Breathless

1. Breathless Pharmacy technician roles in helping clients with respiratory conditions

2. Disclaimer • The views I am presenting today are my own from my experience and references I am able to supply to you if you are interested. They do not reflect the opinions of the Calgary Health Region and I do not work for the region or AHS. • I have accepted funding for speaking many times from different pharmaceutical manufacturers and organizations including, AstraZeneca, GSK, Nycomed, Anaphylaxis Canada and Pfizer

3. Common respiratory conditions • Asthma and allergies • Chronic Obstructive Pulmonary Disease • Croup, RSV, Infectious disease • Sleep apnea • Smoking

4. Medications are a mainstay • Antibiotics for infections • Inhalers for symptoms and prevention • Devices used for inhaled medications • Over the counter treatment • Information on self care • Medication reconciliation role of technicians

5. Anatomy of the respiratory system • The trouble all begins at the nose • Sinuses add to the mix • Move on down to the throat, larynx • Lungs and airways • Branching off to alveoli • Problems can occur at all levels

6. Physiology • We breathe in through the nose, which warms, humidifies and cleans the air. • Once it enters the lungs the blood flowing past the alveoli through the capillaries take the oxygen out of the air and dump the carbon dioxide into the lungs to be blown off as we breathe out.

7. How common are respiratory diseases in the general population? • Asthma is likely present in about 5 per cent of the population making it the most common chronic disease, it affects children and adults. • COPD incidence is rising dramatically , especially among women. • Allergies (allergic rhinitis especially) which can affect breathing are one of the most common causes of visits to MD

8. Why is pharmacy important to respiratory conditions? • Every person in Canada who has a respiratory condition, like asthma, will see pharmacy staff. • They are getting prescriptions filled or are looking for help in the OTC section for cough, allergies, chest congestion (phlegm or mucus) • They are looking for smoking cessation aids • They are looking for allergy treatments • They are looking for sleep aids

9. How can pharmacy staff help? • Be able to recognize people who have these conditions. • Know the treatments and how to use them • Recognize problems in use of medications either on the medication profile or in talking with clients about questions they have . • Some studies estimate that up to 80% of people are using metered dose inhalers incorrectly.

10. Whose problem is it to ensure correct use of medications? • This is a real team effort which starts with correct diagnosis by physician who orders treatment or further tests • The pharmacy staff can ensure safe and effective medication use while filling prescriptions, labeling, dispensing, educating clients and families on use of medication • Technicians need to know how devices work and what is appropriate for labeling

11. PROFILES---Use them • Information on profile must be correct so that it is loaded to electronic health records correctly. Include demographic info • Discuss with pharmacist if a person is asking for large amounts of medications. If they take too many short acting relievers, there is a problem. • Look back ---way back on profiles to see if there is medications indicating chronic conditions which are not being filled and make pharmacist aware.

12. Hands on is best for client • Make sure you have placebo devices for the pharmacist to demonstrate proper technique and to assess if clients are using it properly. • You can answer question about use and demonstrate in response to questions, but the pharmacist must go over the whole thing with clients. • Technicians are so important at starting the dialogue with clients about device technique

13. Demonstration needs • Placebo • Print handouts • Local resources • Online resources • Pharmaceutical industry resources • Check the dates on your print material • Order more and contact representatives of manufacturers to get placebo devices if needed at your location

14. Inhaled medications for asthma • SABA-Short acting bronchodilators • Name 3 of them • LABA -Long acting bronchodilators • Name 2 of them

15. Inhaled medications continued • Preventers • Name 4 of them • Combination medications • Name 2 • Add on medications • Case D Foot pro athlete

16. Inhaled medications for COPD • Short acting bronchodilators • Name 2 classes • Long acting bronchodilators • As for asthma and ? ?? • When to use combination inhalers • Case P Zoski

17. What are problems our clients encounter with these medications • TOP 10 Problems with respiratory meds

18. Demonstration of devices • MDI alone • and with chamber • Diskus • Turbuhaler • Suspension vs solution

19. Difference between asthma and COPD • How do we know if someone has asthma or COPD? • What is an exacerbation? How is it different for the 2 conditions? • What should be done for each? • The role of the action plan for patient and pharmacy staff

20. Extra products we can carry • Sinus nasal rinses and drops • Nasal aspirator • Nasal lubricant gels and sprays for allergies and dry nasal membranes due to oxygen or CPAP • Oral moisturizers for dry mouth due to medications • And>>>>

21. Prevention- don’t just push drugs • Fortunately asthma deaths are decreasing. • Unfortunately COPD incidence is increasing • Lung Cancer is increasing • What triggers aggravate these conditions? • What is number one preventable health condition, the fifth vital sign. How does your pharmacy deal with it?

22. Prevention- Vaccinations • Know where local public health clinics are • Help pharmacists who can immunize to have supplies and information to allow smooth efficient workflow • Proper storage. • Accessing provincial supplies • Immunization records

23. Resources – Don’t just push drugs • www.anaphylaxis.ca (Allergic Living magazine) • www.lung.ca • www.calgaryhealthregion.ca/ican has animated story for prereaders, forms for parents and teachers, games for kids and demos of device use. • www.asthmainschools.com