1 Effectiveness of Counselling for Asthmatic Children in Hospital Melaka By Ng Wang Sing Hospital Melaka

2 INTRODUCTION

3 - Paediatric asthma is a major global health problem (von Mutius 2000). - Asthma can impair the child’s ability to enjoy and participate in activities and affect sleep patterns and academic (Lenney et al. 1994). - A local study found 13.8% of primary school children in Kuala Lumpur to be asthmatic (CPG KKM ). - Many factors are involved in achieving good control of asthma. i) Non pharmacological ii) Pharmacological von Mutius E. The burden of childhood asthma. Arch Dis Child 2000;82(suppl II):ii2-ii5. Lenney W, Wils NEJ, O’Neill BA. The burden of paediatric asthma. Eur Respir Rev 1994;4:49-62.

4 - Patient might need to carry out complex medication plans, initiate home environmental changes and monitor asthma symptoms. - Patient education for asthma self- management is effective in improving asthma control (Gibbson et al. 2002). - The role of pharmacists in patient education and evaluation of therapy is taking on more relevance everyday. INTRODUCTION Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2002;CD

5 AIM & OBJECTIVES

6 AIM & OBJECTIVES AIMS To study the effectiveness of counseling by Pharmacist on Asthmatic children. OBJECTIVES -T-To determine the outcome of asthmatic children in terms of improvement in symptoms -T-To determine the improvement of inhaler technique post counselling sessions.

7 METHODOLOGY

8 - This is a prospective analytical study from June 2006 – 31 October Inclusion criteria: Children with stable and moderate asthma Age of the patient: 1 to 15 years old - Exclusion criteria: Children have illness other than asthma Newly diagnosed asthma Patients who refused to participate in this study - An oral informed consent had been obtained from care givers.

9 METHODOLOGY Interventions: Modified Asthma Control Test (ACT) questionnaires was used to measure the asthmatic control. Consists of 5 questions: 1. Limitation of physical activities due to asthma. 2. Day time asthmatic symptoms 3. Nocturnal cough 4. Frequency of using nebulizer or bronchodilator 5. Perception of parents towards the control of asthma of their children. Scores on each item can range from 1 to 5 (1: maximum impairment & 5: no impairment).

10 METHODOLOGY At admission to the programme, the questionnaire was administered by caregivers. The technique of using easyhaler of patients who were on easyhaler was assessed. The child and caregivers received an explanatory booklet during counselling session. The pharmacist and children with their parents scheduled a visit for 4 weeks and 8 weeks later. For subsequent visit, same questionnaire was administered by caregiver and technique of using easyhaler was assessed.

11 DEFINITION OF COUNSELING 1. Basic facts about asthma 2. Roles of Medications 3. Skills 4. Environmental control measure 5. When and How to take rescue action

12 METHODOLOGY Data analysis: The statistical analysis of data was done using the Statistical Package for Social Sciences for Windows (SPSS) version Comparisons of asthmatic symptoms were made between pre-intervention status (baseline) and post-intervention status (4 weeks and 8 weeks). Data was analyzed using McNemar test for repeated measures. P values of 0.05 or less were considered statistical significant.

13 ALGORITHM Identify Asthmatic patients in clinic Take patient baseline information (Questionnaire 1 given) Counselling by Pharmacist TCA first month (Questionnaire 2 given) TCA second month (Questionnaire 3 given ) Continue follow-up

14 RESULT

15 CHARACTERISTICS OF PATIENTS

16 CHARACTERISTICS OF PATIENTS Majority of patients are Malay, followed by the Indian and Chinese

17 Types of Medications

18 RESULTS: CONTROL OF ASTHMA SYMPTOMS

19 RESULTS:TECHNIQUE OF USING EASYHALER

20 DISCUSSION

21 DISCUSSION Structured counselling by pharmacist can improve the asthmatic control of some patients. Counselling may improve the awareness about asthma, inform them about medication and improve patients’ attitude. Using medicines without being aware of fundamental facts about the treatment may lead to mistakes or non-compliance. Regular and repeated guidance by pharmacists and physicians is important to be ensure patient is coping with treatment (Närhi et al. 2001). Närhi U, Airaksinen M, Tanskanen P, Enlund H. The effects of a pharmacy-based intervention on the knowledge and attitudes of asthma patients. Patient Educ Couns 2001;43:

22 DISCUSSION The pharmacists identified any drug therapy problems. The pharmacist gave recommendations about the correct use of inhalers and reinforced the indications of medicines. The education and intervention seem to be important because patient and caregivers often ignore or fail to remember instruction given by physician.

23 LIMITATIONS Small convenience sample with no control group limits generalization and interpretation of the results. Asthma control was reported by care givers but not patient themselves. Selection bias

24 CONCLUSION Proper counseling helps to achieve good control of disease in asthmatic children. It is useful in clarifying many myths and mistaken concepts about drug therapy and disease.

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