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Retail Therapy
Asthma is a common lung disease that affects one in seven children and one in nine adults in New Zealand. Despite advances in asthma management, large numbers of people are hospitalised every year, some with potentially life-threatening attacks. Disturbingly, a huge inequality still exists in hospital admissions for asthma based on ethnic group and socioeconomic status. Maori are 3.4 times more likely, and Pacific Island peoples 3.9 times more likely, than other New Zealanders to be hospitalised. People living in deprived neighbourhoods have hospital admission rates 3.7 times higher than wealthier New Zealanders. Many of these admissions could potentially be prevented with better education, community support and access to treatments.1,2 Over a half-million people in New Zealand take medication for asthma, which means that, on average, each pharmacy in New Zealand has almost 500 customers with asthma.2 If you are working on the shop floor, it is important to have at least a basic understanding of asthma symptoms, triggers and treatment, so you know what symptoms to look for and which customers to refer to your pharmacist, even when they have come into your pharmacy for unrelated matters.
Asthma affects the airways in the lungs (the trachea, bronchi and bronchioles). These airways are lined with a mucous membrane that secretes mucus and other fluids to wash away any dirt or microbes that enter during a breath. The outside of the airways is surrounded by bands of involuntary (not under our control) muscles that spend most of their time in a relaxed, loose state in people without airways disease. Three major changes happen in people with asthma:3"5
A low-grade inflammation is always present in people with asthma but this can worsen if a person encounters an asthma "trigger", such as pollen, smoke, animal dander, house dust mites, or the cold or flu virus. In addition, bronchoconstriction and excess mucus secretion may also occur.
All result in airway narrowing and symptoms of asthma. While the exact cause of asthma is not known, genetics, allergies, early childhood respiratory infections and the environment are all thought to play a role.3,4,5 People with well-controlled asthma have few, if any, symptoms to report. People who have been exposed to asthma triggers and now have an asthma flare-up or "attack" may describe a tightness in their chest, shortness of breath, difficulty speaking or a cough. Wheezing may or may not be present or mentioned. If you know your customer has asthma, pay attention to the way they look, breathe and talk, every time they come into your pharmacy. Encourage anybody you think looks in poor health to talk with your pharmacist as lung function can quickly deteriorate in people with asthma. If somebody appears blue around the lips or has collapsed and is having difficulty breathing, follow the recommendations outlined in the "Asthma and COP There are three main types of asthma medications: relievers, preventers and long-acting bronchodilators. Most are taken by inhalation. You should familiarise yourself with the different inhalers available, and ask your pharmacist to show you how to use each one, in case you need to show a customer. Some customers may benefit from using a spacer (which is a plastic tube that eliminates the need for coordinated metered dose inhaler [MDI] activation and inhalation).4 Relievers contain either salbutamol or terbutaline which are short-acting bronchodilators that open the airways. These mainly act on beta-2 receptors in the muscle bands surrounding the airways, relaxing and widening them, allowing more oxygen to enter the lungs. They act within minutes and are taken when needed to ease symptoms.4,7,8 The most common preventers contain corticosteroids such as beclomethasone, budesonide or fluticasone, and these suppress the inflammation that is constantly present in the airways of people with asthma. Non-corticosteroid preventers include nedocromil and sodium cromoglycate.
Not everybody is prescribed a preventer; people with very mild or exercise-induced asthma may not need one. However, if they are prescribed, they should be taken every day, regardless of how well the person feels.4,7,8 Long-acting bronchodilators work in a similar way to relievers, but their effects last for up to 12 hours. Some take almost 15 minutes to start working and they are not recommended for acute asthma symptoms. Eformoterol, indacaterol, and salmeterol are all long-acting bronchodilators, and most are available in combination with a corticosteroid.4,7,8 Remind your customers:
® References
In this article, Sue Frankland looks at the global problem of wastage of medications, including causes such as overprescribing and non-adherence. She also presents information from her master’s dissertation on how people understand, and respond to, medication expiration dates
