And Breathe…..

Educational solutions for the NHS pharmacy workforce

And Breathe…..



Why are we here?

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Burden of asthma

UK has largest prevalence of asthma in the world.

There are 4.1 million adults with asthma in the UK and 1.3 million children

Three people die each day from asthma, of which most are preventable

75 percent of hospital admissions for asthma are avoidable

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Burden of COPD

COPD is a leading cause of mortality and morbidity worldwide and the 5th biggest cause of death in the UK

One person dies from COPD every 20 minutes in England, around 23,000 a year

15 percent of those admitted to hospital with COPD die within three months and around 25 percent die within a year of admission

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Financial burden of respiratory disease

NHS spends about £1 billion a year on prescribed respiratory medicines

Cost per item is highest of all BNF categories at over £17 per item on average

Only around 40 percent of asthmatics are compliant with treatment. If this doubled to 80 percent, the NHS could save £90 million per year

COPD is the second most common cause of emergency admission to hospital and one of the most costly inpatient conditions to be treated by the NHS

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Pharmacy interventions improve outcomes

Respiratory disease is an area where there is evidence that high quality pharmacy intervention can significantly affect patient outcomes

Recent evidence:

• SIMPLE project

• The inhaler technique improvement project

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Learning outcomes

By the end of this session you will be able to:

Describe the differences between asthma and COPD and identify the signs that should alert people to the fact that their condition is not being well controlled

Outline ways to improve outcomes for patients by helping them to take their medicines correctly

Provide lifestyle advice to support people to manage their condition

Identify useful resources available to the public and to healthcare professionals

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COPD and asthma: the differences

Small groups

One envelope per group

5 minutes to identify characteristics of each disease

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COPD ASTHMA

Airway obstruction Permanently damaged and narrowed

Inflammation causes constriction; usually

reversible

Cough symptoms Chronic cough often with sputum

Irritating cough, often at night

Breathlessness Persistent and progressive VariableSignificant diurnal or day-to-day variability of symptoms Uncommon CommonNight-time symptoms that

keeps patient awake Not common Common but variableMain age group affected

Over 35 years Any ageSmoker or ex-smoker

Nearly always Possibly

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How did you do?


Asthma – the facts

Asthma is a chronic lung condition in which the airways are inflamed and narrowed, making it harder to breathe normally

The changes to the airways are fully reversible

Although asthma often runs in families, many people with asthma do not have relatives with the condition. Hay fever and eczema are frequently associated with asthma – either in the person with asthma or in their family

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COPD - The facts

COPD comprises a number of respiratory diseases, predominantly chronic bronchitis and emphysema

It is preventable and treatable, characterised by airflow limitation that (unlike asthma) is not fully reversible.

The airflow limitation is usually progressive and not curable

90 percent of cases are caused by cigarette smoking

Although COPD affects the lungs, it also produces significant systemic consequences

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SIMPLE

Stop smokingInhaler techniqueMonitor control and adherencePatient education on medicinesLifestyleEducation

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Stop Smoking

Stopping smoking has been shown to reduce the rate of decline on lung function so is the key message for all those with asthma or COPD, regardless of their age

NICE PH45 Tobacco Harm Reduction

“This guidance recommends harm reduction as an additional new option particularly for those who are highly dependent on smoking who want to quit, but can’t just stop in one go”

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Inhaler technique

Inefficient inhaler technique is a common problem resulting in poor drug delivery, decreased disease control and increased inhaler use

Even with effective technique, maximum lung deposition from MDI is 15 percent

Large volume spacers may be easier to use and they increase deposition to 30 percent

Incorrect use is a huge cost to the NHS

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http://www.blf.org.uk/Page/Outdoor-air-pollution


“Can you show me how you use your inhaler?”

75 percent of patients using an inhaler for on average 2-3 years reported they were using their inhaler correctly

What percentage actually were?

10 25 50 75 90

10%

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How good is your technique?

Patients’ inhaler technique can be significantly improved by brief instruction given by a trained healthcare professional

What percentage of healthcare professionals who teach use can demonstrate them correctly?

9 29 59 69 79 99

9%

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Types of inhaler

How many types of inhaler are on the market?

MDI

• Slow and gentle

DPI

• Fast and forceful

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Practical support

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http://www.leicestershospitals.nhs.uk/professionals

http://www.leicestershospitals.nhs.uk/professionals


Which inhaler is best?

As healthcare professionals we consider the evidence and the costs

BUT

To optimise medicines use the key is the patient’s perspective

Getting it right from their point of view can have a big impact on adherence and therefore the health outcomes

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Monitoring

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Patient education on medicines

Difference between relievers and preventers

Side effects

Use of spacers

Corticosteroids

Oxygen use

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Lifestyle

What lifestyle interventions should you be discussing?

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Lifestyle interventions

Stop smoking

Weight management

Exercise

Self management plans

Trigger avoidance

Vaccination

Advice on heart disease, anxiety, depression for COPD

Pulmonary rehabilitation

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Prevention of exacerbations

Offer annual influenza / pneumococcal vaccination

Give self management advice including use of rescue treatment where appropriate

Optimise bronchodilator therapy with one or more long-acting bronchodilator

Add inhaled corticosteroids (as combination)

Use of breathing techniques

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Education

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CPPE support

Inhaler technique workshops

Focal point : Asthma

iPDF: New medicines service asthma and COPD

Inhaler technique videos

Coming soon:

Learning@lunch: COPD

Focal Point: COPD

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In Summary

Respiratory diseases place a huge burden on the NHS and the wider economy

There is mounting evidence that effective pharmacy-based interventions , particularly involving inhaler technique, can have a large impact on outcomes for both patients and the NHS

Pharmacy technicians are well placed to support people with these long term conditions

SIMPLE!

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And Breathe…..

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