Page 82 - rp-may-2020

CPD ACTIVITY 80
RET AIL PHARMA C Y • MA Y 2020
Adherence
Patient education maximises adherence
and optimises treatment outcomes.
Many patients stop INCS too quickly as they
expect immediate results, and others stop
using them once symptoms improve.
A common reason for treatment failure
is non adherence due to local side
effects such as dryness, irritation and
epistaxis. Treatment failure may also be
due to incorrect administration technique.
Patients should be asked to demonstrate
administration during an HMR interview.
Community pharmacist role
Community pharmacists are easily
accessible and play an important role
in case detection of this common
condition. Allergic rhinitis is often
viewed as ‘bothersome’ by patients
and medical practitioners. However, the
impact on quality of life and functioning
is substantial. The view that allergic
rhinitis is an annoying nuisance often
leads to undertreatment. Many people
with this condition do not report it to
their GP. People with mild symptoms
frequently self medicate with OTC and
pharmacist only products but have
suboptimal management.
Studies have shown that most people
self select OTC medications without
speaking to a pharmacist. In a study of
3
nearly 300 people self managing allergic
rhinitis with OTC medications, 44.3 per
cent bought oral antihistamines, indicating
suboptimal management, as the most
common symptom experienced was
nasal congestion, which is not addressed
by these.
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Patients presenting in the
pharmacy with asthma, eczema, or
rhinoconjunctivitis should be questioned
to identify the presence and severity of
allergic rhinitis, which coexists with other
conditions such as chronic sinusitis, otitis
media and sleep problems.
A best possible medication history
should be conducted and the patient’s
beliefs and preferences explored.
Pharmacists can complete a treatment
plan for allergic rhinitis.
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Patients concerned about systemic
absorption of INCS and adverse effects
typical of steroids such as osteoporosis,
diabetes and hypertension should be
reassured that absorption is minimal.
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Patient consultation
A comprehensive history and assessment
by pharmacists can be elicited by
structured questioning.
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• What is your main symptom? (Check for
rhinorrhoea, sneezing, itchy nose, nasal
congestion and/or obstruction, watery
or itchy eyes.)
• Has a physician ever diagnosed that
you have hay fever, allergic rhinitis,
or asthma?
• How long have you had these
symptoms? (Determines severity.)
• Do you have the symptoms all
the time or do they come and go?
(Determines persistent versus
intermittent symptoms.)
• Are you aware of anything that seems
to bring the symptoms on, such as
being outdoors, around animals, or
related to something you handle at
work or at home?
• Is your nasal discharge clear
and watery? (Purulent discharge
suggests infection.)
• Are you experiencing any wheezing
or shortness of breath? (‘Yes’ may
indicate asthma.)
• Do you have an earache or pain in your
face? (‘Yes’ may indicate otitis media
or sinusitis.)
• Do you have eye symptoms?
• Do you have a family member with
allergy problems?
• What medications have you already
tried for these symptoms?
• Do you have any other medical
conditions or are you using any other
medications?
Ongoing monitoring
Follow-up by community pharmacists in
monitoring for safety and efficacy is critical
for optimal management. This should
include monitoring for:
• Improvement of symptoms and quality
of life.
• Assessment of safety of OTC and
prescription medications.
• Regular checking of device technique.
• Adherence and persistence to therapy.
• Need for referral to medical practitioner.
• Need to discontinue medications.
Summary
Allergic rhinitis is a chronic relapsing
condition, often undertreated and difficult
to adhere to therapy. Pharmacists are well
placed to identify the symptoms of allergic
rhinitis and to recommend appropriate
treatment. Both prescription and OTC
products are effective in relieving the
symptoms of allergic rhinitis and associated
conditions such as asthma. It’s important to
manage comorbidity of allergic rhinitis and
asthma. Patient education is essential for
effective management.
FROM PAGE 79
1.
Prime the spray device according to
manufacturer’s instructions (for the first
time or after a period of non-use).
2. Shake the bottle before each use.
3. Blow nose before spraying if blocked
by mucus.
4. Tilt head slightly forward and gently
insert nozzle into nostril. Use right hand
for left nostril (and left hand for
right nostril).
5. Aim the nozzle away from the middle of
the nose and direct nozzle into the nasal
passage (not upwards towards tip of nose,
but in line with the roof of the mouth).
6. Avoid sniffing hard during or
after spraying.
Table 4.
Recommended technique for using
intranasal corticosteroid sprays.
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