Transcript Slide 1
And Breathe…..
Educational solutions for the NHS pharmacy workforce
Why are we here?
Educational solutions for the NHS pharmacy workforce
2
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
Educational solutions for the NHS pharmacy workforce
3
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
Educational solutions for the NHS pharmacy workforce
4
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
Educational solutions for the NHS pharmacy workforce
5
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
Educational solutions for the NHS pharmacy workforce
6
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
Educational solutions for the NHS pharmacy workforce
7
COPD and asthma: the differences
Small groups
One envelope per group
5 minutes to identify characteristics of each disease
Educational solutions for the NHS pharmacy workforce
8
How did you do?
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
Persistent and progressive
Variable
Uncommon
Common
Not common
Common but variable
Over 35 years
Any age
Nearly always
Possibly
Breathlessness
Significant diurnal or day-today variability of symptoms
Night-time symptoms that
keeps patient awake
Main age group affected
Smoker or ex-smoker
Educational solutions for the NHS pharmacy workforce
9
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
Educational solutions for the NHS pharmacy workforce
10
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
Educational solutions for the NHS pharmacy workforce
11
SIMPLE
Stop smoking
Inhaler technique
Monitor control and adherence
Patient education on medicines
Lifestyle
Education
Educational solutions for the NHS pharmacy workforce
12
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”
Educational solutions for the NHS pharmacy workforce
13
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
Educational solutions for the NHS pharmacy workforce
14
“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%
Educational solutions for the NHS pharmacy workforce
15
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%
Educational solutions for the NHS pharmacy workforce
16
Types of inhaler
How many types of inhaler are on the market?
MDI
• Slow and gentle
DPI
• Fast and forceful
Educational solutions for the NHS pharmacy workforce
17
Practical support
http://www.leicestershospitals.nhs.uk/professionals
Educational solutions for the NHS pharmacy workforce
18
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
Educational solutions for the NHS pharmacy workforce
19
Monitoring
Educational solutions for the NHS pharmacy workforce
20
Patient education on medicines
Difference between relievers and preventers
Side effects
Use of spacers
Corticosteroids
Oxygen use
Educational solutions for the NHS pharmacy workforce
21
Lifestyle
What lifestyle interventions should you be discussing?
Educational solutions for the NHS pharmacy workforce
22
Lifestyle interventions
Stop smoking
Weight management
Exercise
Self management plans
Trigger avoidance
Vaccination
Advice on heart disease, anxiety, depression for COPD
Pulmonary rehabilitation
Educational solutions for the NHS pharmacy workforce
23
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 longacting bronchodilator
Add inhaled corticosteroids (as combination)
Use of breathing techniques
Educational solutions for the NHS pharmacy workforce
24
Education
Educational solutions for the NHS pharmacy workforce
25
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
Educational solutions for the NHS pharmacy workforce
26
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!
Educational solutions for the NHS pharmacy workforce
27