1. ASTHMA COUNSELING PEARLS LAXMI KANDALAI BS PHARM, PHARM D, BCPS MEDICATION SAFETY SYMPOSIUM MAY 14, 2016

2. Disclosure  No conflicts of interest to disclose

3. OBJECTIVE  Pharmacist:  Identify gaps in asthma counseling and illustrate methods to provide a more effective outcome  Technician:  List different types of inhaler devices

4. PATIENT CASE HPI: VS is a 50 year old male who complains of daily symptoms of asthma, increase in nighttime awakenings and has been using his albuterol inhaler more frequently. He is diagnosed as having moderate persistent asthma. He is admitted for asthma exacerbation. PMH: Asthma, Hypertension SH: Smoked 2 packs per day for past 30 years Medication Regimen:Albuterol 2 puffs q6hprn wheezing Albuterol 2.5mg/3ml via nebulizer q4hprn wheezing Advair 250mcg/50mcg Diskus 1 inhalation bid Lisinopril 10mg daily Currently non-compliant of his outpatient medication regimen Today is his third day in the hospital and the pharmacist was consulted to educate the patient prior to discharge

5. Inhalers: Choice is important

6. Counseling Checklist  Rescue vs. Maintenance inhalers  Technique Technique Technique !!  Metered dose Inhaler, Dry power Inhaler and Respimat Inhaler  Cleaning of devices: inhaler/nebulizer  Use of peak flow meter  Triggers  Smoking cessation  Affordability & Access to medication – Indigent prescriptions

7. PATIENT CASE HPI: VS is a 50 year old male who complains of daily symptoms of asthma, increase in nighttime awakenings and has been using his albuterol inhaler more frequently. He is diagnosed as having moderate persistent asthma. He is admitted for asthma exacerbation. PMH: Asthma, Hypertension SH: Smoked 2 packs per day for past 30 years Medication Regimen:Albuterol 2 puffs q6hprn wheezing Albuterol 2.5mg/3ml via nebulizer q4hprn wheezing Advair 250mcg/50mcg Diskus 1 inhalation bid Lisinopril 10mg daily Currently non-compliant of his outpatient medication regimen Today is his third day in the hospital and the pharmacist was consulted to educate the patient prior to discharge

8. OPEN-ENDED QUESTIONS Examples of open ended questions:  How did the doctor tell you to take the medications?  How has your asthma interfered with your daily activities?  How can you tell if the medication is working for you?  Would you mind showing me how you use your inhaler?  What if any difficulties are you experiencing with any of the medications?  What do you do if you missed a dose?  Would you explain to me when you would seek medical assistance?  How often do you clean your inhaler/nebulizer?  How do you store your medications?

9. COUNSELING TOOLS Micromedex care notes:  http://www.micromedexsolutions.com/carenotes/librari an?navitem=topCareNotes http://www.micromedexsolutions.com/carenotes/librari an?navitem=topCareNotes Handouts:  www.nhlbi.nih.gov/files/docs/piblic/lung/asthma_tipshe ets.pdf www.nhlbi.nih.gov/files/docs/piblic/lung/asthma_tipshe ets.pdf Video:  www.cdc.gov/asthma/inhaler_video/default.htm www.cdc.gov/asthma/inhaler_video/default.htm Asthma Educational Videos on St. Joseph’s Intranet:  Inhaler/Peak flow/ Six key steps Asthma control/Trigger/Nebulizer

10. Pharmacist Question  Which of the following are important counseling tips for asthma education: A. The difference between Rescue vs. Maintenance inhalers B. Technique, Technique, Technique !! C. Triggers D. Smoking cessation E. All of the above

11. Technician Question  Which of the following is/are inhaler devices? A. Spacer B. HandiHaler C. Autohaler D. dry-powder inhalers E. B, C, D

12. REFERENCES  Borrelli B, Riekert KA, Weinstein A, Rathier L. Brief motivational interviewing as a clinical strategy to promote asthma medication adherence. J Allergy Clin Immunol. Nov 2007;120(5):1023-1030  Zanni, Guido R., “Counseling for Asthma”, Pharmacy Times, April 18,2013. Web Accessed March 28, 2016  http://www.micromedexsolutions.com/carenotes/librarian?navitem=topCareNotes Accessed March 28, 2016 http://www.micromedexsolutions.com/carenotes/librarian?navitem=topCareNotes  www.nhlbi.nih.gov/files/docs/piblic/lung/asthma_tipsheets.pdf Accessed March 30,2016 www.nhlbi.nih.gov/files/docs/piblic/lung/asthma_tipsheets.pdf  www.cdc.gov/asthma/inhaler_video/default.htm Accessed March 30,2016 www.cdc.gov/asthma/inhaler_video/default.htm  Nemire, Ruth E, and Karen L Kier. Pharmacy Student Survival Guide. New York: McGraw-Hill Medical, 2009  http://www.mckinley.illinois.edu/handouts/inhaler_use/inhaler_use.html Accessed April 7, 2016 http://www.mckinley.illinois.edu/handouts/inhaler_use/inhaler_use.html  http://www.rxlist.com/proair-drug/medication-guide.htm Accessed April 7,2016  http://ecx.images-amazon.com/images/I/21PgjSoDuHL.jpg Accessed April 7, 2016 http://ecx.images-amazon.com/images/I/21PgjSoDuHL.jpg