Asthma – current management
Despite considerable advances in the understanding of asthma and the treatments available, at least three deaths each day in the UK are due to asthma. In this series of interviews, Dr Anna Murphy, Consultant Respiratory Pharmacist, University Hospitals of Leicester NHS Trust, describes the challenges of managing asthma and explains the input that pharmacists can make to the care of people with respiratory diseases.
Preventable factors are present in about 90 percent of asthma deaths which underlines the importance of helping patients to understand and use their treatments effectively.
Biologics are an important new addition to the treatments available for asthma and can help to reduce the frequency of exacerbations and the dose of oral corticosteroids required to control exacerbations. Dr Murphy says that she uses her qualification as an independent prescriber nearly every day. She believes that it has expanded her role as a pharmacist and helped her relationship with both patients and with the other members of the multi-disciplinary team. As part of her work, she is able to explain her approach to prescribing to junior doctors and help them to learn about the factors to be considered, she says.
There are numerous opportunities for pharmacists to work in respiratory medicine across the whole spectrum of health care in a variety of roles, including work in community pharmacies, in GP practices, in hospital and in integrated care. The community pharmacist’s role is important not only in educating patients about their treatment but also in identifying “red flags” that could indicate serious underlying disease.
Steroid stewardship – analogous to antibiotic stewardship – is an important task for respiratory pharmacists and is one of the measures that can have a positive impact on the overall outcomes of asthma. The aim of steroid stewardship is to minimise the risk of harm and maximise the benefits of oral steroid treatment.
When it comes to making the case for respiratory pharmacists there are a number of useful publications. These include work done at Guy’s and St Thomas’ Hospital in collaboration with the integrated care service and work done at Bart’s Health NHS Trust with a pharmacist in general practice. In addition, a community pharmacy service that was developed in Leicestershire called the SIMPLE service has proved to be an effective tool in ‘difficult to manage’ asthma. Furthermore, a workforce assessment by the British Thoracic Society has set out future requirements for specialist pharmacists and the NHS Accelerated Access Collaborative has described the role of a respiratory pharmacist in GP practices.
Pharmacists bring a special and distinctive set of skills to the care of people with asthma – their approach is different but complementary to that of doctors. Moreover, the skills that someone develops as a respiratory specialist pharmacist are transferable across a wide range of pharmacy practice settings. Dr Murphy concludes that respiratory pharmacy is an area that can offer a stimulating and rewarding career and a role that is much valued by patients.