Staying positive – A pharmacist’s view

When I wrote about community pharmacy and asthma for the Ask about Asthma 2020 campaign, I didn’t imagine that covid-19 would still be having such an impact a year later. I had envisaged that community pharmacy would become digitally enabled to provide routine virtual consultations, and innovative services would be in place to support children and young people with asthma. Although ready to embrace new technology and workflows, overwhelmed and exhausted Community Pharmacy teams have had to concentrate on the many challenges being faced daily.

Unfortunately, service development has not formally moved forward as quickly as hoped, but be reassured that Community Pharmacy is still there, Pharmacists are available, talking to patients, children, young people, parents’, and carers, to ensure they understand their asthma treatments. The consultation whereby the patient is asked to demonstrate exactly how they use their inhaler may still be impractical whilst covid-19 is still circulating within our communities, as we need to minimise potential health risks for the pharmacy staff. However, patients presenting at the pharmacy can be asked to talk through the first steps of the inhaler technique process, which include describing exhaling prior to inhaler activation, and then “act-out” the inspiration process. For both face-to face or remote consultations patients, parents, and carers can be directed to a wealth of literature and on-line resources. Questionnaires, such as the reliever reliance test and asthma control test plus discussion around peak flow readings and asthma action plans can be valuable to determine a patient’s control and provide an indication of the subsequent support which may be required.

In fact, the 2021-22 Pharmacy Quality Scheme (PQS), which is part of the Community Pharmacy Contractual Framework (CPCF) includes “checking inhaler technique (at the third “catch up” consultation of the New Medicine Service) and ensuring patients have personalised asthma action plans, as well as encouraging return of unwanted and used inhalers for environmentally safe disposal”.

Also, the standards for the “London Asthma Services for Children and Young People” are being revised with input from Community Pharmacy to ensure uniformity in the quality of services from different healthcare providers involved in the care of children and young people with asthma.

And although we have not yet established commissioned Community Pharmacy Asthma Services, the research is continuing in the background with pipeline studies including “Practical Use of the Reliever Reliance Test in Community Pharmacy”,” Community Pharmacy Spacer Guardians” and a “Paediatric Asthma Discharge Medicine Service” pilot (whereby a discharging ward clinician can send a digital referral for an asthma medicine review to the patient’s nominated pharmacy), to improve the coordination of care between health providers in line with the asthma standard

Let’s hope that Ask About Asthma 2022 will provide an opportunity to showcase results of exciting new studies, and a return to some form of “normality” …. fingers crossed for a better 2021-2022 for all of us!

By Marsha Alter
Community Pharmacist and team member of the Middlesex Group of Local Pharmaceutical Committees