Medicines Use Review Supporting Information for Asthma Patients

Size: px
Start display at page:

Download "Medicines Use Review Supporting Information for Asthma Patients"

Transcription

1 Medicines Use Review Supporting Information for Asthma Patients What is asthma? Asthma is a chronic inflammatory disorder of the airways. The inflammation causes an associated increase in airway hyper-responsiveness, which leads to recurrent episodes of wheezing, breathlessness, tightness in the chest and coughing. These symptoms often present early in the morning or at night. Episodes are usually associated with some degree of airflow obstruction that will resolve spontaneously or with medication. Symptoms may appear variably and patients sometimes may not experience any symptoms for several weeks or months (unlike COPD). As patients get older they may develop fixed airways disease (particularly if inadequately treated) What causes asthma? There is no single known cause of asthma, but there are a number of genetic and environmental factors that may contribute to the development of the condition, including: Family history of asthma or other atopic condition such as eczema or allergic rhinitis Having had bronchiolitis as a child Exposure to tobacco smoke as a child, particularly if mother smoked during pregnancy Being born prematurely or at a low birth weight What can trigger an exacerbation of asthma? Irritants in air such as cigarette smoke, chemical fumes, pollution Allergens such as pollen, dust mite faeces, animal dander or feathers Respiratory tract infections Weather conditions such as cold air Sulphite-containing foods such as beer, wine, shrimp, many processed or precooked meals Emotional factors such as stress or laughter Medicines, such as non-steriodal anti-inflammatories, beta-blockers Exercise What are the signs of completely controlled asthma? A patient with completely controlled asthma will have:

2 No daytime symptoms No night-time awakening due to asthma No need for rescue medication No exacerbations No limitation on activity, including exercise Normal lung function with minimal side effects from medication How can I support patients with asthma? The goals of asthma treatment are discussed in detail in the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines. As a pharmacist you can support patients by: Helping patients prevent exacerbations Providing information and support to facilitate self-management Identifying and promoting adherence with medication Advising on correct inhaler technique Identifying poor asthma control Support should be tailored to individual patients, taking into account their medical history and what they already know about their condition and treatment. It may also be useful to provide information about the condition, explaining that it is a long-term condition that cannot be cured but that symptoms can be adequately managed. Tackling myths about their condition will also help manage patient expectations. How can I help patients prevent exacerbations and self-manage their condition? Patients should be educated about signs of poor asthma control and signs of an exacerbation, thus enabling them to take steps according to their personalised written action plan, and know when to seek further medical help. You should also counsel patients on their medicines and ensure that they are using them correctly. For example, do they understand the difference between preventer and reliever medication and why it is important that they use their preventer regularly? Also see section How do I help promote adherence? Further information about points to cover when counselling patients on their medicines can be found in the RPS Support Counselling Patients on their Medicines quick reference guide. You can also offer advice about avoiding known triggers and allergens (recommended only in those with confirmed allergy): House dust mite avoidance measures, e.g. washing linen at high temperatures, using anti-dust mite bedding, using agents to kill dust mites. Avoiding foods and additives, such as sulphites (in beer, wine, shrimps)

3 Patients whose asthma is triggered by outdoor factors should be advised to minimize exposure, e.g. not doing strenuous exercise in cold weather or low humidity. If a clinically significant allergen cannot be avoided referring the patient to their GP for onward referral for immunotherapy may be appropriate. Exercise-induced symptoms can be managed with various medicines, however these symptoms are often an indication of poorly controlled asthma and a review of therapy is usually required. Work-related asthma should be referred to a GP. Patients with asthma should be reviewed regularly by specialist doctors and nurses and have a personalised written action plan for management of their condition. You should check that patients have an action plan, understand points in the plan and know how to use it. Some patients (e.g. adults with more severe disease and in those with poor perception of bronchoconstriction) may be required to monitor their condition with a peak flow meter. You should make sure that your patient is aware how to use the device, what the readings mean, how often to conduct a reading and how to care for the meter. How can I help promote adherence? You can help ensure that patients adhere to their asthma medicines by providing simple but clear information about them (if appropriate). Corticosteroids ( preventer ) advise patients about the importance of using their preventer inhaler regularly and inform them about how to avoid more common side effects such as oral thrush. The risk of oral thrush can be reduced by using a spacer device with a corticosteroid inhaler; rinsing the mouth with water (or cleaning a child s teeth) after inhalation of a dose may also be helpful. Additionally be aware that brands of CFC-free beclometasone inhalers are not bioequivalent and should not be interchanged. Also inform patients of the adverse effects associated with prolonged and/or frequent courses of oral therapy as extra monitoring may be required, e.g. for signs of osteoporosis, diabetes (serious adverse effects are more likely with oral therapy than inhlaed corticosteroids). Patients who have been instructed to stop oral corticosteroid treatment should be provided with clear instructions on how to stop to reinforce the prescriber s directions. Steroid cards should be issued where appropriate for oral therapy and ensure that you provide an explanation about their use and purpose. Details of where steroid cards can be obtained can be found in the BNF. Beta 2 agonists ( reliever ) ask about the use of reliever medicines as using inhalers more frequently (more than twice a week) may be a sign of uncontrolled asthma. Warn about effects associated with overuse, e.g. tremors, palpitations. Also ensure that patients understand the difference between short- and long-acting medicines and when to use each type, as not all long acting beta 2 agonists are quick relievers. Short-acting beta 2

4 agonists should only be used when required for symptoms and there is no benefit of using if bronchoconstriction is not present. Theophylline and aminophylline both theophylline and aminophylline have a narrow therapeutic range and interact with a number of medicines. Be aware of the cautions and interactions (including effect of smoking) and advise patients accordingly. Brands of modified release preparations differ in the rate of absorption, thus the brand should be specified on the prescription so you know which one to supply. Patients should have blood levels checked every 12 months and if they present with symptoms suggesting that it is out of range. Leukotriene receptor antagonists advise patients that leukotriene receptor antagonists should not be used to relieve symptoms associated with an acute exacerbation. Sodium cromoglicate and nedocromil these inhalers should be used regularly and are not to be used to relieve symptoms associated with an acute exacerbation. Nebuliser check that the patient understands how to use a nebuliser, how to choose between a mouth piece and facemask, who to contact regarding servicing, where to obtain replacement parts, how to change filters, and how to clean. Also offer advice on how to manage adverse effects of using nebulised solutions. Spacers ensure that the spacer prescribed fits the inhaler. Check that the patient understands how to how to use a spacer, and how to clean and care for it. How can I help patients select the most appropriate device and check that they are using it correctly? There are a number of inhalers available and there are advantages and disadvantages of each device. The choice of inhaler device may also depend on the drug itself, and patient preference and ability. The best way of checking inhaler technique is to ask the patient to demonstrate how they use their inhaler. Each type of inhaler has a different delivery mechanism therefore you should be familiar with instructions for individual inhalers and brands. If the patient is not using the inhaler properly you should perform a demonstration. It is suggested that you have dummy/placebo inhalers for this purpose; these can be obtained from most manufacturers. Placebo/dummy inhalers are single patient use and should not be used for more than one patient. Patient information leaflets often contain pictures and clear instructions for use and you may want to refer patients to this. It is suggested that you check the patient s technique during their next visit to the pharmacy and regularly to ensure that they are still using it correctly. The following devices (which can be sold over the counter/obtained from manufacturer) may help improve inhaler technique:

5 Spacers may help those who find it difficult to use metered dose inhalers (does not require co-ordination of pressing down of the inhaler and inhaling the dose). Many spacers are available on NHS prescriptions. Inhaler aids help patients with manual dexterity problems, e.g. arthritis, press down the chamber of metered dosage inhalers. A winged attachment can help patients with manual dexterity problems, e.g. arthritis, twist the dial on Turbohalers (from manufacturer only). If a patient cannot use a particular inhaler correctly they should be referred to their GP/practice nurse for an alternative. What lifestyle advice should I provide patients with asthma? Smokers should be advised to stop smoking and be provided with supportive therapies, and/or referred to local stop smoking services. Parents who smoke and have a child with asthma should also be advised of the adverse effects of smoking and how it might impact on their child s condition. Obese patients with asthma should be advised about how to lose weight as there seems to be an association between Body Mass Index and symptoms of asthma (ideal BMI kg/m 2). Include advice about eating a balanced diet and adopting an exercise regime to sustain a healthy lifestyle. A diet consisting of fresh fruit and vegetables has been shown (in observational studies) to be associated with fewer asthma symptoms and better lung function. What other support/information can I provide? Other support/information that may be appropriate for your patient could include the following: Influenza vaccination is recommended for all those aged 6 months or over in the clinical risk group (this includes people with asthma who require continuous or repeated use of a steroid preventer inhaler or oral steroids or those that have had asthma attacks requiring hospital admission). Pneumococcal vaccination is recommended for patients who have severe asthma and who require continuous or frequent treatment with oral corticosteroids. Patients with asthma often also suffer from rhinitis. Intranasal steroids can be recommended where appropriate. You should check nasal spray technique when supplying/selling. Explain that facial pain, nasal symptoms, indigestion, and snoring are symptoms of co-existing conditions that may worsen asthma, and may require treatment. Other conditions that may co-exist with asthma include sinusitis, gastrooesophageal reflux disease, and sleep apnoea. Offer treatment and advice or refer to a doctor where appropriate. It is suggested that to improve adherence, any verbal advice is supported with written information that patients can take away. Referring the patient to the

6 product information leaflet may be sufficient in some cases; however leaflets about the condition may also be of use. A range of leaflets can be obtained from Asthma UK. When should I refer patients? You should discuss with other healthcare professionals local procedures for referral of patients. Patients who may require referral to a doctor or other healthcare professional could include: Those who have noticed an increase in asthma exacerbations and symptoms which may indicate that their condition is not well controlled Those who have not responded to treatment with medicines Those who are experiencing side effects with their medicine Those presenting with a severe or life threatening acute asthma exacerbation Those with suspected occupational asthma Those with co-existing conditions Those with haemoptysis The following specialists may also be involved in the management of asthma at any stage: dieticians, physiotherapists, occupational therapists and respiratory nurse specialists, and you should be familiar with referral pathways to these specialis Where can I signpost patients wanting further information? Asthma UK British Lung Foundation European Federation of Allergy and Airway Diseases Patients Association NHS Choices Patient.co.uk Where can I go for further information? RPS members can contact RPS Support on , or complete a web form at UKCPA Respiratory Group , RPS Support Resources Counselling Patients on Medicines quick reference guide Smoking cessation quick reference guide Obesity and weight management quick reference guide Supporting patients with COPD quick reference guide

7 Asthma UK is the charity dedicated to changing the outlook on asthma. It has patient management plans, leaflets and an inhaler demonstration video. How to make the most of being asthmatic Your health, your choices. Has videos on asthma and inhaler technique. Offers medical information and support with printable leaflets Video demonstrations on correct inhaler technique

8 Medicines Use Review Supporting Information for Asthma Patients What is asthma? Asthma is a chronic inflammatory disorder of the airways. The inflammation causes an associated increase in airway hyper-responsiveness, which leads to recurrent episodes of wheezing, breathlessness, tightness in the chest and coughing. These symptoms often present early in the morning or at night. Episodes are usually associated with some degree of airflow obstruction that will resolve spontaneously or with medication. Symptoms may appear variably and patients sometimes may not experience any symptoms for several weeks or months (unlike COPD). As patients get older they may develop fixed airways disease (particularly if inadequately treated) What causes asthma? There is no single known cause of asthma, but there are a number of genetic and environmental factors that may contribute to the development of the condition, including: Family history of asthma or other atopic condition such as eczema or allergic rhinitis Having had bronchiolitis as a child Exposure to tobacco smoke as a child, particularly if mother smoked during pregnancy Being born prematurely or at a low birth weight What can trigger an exacerbation of asthma? Irritants in air such as cigarette smoke, chemical fumes, pollution Allergens such as pollen, dust mite faeces, animal dander or feathers Respiratory tract infections Weather conditions such as cold air Sulphite-containing foods such as beer, wine, shrimp, many processed or precooked meals Emotional factors such as stress or laughter Medicines, such as non-steriodal anti-inflammatories, beta-blockers Exercise What are the signs of completely controlled asthma? A patient with completely controlled asthma will have:

9 No daytime symptoms No night-time awakening due to asthma No need for rescue medication No exacerbations No limitation on activity, including exercise Normal lung function with minimal side effects from medication How can I support patients with asthma? The goals of asthma treatment are discussed in detail in the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines. As a pharmacist you can support patients by: Helping patients prevent exacerbations Providing information and support to facilitate self-management Identifying and promoting adherence with medication Advising on correct inhaler technique Identifying poor asthma control Support should be tailored to individual patients, taking into account their medical history and what they already know about their condition and treatment. It may also be useful to provide information about the condition, explaining that it is a long-term condition that cannot be cured but that symptoms can be adequately managed. Tackling myths about their condition will also help manage patient expectations. How can I help patients prevent exacerbations and self-manage their condition? Patients should be educated about signs of poor asthma control and signs of an exacerbation, thus enabling them to take steps according to their personalised written action plan, and know when to seek further medical help. You should also counsel patients on their medicines and ensure that they are using them correctly. For example, do they understand the difference between preventer and reliever medication and why it is important that they use their preventer regularly? Also see section How do I help promote adherence? Further information about points to cover when counselling patients on their medicines can be found in the RPS Support Counselling Patients on their Medicines quick reference guide. You can also offer advice about avoiding known triggers and allergens (recommended only in those with confirmed allergy): House dust mite avoidance measures, e.g. washing linen at high temperatures, using anti-dust mite bedding, using agents to kill dust mites. Avoiding foods and additives, such as sulphites (in beer, wine, shrimps)

10 Patients whose asthma is triggered by outdoor factors should be advised to minimize exposure, e.g. not doing strenuous exercise in cold weather or low humidity. If a clinically significant allergen cannot be avoided referring the patient to their GP for onward referral for immunotherapy may be appropriate. Exercise-induced symptoms can be managed with various medicines, however these symptoms are often an indication of poorly controlled asthma and a review of therapy is usually required. Work-related asthma should be referred to a GP. Patients with asthma should be reviewed regularly by specialist doctors and nurses and have a personalised written action plan for management of their condition. You should check that patients have an action plan, understand points in the plan and know how to use it. Some patients (e.g. adults with more severe disease and in those with poor perception of bronchoconstriction) may be required to monitor their condition with a peak flow meter. You should make sure that your patient is aware how to use the device, what the readings mean, how often to conduct a reading and how to care for the meter. How can I help promote adherence? You can help ensure that patients adhere to their asthma medicines by providing simple but clear information about them (if appropriate). Corticosteroids ( preventer ) advise patients about the importance of using their preventer inhaler regularly and inform them about how to avoid more common side effects such as oral thrush. The risk of oral thrush can be reduced by using a spacer device with a corticosteroid inhaler; rinsing the mouth with water (or cleaning a child s teeth) after inhalation of a dose may also be helpful. Additionally be aware that brands of CFC-free beclometasone inhalers are not bioequivalent and should not be interchanged. Also inform patients of the adverse effects associated with prolonged and/or frequent courses of oral therapy as extra monitoring may be required, e.g. for signs of osteoporosis, diabetes (serious adverse effects are more likely with oral therapy than inhlaed corticosteroids). Patients who have been instructed to stop oral corticosteroid treatment should be provided with clear instructions on how to stop to reinforce the prescriber s directions. Steroid cards should be issued where appropriate for oral therapy and ensure that you provide an explanation about their use and purpose. Details of where steroid cards can be obtained can be found in the BNF. Beta 2 agonists ( reliever ) ask about the use of reliever medicines as using inhalers more frequently (more than twice a week) may be a sign of uncontrolled asthma. Warn about effects associated with overuse, e.g. tremors, palpitations. Also ensure that patients understand the difference between short- and long-acting medicines and when to use each type, as not all long acting beta 2 agonists are quick relievers. Short-acting beta 2

11 agonists should only be used when required for symptoms and there is no benefit of using if bronchoconstriction is not present. Theophylline and aminophylline both theophylline and aminophylline have a narrow therapeutic range and interact with a number of medicines. Be aware of the cautions and interactions (including effect of smoking) and advise patients accordingly. Brands of modified release preparations differ in the rate of absorption, thus the brand should be specified on the prescription so you know which one to supply. Patients should have blood levels checked every 12 months and if they present with symptoms suggesting that it is out of range. Leukotriene receptor antagonists advise patients that leukotriene receptor antagonists should not be used to relieve symptoms associated with an acute exacerbation. Sodium cromoglicate and nedocromil these inhalers should be used regularly and are not to be used to relieve symptoms associated with an acute exacerbation. Nebuliser check that the patient understands how to use a nebuliser, how to choose between a mouth piece and facemask, who to contact regarding servicing, where to obtain replacement parts, how to change filters, and how to clean. Also offer advice on how to manage adverse effects of using nebulised solutions. Spacers ensure that the spacer prescribed fits the inhaler. Check that the patient understands how to how to use a spacer, and how to clean and care for it. How can I help patients select the most appropriate device and check that they are using it correctly? There are a number of inhalers available and there are advantages and disadvantages of each device. The choice of inhaler device may also depend on the drug itself, and patient preference and ability. The best way of checking inhaler technique is to ask the patient to demonstrate how they use their inhaler. Each type of inhaler has a different delivery mechanism therefore you should be familiar with instructions for individual inhalers and brands. If the patient is not using the inhaler properly you should perform a demonstration. It is suggested that you have dummy/placebo inhalers for this purpose; these can be obtained from most manufacturers. Placebo/dummy inhalers are single patient use and should not be used for more than one patient. Patient information leaflets often contain pictures and clear instructions for use and you may want to refer patients to this. It is suggested that you check the patient s technique during their next visit to the pharmacy and regularly to ensure that they are still using it correctly. The following devices (which can be sold over the counter/obtained from manufacturer) may help improve inhaler technique:

12 Spacers may help those who find it difficult to use metered dose inhalers (does not require co-ordination of pressing down of the inhaler and inhaling the dose). Many spacers are available on NHS prescriptions. Inhaler aids help patients with manual dexterity problems, e.g. arthritis, press down the chamber of metered dosage inhalers. A winged attachment can help patients with manual dexterity problems, e.g. arthritis, twist the dial on Turbohalers (from manufacturer only). If a patient cannot use a particular inhaler correctly they should be referred to their GP/practice nurse for an alternative. What lifestyle advice should I provide patients with asthma? Smokers should be advised to stop smoking and be provided with supportive therapies, and/or referred to local stop smoking services. Parents who smoke and have a child with asthma should also be advised of the adverse effects of smoking and how it might impact on their child s condition. Obese patients with asthma should be advised about how to lose weight as there seems to be an association between Body Mass Index and symptoms of asthma (ideal BMI kg/m 2). Include advice about eating a balanced diet and adopting an exercise regime to sustain a healthy lifestyle. A diet consisting of fresh fruit and vegetables has been shown (in observational studies) to be associated with fewer asthma symptoms and better lung function. What other support/information can I provide? Other support/information that may be appropriate for your patient could include the following: Influenza vaccination is recommended for all those aged 6 months or over in the clinical risk group (this includes people with asthma who require continuous or repeated use of a steroid preventer inhaler or oral steroids or those that have had asthma attacks requiring hospital admission). Pneumococcal vaccination is recommended for patients who have severe asthma and who require continuous or frequent treatment with oral corticosteroids. Patients with asthma often also suffer from rhinitis. Intranasal steroids can be recommended where appropriate. You should check nasal spray technique when supplying/selling. Explain that facial pain, nasal symptoms, indigestion, and snoring are symptoms of co-existing conditions that may worsen asthma, and may require treatment. Other conditions that may co-exist with asthma include sinusitis, gastrooesophageal reflux disease, and sleep apnoea. Offer treatment and advice or refer to a doctor where appropriate. It is suggested that to improve adherence, any verbal advice is supported with written information that patients can take away. Referring the patient to the

13 product information leaflet may be sufficient in some cases; however leaflets about the condition may also be of use. A range of leaflets can be obtained from Asthma UK. When should I refer patients? You should discuss with other healthcare professionals local procedures for referral of patients. Patients who may require referral to a doctor or other healthcare professional could include: Those who have noticed an increase in asthma exacerbations and symptoms which may indicate that their condition is not well controlled Those who have not responded to treatment with medicines Those who are experiencing side effects with their medicine Those presenting with a severe or life threatening acute asthma exacerbation Those with suspected occupational asthma Those with co-existing conditions Those with haemoptysis The following specialists may also be involved in the management of asthma at any stage: dieticians, physiotherapists, occupational therapists and respiratory nurse specialists, and you should be familiar with referral pathways to these specialis Where can I signpost patients wanting further information? Asthma UK British Lung Foundation European Federation of Allergy and Airway Diseases Patients Association NHS Choices Patient.co.uk Where can I go for further information? RPS members can contact RPS Support on , or complete a web form at UKCPA Respiratory Group , RPS Support Resources Counselling Patients on Medicines quick reference guide Smoking cessation quick reference guide Obesity and weight management quick reference guide Supporting patients with COPD quick reference guide

14 Asthma UK is the charity dedicated to changing the outlook on asthma. It has patient management plans, leaflets and an inhaler demonstration video. How to make the most of being asthmatic Your health, your choices. Has videos on asthma and inhaler technique. Offers medical information and support with printable leaflets Video demonstrations on correct inhaler technique

15 Medicines Use Review Supporting Information for Asthma Patients What is asthma? Asthma is a chronic inflammatory disorder of the airways. The inflammation causes an associated increase in airway hyper-responsiveness, which leads to recurrent episodes of wheezing, breathlessness, tightness in the chest and coughing. These symptoms often present early in the morning or at night. Episodes are usually associated with some degree of airflow obstruction that will resolve spontaneously or with medication. Symptoms may appear variably and patients sometimes may not experience any symptoms for several weeks or months (unlike COPD). As patients get older they may develop fixed airways disease (particularly if inadequately treated) What causes asthma? There is no single known cause of asthma, but there are a number of genetic and environmental factors that may contribute to the development of the condition, including: Family history of asthma or other atopic condition such as eczema or allergic rhinitis Having had bronchiolitis as a child Exposure to tobacco smoke as a child, particularly if mother smoked during pregnancy Being born prematurely or at a low birth weight What can trigger an exacerbation of asthma? Irritants in air such as cigarette smoke, chemical fumes, pollution Allergens such as pollen, dust mite faeces, animal dander or feathers Respiratory tract infections Weather conditions such as cold air Sulphite-containing foods such as beer, wine, shrimp, many processed or precooked meals Emotional factors such as stress or laughter Medicines, such as non-steriodal anti-inflammatories, beta-blockers Exercise What are the signs of completely controlled asthma? A patient with completely controlled asthma will have:

16 No daytime symptoms No night-time awakening due to asthma No need for rescue medication No exacerbations No limitation on activity, including exercise Normal lung function with minimal side effects from medication How can I support patients with asthma? The goals of asthma treatment are discussed in detail in the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines. As a pharmacist you can support patients by: Helping patients prevent exacerbations Providing information and support to facilitate self-management Identifying and promoting adherence with medication Advising on correct inhaler technique Identifying poor asthma control Support should be tailored to individual patients, taking into account their medical history and what they already know about their condition and treatment. It may also be useful to provide information about the condition, explaining that it is a long-term condition that cannot be cured but that symptoms can be adequately managed. Tackling myths about their condition will also help manage patient expectations. How can I help patients prevent exacerbations and self-manage their condition? Patients should be educated about signs of poor asthma control and signs of an exacerbation, thus enabling them to take steps according to their personalised written action plan, and know when to seek further medical help. You should also counsel patients on their medicines and ensure that they are using them correctly. For example, do they understand the difference between preventer and reliever medication and why it is important that they use their preventer regularly? Also see section How do I help promote adherence? Further information about points to cover when counselling patients on their medicines can be found in the RPS Support Counselling Patients on their Medicines quick reference guide. You can also offer advice about avoiding known triggers and allergens (recommended only in those with confirmed allergy): House dust mite avoidance measures, e.g. washing linen at high temperatures, using anti-dust mite bedding, using agents to kill dust mites. Avoiding foods and additives, such as sulphites (in beer, wine, shrimps)

17 Patients whose asthma is triggered by outdoor factors should be advised to minimize exposure, e.g. not doing strenuous exercise in cold weather or low humidity. If a clinically significant allergen cannot be avoided referring the patient to their GP for onward referral for immunotherapy may be appropriate. Exercise-induced symptoms can be managed with various medicines, however these symptoms are often an indication of poorly controlled asthma and a review of therapy is usually required. Work-related asthma should be referred to a GP. Patients with asthma should be reviewed regularly by specialist doctors and nurses and have a personalised written action plan for management of their condition. You should check that patients have an action plan, understand points in the plan and know how to use it. Some patients (e.g. adults with more severe disease and in those with poor perception of bronchoconstriction) may be required to monitor their condition with a peak flow meter. You should make sure that your patient is aware how to use the device, what the readings mean, how often to conduct a reading and how to care for the meter. How can I help promote adherence? You can help ensure that patients adhere to their asthma medicines by providing simple but clear information about them (if appropriate). Corticosteroids ( preventer ) advise patients about the importance of using their preventer inhaler regularly and inform them about how to avoid more common side effects such as oral thrush. The risk of oral thrush can be reduced by using a spacer device with a corticosteroid inhaler; rinsing the mouth with water (or cleaning a child s teeth) after inhalation of a dose may also be helpful. Additionally be aware that brands of CFC-free beclometasone inhalers are not bioequivalent and should not be interchanged. Also inform patients of the adverse effects associated with prolonged and/or frequent courses of oral therapy as extra monitoring may be required, e.g. for signs of osteoporosis, diabetes (serious adverse effects are more likely with oral therapy than inhlaed corticosteroids). Patients who have been instructed to stop oral corticosteroid treatment should be provided with clear instructions on how to stop to reinforce the prescriber s directions. Steroid cards should be issued where appropriate for oral therapy and ensure that you provide an explanation about their use and purpose. Details of where steroid cards can be obtained can be found in the BNF. Beta 2 agonists ( reliever ) ask about the use of reliever medicines as using inhalers more frequently (more than twice a week) may be a sign of uncontrolled asthma. Warn about effects associated with overuse, e.g. tremors, palpitations. Also ensure that patients understand the difference between short- and long-acting medicines and when to use each type, as not all long acting beta 2 agonists are quick relievers. Short-acting beta 2

18 agonists should only be used when required for symptoms and there is no benefit of using if bronchoconstriction is not present. Theophylline and aminophylline both theophylline and aminophylline have a narrow therapeutic range and interact with a number of medicines. Be aware of the cautions and interactions (including effect of smoking) and advise patients accordingly. Brands of modified release preparations differ in the rate of absorption, thus the brand should be specified on the prescription so you know which one to supply. Patients should have blood levels checked every 12 months and if they present with symptoms suggesting that it is out of range. Leukotriene receptor antagonists advise patients that leukotriene receptor antagonists should not be used to relieve symptoms associated with an acute exacerbation. Sodium cromoglicate and nedocromil these inhalers should be used regularly and are not to be used to relieve symptoms associated with an acute exacerbation. Nebuliser check that the patient understands how to use a nebuliser, how to choose between a mouth piece and facemask, who to contact regarding servicing, where to obtain replacement parts, how to change filters, and how to clean. Also offer advice on how to manage adverse effects of using nebulised solutions. Spacers ensure that the spacer prescribed fits the inhaler. Check that the patient understands how to how to use a spacer, and how to clean and care for it. How can I help patients select the most appropriate device and check that they are using it correctly? There are a number of inhalers available and there are advantages and disadvantages of each device. The choice of inhaler device may also depend on the drug itself, and patient preference and ability. The best way of checking inhaler technique is to ask the patient to demonstrate how they use their inhaler. Each type of inhaler has a different delivery mechanism therefore you should be familiar with instructions for individual inhalers and brands. If the patient is not using the inhaler properly you should perform a demonstration. It is suggested that you have dummy/placebo inhalers for this purpose; these can be obtained from most manufacturers. Placebo/dummy inhalers are single patient use and should not be used for more than one patient. Patient information leaflets often contain pictures and clear instructions for use and you may want to refer patients to this. It is suggested that you check the patient s technique during their next visit to the pharmacy and regularly to ensure that they are still using it correctly. The following devices (which can be sold over the counter/obtained from manufacturer) may help improve inhaler technique:

19 Spacers may help those who find it difficult to use metered dose inhalers (does not require co-ordination of pressing down of the inhaler and inhaling the dose). Many spacers are available on NHS prescriptions. Inhaler aids help patients with manual dexterity problems, e.g. arthritis, press down the chamber of metered dosage inhalers. A winged attachment can help patients with manual dexterity problems, e.g. arthritis, twist the dial on Turbohalers (from manufacturer only). If a patient cannot use a particular inhaler correctly they should be referred to their GP/practice nurse for an alternative. What lifestyle advice should I provide patients with asthma? Smokers should be advised to stop smoking and be provided with supportive therapies, and/or referred to local stop smoking services. Parents who smoke and have a child with asthma should also be advised of the adverse effects of smoking and how it might impact on their child s condition. Obese patients with asthma should be advised about how to lose weight as there seems to be an association between Body Mass Index and symptoms of asthma (ideal BMI kg/m 2). Include advice about eating a balanced diet and adopting an exercise regime to sustain a healthy lifestyle. A diet consisting of fresh fruit and vegetables has been shown (in observational studies) to be associated with fewer asthma symptoms and better lung function. What other support/information can I provide? Other support/information that may be appropriate for your patient could include the following: Influenza vaccination is recommended for all those aged 6 months or over in the clinical risk group (this includes people with asthma who require continuous or repeated use of a steroid preventer inhaler or oral steroids or those that have had asthma attacks requiring hospital admission). Pneumococcal vaccination is recommended for patients who have severe asthma and who require continuous or frequent treatment with oral corticosteroids. Patients with asthma often also suffer from rhinitis. Intranasal steroids can be recommended where appropriate. You should check nasal spray technique when supplying/selling. Explain that facial pain, nasal symptoms, indigestion, and snoring are symptoms of co-existing conditions that may worsen asthma, and may require treatment. Other conditions that may co-exist with asthma include sinusitis, gastrooesophageal reflux disease, and sleep apnoea. Offer treatment and advice or refer to a doctor where appropriate. It is suggested that to improve adherence, any verbal advice is supported with written information that patients can take away. Referring the patient to the

20 product information leaflet may be sufficient in some cases; however leaflets about the condition may also be of use. A range of leaflets can be obtained from Asthma UK. When should I refer patients? You should discuss with other healthcare professionals local procedures for referral of patients. Patients who may require referral to a doctor or other healthcare professional could include: Those who have noticed an increase in asthma exacerbations and symptoms which may indicate that their condition is not well controlled Those who have not responded to treatment with medicines Those who are experiencing side effects with their medicine Those presenting with a severe or life threatening acute asthma exacerbation Those with suspected occupational asthma Those with co-existing conditions Those with haemoptysis The following specialists may also be involved in the management of asthma at any stage: dieticians, physiotherapists, occupational therapists and respiratory nurse specialists, and you should be familiar with referral pathways to these specialis Where can I signpost patients wanting further information? Asthma UK British Lung Foundation European Federation of Allergy and Airway Diseases Patients Association NHS Choices Patient.co.uk Where can I go for further information? RPS members can contact RPS Support on , or complete a web form at UKCPA Respiratory Group , RPS Support Resources Counselling Patients on Medicines quick reference guide Smoking cessation quick reference guide Obesity and weight management quick reference guide Supporting patients with COPD quick reference guide

21 Asthma UK is the charity dedicated to changing the outlook on asthma. It has patient management plans, leaflets and an inhaler demonstration video. How to make the most of being asthmatic Your health, your choices. Has videos on asthma and inhaler technique. Offers medical information and support with printable leaflets Video demonstrations on correct inhaler technique

22 Medicines Use Review Supporting Information for Asthma Patients What is asthma? Asthma is a chronic inflammatory disorder of the airways. The inflammation causes an associated increase in airway hyper-responsiveness, which leads to recurrent episodes of wheezing, breathlessness, tightness in the chest and coughing. These symptoms often present early in the morning or at night. Episodes are usually associated with some degree of airflow obstruction that will resolve spontaneously or with medication. Symptoms may appear variably and patients sometimes may not experience any symptoms for several weeks or months (unlike COPD). As patients get older they may develop fixed airways disease (particularly if inadequately treated) What causes asthma? There is no single known cause of asthma, but there are a number of genetic and environmental factors that may contribute to the development of the condition, including: Family history of asthma or other atopic condition such as eczema or allergic rhinitis Having had bronchiolitis as a child Exposure to tobacco smoke as a child, particularly if mother smoked during pregnancy Being born prematurely or at a low birth weight What can trigger an exacerbation of asthma? Irritants in air such as cigarette smoke, chemical fumes, pollution Allergens such as pollen, dust mite faeces, animal dander or feathers Respiratory tract infections Weather conditions such as cold air Sulphite-containing foods such as beer, wine, shrimp, many processed or precooked meals Emotional factors such as stress or laughter Medicines, such as non-steriodal anti-inflammatories, beta-blockers Exercise What are the signs of completely controlled asthma? A patient with completely controlled asthma will have:

23 No daytime symptoms No night-time awakening due to asthma No need for rescue medication No exacerbations No limitation on activity, including exercise Normal lung function with minimal side effects from medication How can I support patients with asthma? The goals of asthma treatment are discussed in detail in the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines. As a pharmacist you can support patients by: Helping patients prevent exacerbations Providing information and support to facilitate self-management Identifying and promoting adherence with medication Advising on correct inhaler technique Identifying poor asthma control Support should be tailored to individual patients, taking into account their medical history and what they already know about their condition and treatment. It may also be useful to provide information about the condition, explaining that it is a long-term condition that cannot be cured but that symptoms can be adequately managed. Tackling myths about their condition will also help manage patient expectations. How can I help patients prevent exacerbations and self-manage their condition? Patients should be educated about signs of poor asthma control and signs of an exacerbation, thus enabling them to take steps according to their personalised written action plan, and know when to seek further medical help. You should also counsel patients on their medicines and ensure that they are using them correctly. For example, do they understand the difference between preventer and reliever medication and why it is important that they use their preventer regularly? Also see section How do I help promote adherence? Further information about points to cover when counselling patients on their medicines can be found in the RPS Support Counselling Patients on their Medicines quick reference guide. You can also offer advice about avoiding known triggers and allergens (recommended only in those with confirmed allergy): House dust mite avoidance measures, e.g. washing linen at high temperatures, using anti-dust mite bedding, using agents to kill dust mites. Avoiding foods and additives, such as sulphites (in beer, wine, shrimps)

24 Patients whose asthma is triggered by outdoor factors should be advised to minimize exposure, e.g. not doing strenuous exercise in cold weather or low humidity. If a clinically significant allergen cannot be avoided referring the patient to their GP for onward referral for immunotherapy may be appropriate. Exercise-induced symptoms can be managed with various medicines, however these symptoms are often an indication of poorly controlled asthma and a review of therapy is usually required. Work-related asthma should be referred to a GP. Patients with asthma should be reviewed regularly by specialist doctors and nurses and have a personalised written action plan for management of their condition. You should check that patients have an action plan, understand points in the plan and know how to use it. Some patients (e.g. adults with more severe disease and in those with poor perception of bronchoconstriction) may be required to monitor their condition with a peak flow meter. You should make sure that your patient is aware how to use the device, what the readings mean, how often to conduct a reading and how to care for the meter. How can I help promote adherence? You can help ensure that patients adhere to their asthma medicines by providing simple but clear information about them (if appropriate). Corticosteroids ( preventer ) advise patients about the importance of using their preventer inhaler regularly and inform them about how to avoid more common side effects such as oral thrush. The risk of oral thrush can be reduced by using a spacer device with a corticosteroid inhaler; rinsing the mouth with water (or cleaning a child s teeth) after inhalation of a dose may also be helpful. Additionally be aware that brands of CFC-free beclometasone inhalers are not bioequivalent and should not be interchanged. Also inform patients of the adverse effects associated with prolonged and/or frequent courses of oral therapy as extra monitoring may be required, e.g. for signs of osteoporosis, diabetes (serious adverse effects are more likely with oral therapy than inhlaed corticosteroids). Patients who have been instructed to stop oral corticosteroid treatment should be provided with clear instructions on how to stop to reinforce the prescriber s directions. Steroid cards should be issued where appropriate for oral therapy and ensure that you provide an explanation about their use and purpose. Details of where steroid cards can be obtained can be found in the BNF. Beta 2 agonists ( reliever ) ask about the use of reliever medicines as using inhalers more frequently (more than twice a week) may be a sign of uncontrolled asthma. Warn about effects associated with overuse, e.g. tremors, palpitations. Also ensure that patients understand the difference between short- and long-acting medicines and when to use each type, as not all long acting beta 2 agonists are quick relievers. Short-acting beta 2

On completion of this chapter you should be able to: discuss the stepwise approach to the pharmacological management of asthma in children

On completion of this chapter you should be able to: discuss the stepwise approach to the pharmacological management of asthma in children 7 Asthma Asthma is a common disease in children and its incidence has been increasing in recent years. Between 10-15% of children have been diagnosed with asthma. It is therefore a condition that pharmacists

More information

Background information

Background information Background information Asthma Asthma is a complex disease affecting the lungs that can be managed but cannot be cured. 1 Asthma can be controlled well in most people most of the time, although some people

More information

Respiratory conditions

Respiratory conditions 3 Respiratory conditions Asthma Condition A common disorder in which there is reversible bronchospasm of the bronchial airways, resulting in chest tightness and wheeze. Treatment options Inhaled short-acting

More information

Clinical Practice Guideline for the Management of Asthma in Children and Adults

Clinical Practice Guideline for the Management of Asthma in Children and Adults Clinical Practice Guideline for the Management of Asthma in Children and Adults Assessment: A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function

More information

Information for Behavioral Health Providers in Primary Care. Asthma

Information for Behavioral Health Providers in Primary Care. Asthma What is Asthma? Information for Behavioral Health Providers in Primary Care Asthma Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods

More information

The Annual Direct Care of Asthma

The Annual Direct Care of Asthma The Annual Direct Care of Asthma The annual direct health care cost of asthma in the United States is approximately $11.5 billion; indirect costs (e.g. lost productivity) add another $4.6 billion for a

More information

Asthma. When do these symptoms arise? What triggers make asthma worse?

Asthma. When do these symptoms arise? What triggers make asthma worse? Asthma Asthma is the term which describes a specific type of breathing problem that arises due to narrowing of the airways. This narrowing is caused when certain natural chemicals within the body are released,

More information

An Overview of Asthma - Diagnosis and Treatment

An Overview of Asthma - Diagnosis and Treatment An Overview of Asthma - Diagnosis and Treatment Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness,

More information

YOU VE BEEN REFERRED TO AN ASTHMA SPECIALIST...

YOU VE BEEN REFERRED TO AN ASTHMA SPECIALIST... YOU VE BEEN REFERRED TO AN ASTHMA SPECIALIST... ...HERE S WHAT TO EXPECT You have been referred to an allergist because you have or may have asthma. The health professional who referred you wants you to

More information

Asthma Diagnosis and Management

Asthma Diagnosis and Management Asthma Diagnosis and Management Asthma is a condition characterized by narrowing and inflammation of the airways. This inflammation causes the airways to be very sensitive and react to a variety of stimuli

More information

Asthma Intervention. An Independent Licensee of the Blue Cross and Blue Shield Association.

Asthma Intervention. An Independent Licensee of the Blue Cross and Blue Shield Association. Asthma Intervention 1. Primary disease education Member will have an increased understanding of asthma and the classification by severity, the risks and the complications. Define asthma Explain how lungs

More information

understanding the professional guidelines

understanding the professional guidelines SEVERE ASTHMA understanding the professional guidelines This guide includes information on what the European Respiratory Society (ERS) and the American Thoracic Society (ATS) have said about severe asthma.

More information

Treatment of Asthma. Talk to your doctor about the various medications available to treat asthma.

Treatment of Asthma. Talk to your doctor about the various medications available to treat asthma. Please call 911 if you think you have a medical emergency. Treatment of Asthma The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child's

More information

GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1. Pre-release Article for Examination in January 2010 JD*(A09-1661-01A)

GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1. Pre-release Article for Examination in January 2010 JD*(A09-1661-01A) GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1 Pre-release Article for Examination in January 2010 JD*(A09-1661-01A) 2 BLANK PAGE 3 Information for Teachers The attached article on asthma is based on some

More information

Medication and Devices for Chronic Obstructive Pulmonary Disease (COPD)

Medication and Devices for Chronic Obstructive Pulmonary Disease (COPD) Medication and Devices for Chronic Obstructive Pulmonary Disease (COPD) Patients with COPD take a wide variety of medicines to manage their symptoms these include: Inhaled Short Acting Bronchodilators

More information

Adult asthma Hope and support

Adult asthma Hope and support Adult asthma Hope and support at every step Contents What is asthma? 4 What are the symptoms of asthma? 4 Who gets asthma? 4 What causes asthma? 5 What can treatment offer? 7 Diagnosing asthma 7 What your

More information

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD) is the name for a group of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways

More information

Where kids come first. Childhood asthma

Where kids come first. Childhood asthma 14 Where kids come first Childhood asthma In Canada, childhood asthma has quadrupled in the last decade. It is one of the most common reasons children are hospitalized or visit emergency departments. A

More information

PATIENT INFORMATION ABOUT TREATMENTS FOR ASTHMA AND ALLERGIC RHINITIS, PRESCRIPTIONS & OVER THE COUNTER MEDICINE

PATIENT INFORMATION ABOUT TREATMENTS FOR ASTHMA AND ALLERGIC RHINITIS, PRESCRIPTIONS & OVER THE COUNTER MEDICINE PATIENT INFORMATION ABOUT TREATMENTS FOR ASTHMA AND ALLERGIC RHINITIS, PRESCRIPTIONS & OVER THE COUNTER MEDICINE The content of this booklet was developed by Allergy UK. MSD reviewed this booklet to comment

More information

Virginia Tech Departmental Policy 27 Sports Medicine Key Function:

Virginia Tech Departmental Policy 27 Sports Medicine Key Function: Virginia Tech Departmental Policy 27 Sports Medicine Key Function: Review: Yearly Director of Athletic Training Title: Management of Asthma in Athletes Section: Treatment S-A Safety POLICY STATEMENT: This

More information

Continuing Professional Pharmacy Development (CPPD) CPPD calendar. Facebook: QUCPPD

Continuing Professional Pharmacy Development (CPPD) CPPD calendar. Facebook: QUCPPD Continuing Professional Pharmacy Development (CPPD) CPPD 2013-2014 calendar Facebook: QUCPPD Continuing Professional Pharmacy Development (CPPD) Essentials in Asthma Management: The Action Plan 30 Oct

More information

ASTHMA IN INFANTS AND YOUNG CHILDREN

ASTHMA IN INFANTS AND YOUNG CHILDREN ASTHMA IN INFANTS AND YOUNG CHILDREN What is Asthma? Asthma is a chronic inflammatory disease of the airways. Symptoms of asthma are variable. That means that they can be mild to severe, intermittent to

More information

Guidance to support the stepwise review of combination inhaled corticosteroid therapy for adults ( 18yrs) in asthma

Guidance to support the stepwise review of combination inhaled corticosteroid therapy for adults ( 18yrs) in asthma Guidance to support the stepwise review of combination inhaled corticosteroid therapy for adults ( 18yrs) in asthma Important Complete asthma control needs to be achieved for at least 12 weeks before attempting

More information

Fostair Maintenance & Reliever Therapy (MART) for asthma

Fostair Maintenance & Reliever Therapy (MART) for asthma Fostair Maintenance & Reliever Therapy (MART) for asthma Turnberg Building Respiratory Medicine 0161 206 3158 All Rights Reserved 2014. Document for issue as handout. Name: Date: Best peak flow recording

More information

In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away.

In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Asthma Basics Patient and Family Education This teaching sheet contains general information only. Talk with your child s doctor or a member of your child s healthcare team about specific care of your child.

More information

Understanding and Controlling Asthma Attacks. Information for parents

Understanding and Controlling Asthma Attacks. Information for parents Understanding and Controlling Asthma Attacks Information for parents Your child was recently seen by a doctor for asthma. This guide will help you gain a better understanding about your child's recent

More information

Before prescribing montelukast sodium, please read the accompanying Prescribing Information.

Before prescribing montelukast sodium, please read the accompanying Prescribing Information. Merck & Co., Inc. U.S. Human Health P.O. Box 1000 North Wales, PA 19454-1099 Dear Health Care Professional: Thank you for your interest in the enclosed attachment, Stepwise Approach for Managing, excerpted

More information

Severe asthma Definition, epidemiology and risk factors. Mina Gaga Athens Chest Hospital

Severe asthma Definition, epidemiology and risk factors. Mina Gaga Athens Chest Hospital Severe asthma Definition, epidemiology and risk factors Mina Gaga Athens Chest Hospital Difficult asthma Defined as asthma, poorly controlled in terms of chronic symptoms, with episodic exacerbations,

More information

The Right Medicines Can Help You Get Control of Asthma. BlueCare SM TennCareSelect

The Right Medicines Can Help You Get Control of Asthma. BlueCare SM TennCareSelect The Right Medicines Can Help You Get Control of Asthma BlueCare SM TennCareSelect WHEEZING. COUGHING. SHORTNESS OF BREATH. CHEST TIGHTNESS. If you or a family member has asthma, you know these symptoms

More information

This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are irritated. Asthma

This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are irritated. Asthma DCI Home: Lung Diseases: Asthma: Printer Friendly Summary Page What Is Asthma? Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods

More information

Asthma and Pregnancy

Asthma and Pregnancy Asthma and Pregnancy When you become pregnant you may notice many physical and emotional changes. Joy and wonder are often mixed with concerns about your health and the health of your unborn child. If

More information

ASTHMA RESOURCE PACK Section 3. Chronic Cough Guidelines

ASTHMA RESOURCE PACK Section 3. Chronic Cough Guidelines ASTHMA RESOURCE PACK Section 3 Chronic Cough Guidelines NHS Fife Guidelines for the Management of Chronic Cough in Adults In this section: 1. Introduction 2. Scope Guidelines for Management of Chronic

More information

Better Breathing with COPD

Better Breathing with COPD Better Breathing with COPD People with Chronic Obstructive Pulmonary Disease (COPD) often benefit from learning different breathing techniques. Pursed Lip Breathing Pursed Lip Breathing (PLB) can be very

More information

II. ASTHMA BASICS. Overview of Asthma. Why do I need to know about asthma?

II. ASTHMA BASICS. Overview of Asthma. Why do I need to know about asthma? II. ASTHMA BASICS Overview of Asthma Why do I need to know about asthma? In the United States, asthma is the most common chronic childhood illness. Asthma affects an estimated 4.8 million children nationally,

More information

Asthma Triggers. What are they and what can be done about them?

Asthma Triggers. What are they and what can be done about them? Asthma Triggers What are they and what can be done about them? This brochure has been developed for the community by Asthma Australia It provides information about: Asthma triggers What you can do about

More information

Asthma Care. Of course, your coach is there to answer any questions you have about your asthma, such as:

Asthma Care. Of course, your coach is there to answer any questions you have about your asthma, such as: Asthma Care All Health Coaches in the Asthma Care Management program are registered or certified respiratory therapists. Your coach will listen to your story of living with asthma. This will help your

More information

Leukotriene receptor antagonists: Montelukast and zafirlukast

Leukotriene receptor antagonists: Montelukast and zafirlukast Bulletin 61 February 2014 2.0 Leukotriene receptor antagonists: Montelukast and zafirlukast Across the PrescQIPP membership (20.2 million patients, November 2013), annual spend for the leukotriene receptor

More information

What You Should Know About ASTHMA

What You Should Know About ASTHMA What You Should Know About ASTHMA 200 Hospital Drive Galax, VA 24333 (276) 236-8181 www.tcrh.org WHAT IS ASTHMA? It s a lung condition that makes breathing difficult. The cause of asthma is not known.

More information

Childhood Asthma / Wheeze

Childhood Asthma / Wheeze Childhood Asthma / Wheeze Symptoms Asthma causes a range of breathing problems. These include wheezing, feeling of tightness in the lungs/chest and a cough (often in the night or early morning). The most

More information

Ear Infections Asthma in childhood asthma in childhood

Ear Infections Asthma in childhood asthma in childhood Asthma Ear Infections in childhood asthma in childhood Asthma in childhood is common and it can be serious. About one in six children (aged less than 15 years) in Western Australia are affected by asthma.

More information

Special Conditions That May Have an Impact on Asthma

Special Conditions That May Have an Impact on Asthma Special Conditions That May Have an Impact on Asthma When asthma is not optimally controlled, there may be issues with compliance or adherence to the therapeutic program or issues with proper medication

More information

Key Components in Treating Asthma in Adults and Children Older than 5 Years: Diagnosis, Treatment and Referral

Key Components in Treating Asthma in Adults and Children Older than 5 Years: Diagnosis, Treatment and Referral Key Components in Treating Asthma in Adults and Children Older than 5 Years: Diagnosis, Treatment and Referral Initial Asthma Assessment Critical to accurately diagnose asthma by: Identifying the presence

More information

Children are at greater risk of developing asthma than adults; over 2.5 million children under age 18 suffer from allergic asthma.

Children are at greater risk of developing asthma than adults; over 2.5 million children under age 18 suffer from allergic asthma. Children are at greater risk of developing asthma than adults; over 2.5 million children under age 18 suffer from allergic asthma. Asthma What Is Asthma? Asthma is a chronic (long-term) lung disease that

More information

Ambulatory Asthma Management

Ambulatory Asthma Management Ambulatory Asthma Management Summary of Recommendations Algorithm Patient presents with symptoms of asthma Establish diagnosis and determine level of severity by H and P and spirometry. (A) Consider alternative

More information

COPD Patient Education Resource

COPD Patient Education Resource Contact Information Prince of Wales Hospital Switchboard 02 9382 2222 Department of Respiratory Medicine 02 9382 4631 / 9382 8643 Respiratory Coordinated Care Program (RCCP) 02 9382 3486 Pulmonary Rehabilitation

More information

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD)

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD) Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease Patient held record and self-management plan Keep this in a safe place and bring it with you to GP or hospital visits, including admissions.

More information

Chronic Obstructive Pulmonary Disease (COPD) Exacerbation. Protocol in Primary Care for South Kent CCG

Chronic Obstructive Pulmonary Disease (COPD) Exacerbation. Protocol in Primary Care for South Kent CCG Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Protocol in Primary Care for South Kent CCG NHS South Kent Coast CCG, Council Offices, White Cliffs Business Park, Dover CT16 3PJ T.030004 24700

More information

COPD and Asthma Differential Diagnosis

COPD and Asthma Differential Diagnosis COPD and Asthma Differential Diagnosis Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in America. physician education Learning Objectives Use tools to effectively diagnose

More information

Service Specification

Service Specification Service Specification Spirometry in Primary Care Date: February 2011 Document Reference: Service Specification (V4.0) Contents: Section Page 1 Definition of service 3 2 Training 4 3 Reporting / Monitoring

More information

Asthma and COPD Awareness

Asthma and COPD Awareness Asthma and COPD Awareness Molina Breathe with Ease sm and Chronic Obstructive Pulmonary Disease Molina Healthcare of Michigan Fall 2012 Importance of Controller Medicines Asthma is a disease that causes

More information

SmPC SYMBICORT pressurised inhalation, suspension Approved indications and posology given in Section 4. CLINICAL PARTICULARS

SmPC SYMBICORT pressurised inhalation, suspension Approved indications and posology given in Section 4. CLINICAL PARTICULARS Table VI-14 Risk miminisation by safety concern: off-label use of SYMBICORT pressurised inhalation, suspension for the treatment of asthma, in children, adolescents, or adults Safety concern Routine risk

More information

Take Action on Asthma. Environmental triggers of asthma and allergies

Take Action on Asthma. Environmental triggers of asthma and allergies Take Action on Asthma Environmental triggers of asthma and allergies What are asthma and allergies? They are both conditions where the body reacts to substances commonly found in the air. Asthma is a very

More information

Chronic Rhino-Sinusitis (CRS)

Chronic Rhino-Sinusitis (CRS) Who is this information for? Chronic Rhino-Sinusitis (CRS) This information is for patients and carers of individuals who have a sore throat. Chronic Rhino-Sinusitis Overview The sinuses are hollow air

More information

Asthma Basic Facts. Staying safe and well with asthma For people with asthma and their carers

Asthma Basic Facts. Staying safe and well with asthma For people with asthma and their carers Asthma Basic Facts Staying safe and well with asthma For people with asthma and their carers Breathing Breathing is how we get air in and out of our body. We all need air to live. The lungs (inside your

More information

COPD Intervention. Components:

COPD Intervention. Components: COPD Intervention 1. Primary disease education Member will have an increased understanding of chronic obstructive pulmonary disease, the causes, risks and complications. Explain COPD Explain how COPD is

More information

Cough, as a leading symptom, would certainly be in the top 10 of reasons for seeing a GP.

Cough, as a leading symptom, would certainly be in the top 10 of reasons for seeing a GP. COUGH Cough, as a leading symptom, would certainly be in the top 10 of reasons for seeing a GP. A cough in a child seems to cause more concern, even when it has not been present very long, whereas in adults

More information

Royal Manchester Children s Hospital. Asthma. Information For Parents and Carers. Ward: Ward Telephone Number: Consultant:

Royal Manchester Children s Hospital. Asthma. Information For Parents and Carers. Ward: Ward Telephone Number: Consultant: Royal Manchester Children s Hospital Asthma Information For Parents and Carers Ward: Ward Telephone Number: Consultant: Understanding asthma Asthma is a common condition that affects approximately 1 in

More information

NHS Forth Valley Guideline for the Management of Chronic Cough in Adults

NHS Forth Valley Guideline for the Management of Chronic Cough in Adults NHS Forth Valley Guideline for the Management of Chronic in Adults Approved 07/05/2008 Version 1.1 Date of First Issue 18/11/2015 Review Date 18/11/2017 Date of Issue 07/05/2008 EQIA Yes 01/05/2008 Author

More information

Breathe Easy: Asthma and FMLA

Breathe Easy: Asthma and FMLA This article was published in the FMLA Policy, Practice, and Legal Update newsletter, by Business & Legal Reports, Inc. (BLR). BLR is a nationally recognized publisher of regulatory and legal compliance

More information

Seasonal Allergies. 1995-2012 The Patient Education Institute, Inc. www.x-plain.com im010101 Last reviewed: 05/30/2012 1

Seasonal Allergies. 1995-2012 The Patient Education Institute, Inc. www.x-plain.com im010101 Last reviewed: 05/30/2012 1 Seasonal Allergies Introduction Seasonal allergies are allergies that develop during certain times of the year. Seasonal allergies are usually a response to pollen from trees, grasses, and weeds. Constant

More information

PATIENT GROUP DIRECTION (PGD) ADMINISTRATION OF INHALED SALBUTAMOL FOR THE EMERGENCY TREATMENT OF ACUTE ASTHMA OR COPD EXACERBATION AT HMP FORD

PATIENT GROUP DIRECTION (PGD) ADMINISTRATION OF INHALED SALBUTAMOL FOR THE EMERGENCY TREATMENT OF ACUTE ASTHMA OR COPD EXACERBATION AT HMP FORD PATIENT GROUP DIRECTION (PGD) ADMINISTRATION OF INHALED SALBUTAMOL FOR THE EMERGENCY TREATMENT OF ACUTE ASTHMA OR COPD EXACERBATION AT HMP FORD Version Number: 01HMP Patient Group Direction originally

More information

Learning the Asthma Guidelines by Case Studies

Learning the Asthma Guidelines by Case Studies Learning the Asthma Guidelines by Case Studies Timothy Craig, DO Professor of Medicine and Pediatrics Distinguished Educator Penn State University Hershey Medical Center Objectives 1. Learn the Asthma

More information

F r e q u e n t l y As k e d Qu e s t i o n s. Lung Disease

F r e q u e n t l y As k e d Qu e s t i o n s. Lung Disease Lung Disease page 1 Q: What is lung disease? A: Lung disease refers to disorders that affect the lungs, the organs that allow us to breathe. Breathing problems caused by lung disease may prevent the body

More information

SUMMARY OF RECOMMENDATIONS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

SUMMARY OF RECOMMENDATIONS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) SUMMARY OF RECOMMENDATIONS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Diagnosis and diagnostic tools Recommendation 1 Diagnosis of COPD (IV) It is recommended that spirometry should be performed

More information

medicineupdate to find out more about this medicine

medicineupdate to find out more about this medicine medicineupdate Asking the right questions about new medicines Seretide for chronic obstructive pulmonary disease What this medicine is 1 What this medicine treats 2 Other medicines available for this condition

More information

CARE GUIDE for ASTHMA

CARE GUIDE for ASTHMA Suggested Diagnosis (1) Confirm a diagnosis by establishing that: Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present Airflow obstruction is at least partially reversible

More information

Script Notes: Good (morning, afternoon, evening), my name is, and I will present Asthma Basics for Schools. My goal today is to help you learn more

Script Notes: Good (morning, afternoon, evening), my name is, and I will present Asthma Basics for Schools. My goal today is to help you learn more Script Notes: Good (morning, afternoon, evening), my name is, and I will present Asthma Basics for Schools. My goal today is to help you learn more about asthma and the school age child, as well as the

More information

Nose Disorders. This reference summary explains common nose disorders, including symptoms and treatment options. Sinus

Nose Disorders. This reference summary explains common nose disorders, including symptoms and treatment options. Sinus Nose Disorders Introduction Your nose is important to your health. It filters the air you breathe and removes dust and germs. It warms and moistens the air to keep your lungs and the tubes that lead to

More information

Strategies for Improving Patient Outcomes in Pediatric Asthma Through Education. Pediatric Asthma. Epidemiology. Epidemiology

Strategies for Improving Patient Outcomes in Pediatric Asthma Through Education. Pediatric Asthma. Epidemiology. Epidemiology Strategies for Improving Patient Outcomes in Pediatric Asthma Through Education Chris Orelup, MS3 Max Project 3/1/01 Pediatric Asthma The leading cause of illness in childhood 10, 000, 000 school absences

More information

A New Anti-inflammatory Therapy For COPD

A New Anti-inflammatory Therapy For COPD A New Anti-inflammatory Therapy For COPD A Brief Introduction to COPD Current Treatment of COPD Corticosteroid Resistant Chronic Inflammation Looking For New Anti-inflammatory Therapy Introduction to Moxibustion

More information

Breathe With Ease. Asthma Disease Management Program

Breathe With Ease. Asthma Disease Management Program Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program

More information

Understanding Cough, Wheezing and Noisy Breathing in Children. Introduction

Understanding Cough, Wheezing and Noisy Breathing in Children. Introduction Understanding Cough, Wheezing and Noisy Breathing in Children Introduction Symptoms such as cough, wheezing or noisy breathing can be caused by a number of conditions. When these occur, it is natural for

More information

A ragweed pollen as a treatment for a ragweed allergy? It s called immunotherapy.

A ragweed pollen as a treatment for a ragweed allergy? It s called immunotherapy. A ragweed pollen as a treatment for a ragweed allergy? It s called immunotherapy. RAGWITEK is a prescription medicine used for sublingual (under the tongue) immunotherapy to treat ragweed pollen allergies

More information

Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis, and asthma

Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis, and asthma Chapter 31 Drugs Used to Treat Lower Respiratory Disease Learning Objectives Describe the physiology of respirations Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis,

More information

بسم اهلل الرحمن الرحيم

بسم اهلل الرحمن الرحيم بسم اهلل الرحمن الرحيم College of medicine 432 ASTHMA Done By Mohammed Abdullah Alghammass *please make sure you read the objectives from the reading material file Asthma: Asthma is a chronic inflammatory

More information

What You And Your Family Can Do About Asthma

What You And Your Family Can Do About Asthma GLOBAL INITIATIVE FOR ASTHMA What You And Your Family Can Do About Asthma BASED ON THE GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION NHLBI/WHO WORKSHOP REPORT NATIONAL INSTITUTES OF HEALTH NATIONAL

More information

Your information prescription

Your information prescription Prepared on 10 Apr 2013 Serial number: HQA076SC View this prescription online http://www.nhs.uk/ipg/pages/ippreviewcover.aspx?ref=hqa076sc More health information at http://www.nhs.uk Your information

More information

ACTIVITY #3: LUNG HEALTH ASTHMA AND ALLERGIES

ACTIVITY #3: LUNG HEALTH ASTHMA AND ALLERGIES ACTIVITY #3: LUNG HEALTH ASTHMA AND ALLERGIES TIME 50 minutes, computer lab REQUIRED RESOURCES Activity Computer lab with internet access for student research Notepaper and pencil for research Poster board

More information

ASTHMA DISCHARGE PLAN

ASTHMA DISCHARGE PLAN ASTHMA DISCHARGE PLAN Information Leaflet Your Health. Our Priority. Page 2 of 6 Asthma When a child with asthma comes into contact with something that irritates their airways (an asthma trigger) the muscles

More information

SPRINGFIELD CLINIC ASTHMA EDUCATION

SPRINGFIELD CLINIC ASTHMA EDUCATION SPRINGFIELD CLINIC ASTHMA EDUCATION Table of Contents 1. What is Asthma? 2. Asthma Triggers 3. Using Your Inhaler 4. Cleansing Practices for Inhaled Medication 5. Controlling Your Asthma 6. Fast Acting

More information

Subject ID: Subject Initials Date completed Interviewer. Person answering questions. 1 yes 2 no

Subject ID: Subject Initials Date completed Interviewer. Person answering questions. 1 yes 2 no COAST III Childhood Origins of ASThma Asthma Allergy Symptoms COAST 3 year visit Subject ID Subject ID: Subject Initials Date completed Interviewer Person answering questions 99. This form was completed

More information

Doncaster & Bassetlaw Medicines Formulary

Doncaster & Bassetlaw Medicines Formulary Doncaster & Bassetlaw Medicines Formulary Section 3.2: Corticosteroids Beclometasone 50, 100 and 250micrograms/dose Clickhaler Clenil Modulite (Beclometasone CFC free) 50, 100, and 250micrograms/dose MDI

More information

Your COPD action plan

Your COPD action plan University Teaching Trust Your COPD action plan Patient name: Better Breathing 0161 206 3159 All Rights Reserved 2014. Document for issue as handout. Your COPD Action Plan This plan will help you: Learn

More information

Management of your Chronic Obstructive Pulmonary Disease (COPD)

Management of your Chronic Obstructive Pulmonary Disease (COPD) Management of your Chronic Obstructive Pulmonary Disease (COPD) Your personal COPD self management plan (Please bring this plan with you at each review) Name: NHS Number: Date of Birth: GP Name: GP Practice:

More information

Ipratropium bromide/salbutamol

Ipratropium bromide/salbutamol Ipratropium bromide VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Chronic obstructive pulmonary disease (COPD): Chronic obstructive pulmonary disease (COPD) is an umbrella

More information

COPD PATIENT SUPPORT. What is COPD? This piece has been reviewed by COPD Support Ireland.

COPD PATIENT SUPPORT. What is COPD? This piece has been reviewed by COPD Support Ireland. COPD PATIENT SUPPORT What is COPD? This piece has been reviewed by COPD Support Ireland. COPD & Me Chronic obstructive pulmonary disease (COPD) is a very common lung disease. If you have been diagnosed

More information

COPD - Education for Patients and Carers Integrated Care Pathway

COPD - Education for Patients and Carers Integrated Care Pathway Patient NHS COPD - Education for Patients and Carers Integrated Care Pathway Date ICP completed:. Is the patient following another Integrated Care Pathway[s].. / If yes, record which other Integrated Care

More information

Comparison between Clinic attendance and unattended treatment in patients with COPD and Asthma. Soidao Hospital, 2015

Comparison between Clinic attendance and unattended treatment in patients with COPD and Asthma. Soidao Hospital, 2015 Comparison between Clinic attendance and unattended treatment in patients with COPD and Asthma Soidao Hospital, 2015 November 19, 2015 Editors Meteera Ariyadeh Nawaporn Simarangsan Teerachai Manak 6 th

More information

Northumbria Healthcare NHS Foundation Trust. Bronchiectasis. Issued by Respiratory Medicine

Northumbria Healthcare NHS Foundation Trust. Bronchiectasis. Issued by Respiratory Medicine Northumbria Healthcare NHS Foundation Trust Bronchiectasis Issued by Respiratory Medicine The aim of this booklet is to help you manage your bronchiectasis. It contains information which you should find

More information

C Take control of OPD. and your life. Chronic Obstructive Pulmonary Disease. a practical guide to living with. brought to you by

C Take control of OPD. and your life. Chronic Obstructive Pulmonary Disease. a practical guide to living with. brought to you by C Take control of and your life Chronic Obstructive Pulmonary Disease OPD a practical guide to living with brought to you by MY PERSONAL PLAN I will work on the following areas to manage my COPD: Take

More information

Yoon Nofsinger, M.D. Tampa ENT Associates, 3450 East Fletcher Avenue, Tampa, FL 33613 Phone (813) 972-3353, Fax (813) 978 3667

Yoon Nofsinger, M.D. Tampa ENT Associates, 3450 East Fletcher Avenue, Tampa, FL 33613 Phone (813) 972-3353, Fax (813) 978 3667 Yoon Nofsinger, M.D. Tampa ENT Associates, 3450 East Fletcher Avenue, Tampa, FL 33613 Phone (813) 972-3353, Fax (813) 978 3667 General Information: Allergies and Injection Therapy 1. General: You have

More information

ASTHMA< Observation about treatment and education of patients in San Pablo Clinic, Heredia Costa Rica

ASTHMA< Observation about treatment and education of patients in San Pablo Clinic, Heredia Costa Rica ASTHMA< Observation about treatment and education of patients in San Pablo Clinic, Heredia Costa Rica Rachel Borovina, MSIV Lisa Troeger, MSIV University of California San Francisco IHCAI FOUNDATION 2001

More information

Emphysema. Introduction Emphysema is a type of chronic obstructive pulmonary disease, or COPD. COPD affects about 64 million people worldwide.

Emphysema. Introduction Emphysema is a type of chronic obstructive pulmonary disease, or COPD. COPD affects about 64 million people worldwide. Emphysema Introduction Emphysema is a type of chronic obstructive pulmonary disease, or COPD. COPD affects about 64 million people worldwide. Emphysema involves damage to the air sacs in the lungs. This

More information

"Respiratory Problems in Swimmers: How to keep Swimmers Afloat" and in the Pool!

Respiratory Problems in Swimmers: How to keep Swimmers Afloat and in the Pool! "Respiratory Problems in Swimmers: How to keep Swimmers Afloat" and in the Pool! Charles Siegel, MD Associate Clinical Professor University of Missouri @ Kansas City School of Medicine USA Swimming does

More information

The Proper Treatment Of Asthma

The Proper Treatment Of Asthma The Proper Treatment Of Asthma Southwest Allergy & Asthma Foundation Page 1 of 10 INTRODUCTION The purpose of this pamphlet is to supply information which will give patients suffering with asthma, an intelligent

More information

Get Your Head In The Game. Matthew Voorman, MD Hutchinson Clinic March 21, 2016

Get Your Head In The Game. Matthew Voorman, MD Hutchinson Clinic March 21, 2016 Get Your Head In The Game Matthew Voorman, MD Hutchinson Clinic March 21, 2016 About Me Otolaryngology Head & Neck Surgery Geisinger Medical Center General Surgery University of California San Francisco

More information

TAKING CARE OF YOUR ASTHMA

TAKING CARE OF YOUR ASTHMA TAKING CARE OF YOUR ASTHMA WHAT IS ASTHMA? Asthma is a disease that affects the lungs. If you have asthma, you have it all the time, but will have an asthma attack only when something, known as a trigger,

More information

Lifestyles for children

Lifestyles for children Fall 2014 INSIDE: Your child s asthma action plan Lifestyles for children and teens with Asthma Get the basics: Asthma Control 101 Managing your child s asthma is a 24/7 job. The symptoms might flare up

More information

Live well with COPD 1

Live well with COPD 1 Live well with COPD 1 Understanding COPD Chronic Obstructive Pulmonary Disease describes several different lung conditions that can lead to blocking the airflow out of the lungs. Breathing can become more

More information