The Pharmaceutical Journal
Vol 280 No 7493 p308
15 March 2008

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• Category M medicines
• Community pharmacy (3)
• Primary care contracts
• 100-hour pharmacies
• PCT commissioning
• Prescription charges
• Medicines use reviews
• Dispensing
• Minor ailment scheme
• Adverse drug reactions
• Asthma management (2)
• Non-practising status
• The Society

Letters to the Editor

Asthma management

Is the proposed strategy smart?

From Mr J. Knowles, MRPharmS

Anna Murphy provided a useful update on asthma management (PJ, 8 March 2008, pp283–6), but pharmacists need to consider whether the so called “SMART strategy” is consistent with the principles of current guidelines.

The maximum dose of inhaled steroid in adults with persistently poor control is 2,000µg per day of beclometasone equivalent according to the British Thoracic Society/Scottish Intercollegiate Guidelines Network. Patients using the “SMART strategy” could legitimately use 2,400µg of budesonide, putting them at increased risk of steroid adverse effects.

I would suggest that until this AstraZeneca marketing strategy has been properly evaluated by SIGN or the National Institute for Health and Clinical Excellence, pharmacists continue to follow the evidence-based guidelines.

John Knowles
Lichfield, Staffordshire

Monitor inhaler technique

From Mr M. A. Charvonia, MRPharmS

Like Perry Melnick (PJ, 8 March 2008, p281), I found asthma problems an excellent focus for medicines use reviews, as poor inhaler technique is one of the biggest barriers to good control. Pharmacists are in a unique position to help people with asthma understand the differences between the myriad of different devices and how to use them correctly.

Breath-activated devices only solve the problem of co-ordination. Although this is a common problem there are many others, such as not shaking first, not holding the device correctly, not breathing in at the optimal rate, not holding the puff in for long enough and not washing the device frequently.

The last is rarely mentioned, but in my experience a CFC-free salbutamol inhaler clogs rapidly if not washed frequently and well before it stops completely, it is not giving a full dose. Patients using their inhaler daily probably need to wash it at least twice a week.

Michael Charvonia
London

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