Page 55 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 55
. Their role is potentially multidimen- easily interpreted by the Asthma Specialist 55
sional with focused activities including assess- Pharmacist. One obvious drawback of this
ment of inhaler adherence, optimisation of approach is that prescription refill does not al- the multi-disciplinary team approach to specialist adult difficult asthma care
inhaler technique, undertaking patient con- ways equate to actual medication usage. An
sultations within the clinical pathway and in- alternative adherence assessment is the FeNO
put to providing governance oversight to bio- suppression test used in patients with high
logics treatment pathways. baseline FeNO, whereby they undergo daily
FeNO measurement alongside monitored in-
Suboptimal adherence to asthma thera- haler usage.68,69 This has accurately identified
pies has long been recognised among patients patients with poor adherence who showed
with difficult asthma. A UK study over a dec- greater falls in FeNO during the course of the
ade ago identified that over one third of such test. Increasing adoption of electronic tech-
patients had obtained less than 50% of their nologies in healthcare offers opportunities
prescribed ICS while nearly half of those pre- with respect to adherence assessment in asth-
scribed maintenance OCS were found to be ma too. Numerous electronic add-on devices
non-adherent to that medication.65 Anoth- can yield useful insight into inhaler usage.67,70
er contemporaneous UK study demonstrat- These tools can offer a foundation for dis-
ed that 65% of patients in a difficult asth- cussions with patients on then improving ad-
ma clinic were non-adherent to their asthma herence to inhaled medications. Blood mon-
medications defined by less than 80% pick itoring for adherence to OCS has also seen
up of prescribed medications.66 In this study, increasing uptake with development of paired
prednisolone and cortisol assays for use in
non-adherence was a predictor of poor asth- clinical practice for patients on maintenance
ma outcome including history of needing ven- OCS.71,72
tilation for acute severe asthma. A more re-
cent Australian study identified that nearly There are also multiple dimensions to
50% of patients assessed in a difficult asth- non-adherence which might be either a con-
ma clinic setting using electronic monitor- sidered intentional act by the patient or a
ing devices were found to have suboptimal non-intentional outcome associated with oth-
inhaler adherence defined as taking less than er demographic patient factors that influence
75% of prescribed doses. That study also not- poor medication usage.73 Therefore individ-
ed that around half of those eligible for cost- ualised approaches to addressing adherence
ly biologic therapies met non-adherence crite- may be needed dependent on the specific pa-
ria for their conventional preventer treatment tient. An Asthma Specialist Pharmacist may
regime.67 These studies collectively highlight be well placed to deliver such activity in the
a significant problem with non-adherence difficult asthma MDT setting, coupled to ac-
in this patient population which an Asthma tions such as inhaler training consultations.
Specialist Pharmacist would be well suited to Pharmacist delivered asthma inhaler train-
identifying and addressing. However, subjec- ing has been shown to improve both adher-
tive patient reporting is unreliable and simple ence and asthma control at a general asthma
clinical assessment has been shown to be in- population level.74 Systematic reviews have
accurate too.67 Tools such as prescription pick demonstrated positive impact of Pharmacist
up data and calculation of the medicines pos- delivered interventions on both asthma adher-
session ratio have gained widespread use.65 ence and a range of outcomes.75,76 However,
These probably work best in healthcare set- improved asthma medication adherence may
tings with well-constructed electronic health not always be followed by improved clinical
record systems clearly documenting prescrip- status in a multimorbid disease m odel such
tion issues that can be readily accessed and
sional with focused activities including assess- Pharmacist. One obvious drawback of this
ment of inhaler adherence, optimisation of approach is that prescription refill does not al- the multi-disciplinary team approach to specialist adult difficult asthma care
inhaler technique, undertaking patient con- ways equate to actual medication usage. An
sultations within the clinical pathway and in- alternative adherence assessment is the FeNO
put to providing governance oversight to bio- suppression test used in patients with high
logics treatment pathways. baseline FeNO, whereby they undergo daily
FeNO measurement alongside monitored in-
Suboptimal adherence to asthma thera- haler usage.68,69 This has accurately identified
pies has long been recognised among patients patients with poor adherence who showed
with difficult asthma. A UK study over a dec- greater falls in FeNO during the course of the
ade ago identified that over one third of such test. Increasing adoption of electronic tech-
patients had obtained less than 50% of their nologies in healthcare offers opportunities
prescribed ICS while nearly half of those pre- with respect to adherence assessment in asth-
scribed maintenance OCS were found to be ma too. Numerous electronic add-on devices
non-adherent to that medication.65 Anoth- can yield useful insight into inhaler usage.67,70
er contemporaneous UK study demonstrat- These tools can offer a foundation for dis-
ed that 65% of patients in a difficult asth- cussions with patients on then improving ad-
ma clinic were non-adherent to their asthma herence to inhaled medications. Blood mon-
medications defined by less than 80% pick itoring for adherence to OCS has also seen
up of prescribed medications.66 In this study, increasing uptake with development of paired
prednisolone and cortisol assays for use in
non-adherence was a predictor of poor asth- clinical practice for patients on maintenance
ma outcome including history of needing ven- OCS.71,72
tilation for acute severe asthma. A more re-
cent Australian study identified that nearly There are also multiple dimensions to
50% of patients assessed in a difficult asth- non-adherence which might be either a con-
ma clinic setting using electronic monitor- sidered intentional act by the patient or a
ing devices were found to have suboptimal non-intentional outcome associated with oth-
inhaler adherence defined as taking less than er demographic patient factors that influence
75% of prescribed doses. That study also not- poor medication usage.73 Therefore individ-
ed that around half of those eligible for cost- ualised approaches to addressing adherence
ly biologic therapies met non-adherence crite- may be needed dependent on the specific pa-
ria for their conventional preventer treatment tient. An Asthma Specialist Pharmacist may
regime.67 These studies collectively highlight be well placed to deliver such activity in the
a significant problem with non-adherence difficult asthma MDT setting, coupled to ac-
in this patient population which an Asthma tions such as inhaler training consultations.
Specialist Pharmacist would be well suited to Pharmacist delivered asthma inhaler train-
identifying and addressing. However, subjec- ing has been shown to improve both adher-
tive patient reporting is unreliable and simple ence and asthma control at a general asthma
clinical assessment has been shown to be in- population level.74 Systematic reviews have
accurate too.67 Tools such as prescription pick demonstrated positive impact of Pharmacist
up data and calculation of the medicines pos- delivered interventions on both asthma adher-
session ratio have gained widespread use.65 ence and a range of outcomes.75,76 However,
These probably work best in healthcare set- improved asthma medication adherence may
tings with well-constructed electronic health not always be followed by improved clinical
record systems clearly documenting prescrip- status in a multimorbid disease m odel such
tion issues that can be readily accessed and
