After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:
Describe the economic and clinical impact of uncontrolled asthma.
List the four components of asthma management.
Synthesize a business plan for asthma clinic development in community pharmacies including successful marketing and pricing strategies.
Describe the structure of patient visits required in an asthma clinic in a community pharmacy setting.
Develop appropriate documentation for prescriber communication, internal documentation, and third-party documentation requirements.
According to the National Health Interview Survey conducted by the Centers for Disease Control and Prevention (CDC), 13.3% of the population in the United States has been diagnosed with asthma.1 The Asthma and Allergy Foundation of America reports the following associated costs of asthma to patients, society, and the health-care system. They state that every day in America:
- 40,000 people miss work or school.
- 30,000 people have an asthma attack.
- 5,000 people visit the emergency room (ER).
- 1,000 people are admitted to the hospital.
- 11 people die.2
Uncontrolled asthma has negative effects on clinical, humanistic, and economic outcomes. The Task Force on Community Preventative Services, a volunteer group of preventative and public health-care experts appointed by the director of the CDC, has recommended an educational and interventional approach to asthma care that has demonstrated an increase in symptom-free days and in cost avoidance. Evidence-based interventions for patients with asthma include proper inhaler technique and trigger identification and avoidance.3
Community pharmacists are uniquely positioned to identify asthma patients with uncontrolled asthma through simple observation such as early or frequent refills of rescue inhalers. A recent study found that community pharmacists were able to identify patients at risk for poorly controlled asthma using assessment tools to determine patient symptoms and medication records to determine appropriate fill history of asthma medications and devices.4
Patient counseling for meter dose inhalers (MDI) and dry powder inhalers (DPI) is an opportunity community pharmacists experience every day that can make a measurable impact on the control of symptoms for patients with asthma. New prescriptions for spacers and peak flow meters also give pharmacists an opportunity to speak with a patient not only regarding the use of a new device but also regarding the reasoning behind the new prescription. An educational intervention may uncover a patient suffering from asthma that is not as well controlled as it could be. Incorrect inhaler technique has been reported frequently in the literature and is estimated to be present in 28–68% of patients.5 Incorrect inhaler technique has been linked to decreased control of asthma symptoms and an increase in ER visits.6 Further research has determined that repeated instruction and demonstration of correct inhaler technique can help to decrease intentional nonadherence to asthma medications.7
One of the most common interventions community pharmacists can utilize is the discovery of underutilization of inhaled corticosteroid (ICS) inhalers. Sometimes ...