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Pharmacy-based asthma care success

PHARMACEUTICAL care of patients with asthma provided by local pharmacies has a clear and positive impact on patients’ asthma management and quality of life, say researchers from Germany.

Patients given pharmaceutical care over the course of one year showed significant improvements in their evening peak flow rate, inhaler technique, asthma-specific quality of life and knowledge of their condition. Only small changes in lung function were recorded: the improvement in forced expiratory volume in one second (FEV1) after six months had reverted to control level at 12 months. However, the researchers question whether morbidity could accurately be reflected by FEV1, measured only three times in one year, without considering additional factors such as the need for admission to hospital.

Patients had been allocated to either an intervention group (n=101) or a control group (n=63) spread among 48 of the 465 community pharmacies in the city of Hamburg. Up to nine meetings between patients and pharmacists were held at intervals of six weeks. Pharmacists did not follow a predefined educational program but aimed to detect and solve individual drug and health problems. For example, needs for additional drug therapy and dosage titration were considered and inhaler techniques were assessed and corrected.

Intervention pharmacists had received 13 hours of training whereas control pharmacists were only given an introduction to the study. Pharmacists joined the study on a voluntary basis and no comment is made on time or cost implications (Journal of Clinical Pharmacology 2001;41:668).

In the United Kingdom, a pilot study of community pharmacists involved in asthma care was carried out last year in the East Sussex, Brighton and Hove Health Authority by Chris Cairns, chief pharmacist, University Hospital Lewisham, and colleagues (Pharm J, 2000;265:136). Commenting on the Hamburg study and the role of the pharmacist in providing asthma care, Mr Cairns told The Journal that there was no doubt that patients benefited from pharmaceutical care and intervention. It made sense, he said, to base such care in community pharmacies as over 80 per cent of patients regularly returned to the same pharmacy each time.

However, there were some difficulties in protecting the clinical time needed for pharmacists to carry out these activities, commented Mr Cairns. The present model of pharmacy should evolve to harness this captive audience without compromising the other important services provided by pharmacists, he said.

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