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56 RESPIRATORY HEALTH FROM PAGE 55 then open that conversation. “Everyone needs to have short-acting reliever for acute flare-ups of symptoms, but the most recent research certainly shows that because asthma is an inflammatory condition of the small airways of the lungs, the long term effect of being on low dose preventive therapy, which is usually inhaled corticosteroids in Australia, is very beneficial to good asthma control. It reduces the risk of severe flare-ups and improving quality of life for people. “While this isn’t really a change, we need to focus on getting the consumer message out that, while it may be cheap and easy to buy a reliever over the counter, it may not be the best treatment.” It’s not what but how Skill is a funny thing. We can develop a high degree of excellence in something but, over time, as we continue to do it regularly, that excellence loses its shine and slips back into the mediocrity zone. Driving a vehicle is a good example, with most experienced drivers admitting they can be somewhat blasé about certain road rules, particularly when no one is watching. Ms Goldman says this is also true of patient technique in the use of asthma devices, and suggests pharmacists are perhaps the best placed among health professionals to help maximise the benefits of those devices for their patients. “A key role pharmacists can play is looking at the way patients are using their medications, because so often people aren’t using their devices correctly,” she said. “This of course means they’re not going to be getting the full benefit of the medication, so they’ll be symptomatic. “The importance of technique is one of our core messages, and not just in bushfire season, because up to nine out of 10 people aren’t using their devices correctly. The research shows device technique should be reviewed regularly, at least every few months. “Asthma devices are really complex, and with so many different types, the chances of knowing how to use a device intuitively are very low. Even if your health professional, or your doctor or your pharmacist has shown you how to use it first time around, you’re not going to get it perfect first time and you’re going to forget. In day-to- day use, only half concentrating when you’re using your meditation, you’ll quickly slip back into other habits.” For a pharmacist to be effective when advising patients on device technique, it’s important not to simply ask if they’re using their device correctly, because they’re going to reply, ‘Yes, I think I am’. Instead, Ms Goldman suggests pharmacists should be asking, ‘Would you mind showing me how you use this device?’ A wealth of resources is available for pharmacists wanting to learn and keep current on asthma issues, with device technique videos available at: asthma. org.au/about-asthma/medicines-and- devices/techniques/. Asthma Australia also recommends the ThinkGP online asthma modules available at: thinkgp.com.au/content-partner/ asthmaaustralia. Asthma Australia says pharmacists have found module four, ‘Preventative care to stop asthma flares’, particularly beneficial and suggests modules one and two would be very helpful as well, while all modules also earn pharmacists CPD credits. Final thoughts Clearly, the consistent advice coming from those involved in respiratory health is around awareness, preparation, use of both preventive and reliever medication, and technique. To understand the patient’s situation across these factors requires engagement through effective dialogue, questions and perhaps demonstration. Pharmacists are well placed to initiate and guide these important conversations. Patients trust them to do so before offering advice, such as the following recommendation from Ms Golding concerning the 80 per cent of asthma patients who also have allergies: “We encourage pharmacists to advise patients with asthma and hayfever to get the hayfever under control. This is especially important in spring months, with extreme weather patterns and high pollen levels. They’ll find with hayfever under control, their asthma is better controlled, too.” Reference: 1. asthma.org.au/wp-content/uploads/Resources/ AA6_Smoke-Impact-Survey-1920_Revised.pdf CASE STUDY Telling it like it is Pharmacist Mark Leighton, co-owner of Lanyon Pharmacy in the ACT, was working when the fires came within striking distance of his pharmacy. He clearly recalls the nervousness he and his patients felt before the wind changed direction. While the fire retreated, the smoke remained, with air quality completely beyond the hazardous level. Retail Pharmacy asked him what patient health issues or other changes he was seeing, eight months after those events. “The main thing I’ve noticed is people are taking their respiratory health more seriously now,” Mr Leighton said. “The conversations I’ve had in the months since the fires have actually been a lot more positive. People are more open, receptive and willing to actually talk about their respiratory condition. Whether it’s something severe or very mild asthma, it’s being taken seriously now. “We saw the milder category of patients, such as the exercise-induced asthma cohort who normally manage themselves, coming in a bit more frequently during the peak fire period and throughout the smoke pollution. “Then we noticed the middle group, who aren’t the really severe ones and who typically aren’t the most compliant, begin to take it more seriously. They started coming in just to make sure they were compliant with their medications, sometimes asking about technique, too.” Based on his experiences, we asked Mr Leighton what advice he’d now offer to other pharmacists. “Never underestimate the importance of opening a conversation with the patient and asking plenty of questions to understand and get as much information as you can,” he said. “That way you’ll find those trigger points where you can confidently either say, ‘OK, that’s probably something for which we need to refer you’, or where you decide it’s something you can do at the community pharmacy level, such as improving their device technique or assisting with their medicines compliance, which should both improve overall outcomes.” RETAIL PHARMACY • AUG 2020