients had good inhaler technique.

Patients reported significantly more prednisolone courses over a 12-month period compared with courses confirmed prescribed courses. 

Optimising adherence and inhaler technique with pharmacist support plays a vital role in optimising asthma control. The data highlights the need for pharmacist review and education as early as possible in the patient’s asthma treatment, before they are referred to the specialist service.  

Patients were found to over-report prednisolone courses which can lead to unnecessary changes to asthma treatment. Overall, the pharmacist review enables a true assessment of steroid treatment received, which will have an impact on the severity of the patient’s asthma and can prevent unnecessary applications for biologic therapy. 

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement: 

The author declares Speakers fees, educational and travel grants from Astra Zeneca, GSK, Chiesi, Novartis and Teva.