Combination products

Many corticosteroid and long-acting beta2 receptor agonist combination products are available (e.g. Seretide, Symbicort and Fostair). The British Guideline on the Management of Asthma says that where good compliance exists there is no clinical difference between the combination or individual inhalers but that combination products should be used where compliance is questionable.

Devices

With many inhaler and spacer devices available it is essential that the patient uses one that is most appropriate to their needs. Delivery systems include pressurised metereddose inhalers (PMDIs), which are the most common and cost effective, and dry-powder inhalers (DPIs). Many factors influence the device prescribed including the patient’s lifestyle, portability and convenience, plus other factors such as age, dexterity, co-ordination and inspiratory flow.

PMDIs require a high degree of co-ordination. DPIs are breath activated and may improve deposition rates as less co-ordination is required for their use. However, the user must have sufficient lung function to inhale the dose into the lungs to achieve the required drug deposition.

The pharmacy team should ensure the patient has received appropriate training and can demonstrate how to use the inhaler. This should be checked regularly.

Asthma action plans

Evidence shows that people with an asthma action plan are four times less likely to be admitted to hospital because of their asthma. Action plans are a way to remind individuals about aspects of their asthma plan and can detail information relating to their medicines, what to do if the asthma gets worse or in an asthma attack, the triggers and how to avoid them, and when a review is needed. Asthma UK has free downloadable plans for children under 12, as well as asthma action plans for adults and children over 12.