And Breathe…..

1. And Breathe….. Educational solutions for the NHS pharmacy workforce

2. Why are we here?

3. Burden of asthma UK has largest prevalence of asthma in the world. There are 4.1 million adults with asthma in the UK and 1.3 million children Three people die each day from asthma, of which most are preventable 75 percent of hospital admissions for asthma are avoidable

4. Burden of COPD COPD is a leading cause of mortality and morbidity worldwide and the 5th biggest cause of death in the UK One person dies from COPD every 20 minutes in England, around 23,000 a year 15 percent of those admitted to hospital with COPD die within three months and around 25 percent die within a year of admission

5. Financial burden of respiratory disease NHS spends about £1 billion a year on prescribed respiratory medicines Cost per item is highest of all BNF categories at over £17 per item on average Only around 40 percent of asthmatics are compliant with treatment. If this doubled to 80 percent, the NHS could save £90 million per year COPD is the second most common cause of emergency admission to hospital and one of the most costly inpatient conditions to be treated by the NHS

6. Pharmacy interventions improve outcomes • Respiratory disease is an area where there is evidence that high quality pharmacy intervention can significantly affect patient outcomes • Recent evidence: • SIMPLE project • The inhaler technique improvement project

7. Learning outcomes By the end of this session you will be able to: Describe the differences between asthma and COPD and identify the signs that should alert people to the fact that their condition is not being well controlled Outline ways to improve outcomes for patients by helping them to take their medicines correctly Provide lifestyle advice to support people to manage their condition Identify useful resources available to the public and to healthcare professionals

8. COPD and asthma: the differences Small groups One envelope per group 5 minutes to identify characteristics of each disease

9. How did you do?

10. Asthma – the facts Asthma is a chronic lung condition in which the airways are inflamed and narrowed, making it harder to breathe normally The changes to the airways are fully reversible Although asthma often runs in families, many people with asthma do not have relatives with the condition. Hay fever and eczema are frequently associated with asthma – either in the person with asthma or in their family

11. COPD - The facts COPD comprises a number of respiratory diseases, predominantly chronic bronchitis and emphysema It is preventable and treatable, characterised by airflow limitation that (unlike asthma) is not fully reversible. The airflow limitation is usually progressive and not curable 90 percent of cases are caused by cigarette smoking Although COPD affects the lungs, it also produces significant systemic consequences

12. SIMPLE Stop smoking Inhaler technique Monitor control and adherence Patient education on medicines Lifestyle Education

13. Stop Smoking Stopping smoking has been shown to reduce the rate of decline on lung function so is the key message for all those with asthma or COPD, regardless of their age NICE PH45 Tobacco Harm Reduction “This guidance recommends harm reduction as an additional new option particularly for those who are highly dependent on smoking who want to quit, but can’t just stop in one go”

14. Inhaler technique Inefficient inhaler technique is a common problem resulting in poor drug delivery, decreased disease control and increased inhaler use Even with effective technique, maximum lung deposition from MDI is 15 percent Large volume spacers may be easier to use and they increase deposition to 30 percent Incorrect use is a huge cost to the NHS

15. “Can you show me how you use your inhaler?” 75 percent of patients using an inhaler for on average 2-3 years reported they were using their inhaler correctly What percentage actually were? 10 25 50 75 90 10%

16. How good is your technique? Patients’ inhaler technique can be significantly improved by brief instruction given by a trained healthcare professional What percentage of healthcare professionals who teach use can demonstrate them correctly? 9 29 59 69 79 99 9%

17. Types of inhaler • How many types of inhaler are on the market? • MDI • Slow and gentle • DPI • Fast and forceful

18. Practical support http://www.leicestershospitals.nhs.uk/professionals

19. Which inhaler is best? As healthcare professionals we consider the evidence and the costs BUT To optimise medicines use the key is the patient’s perspective Getting it right from their point of view can have a big impact on adherence and therefore the health outcomes

20. Monitoring

21. Patient education on medicines Difference between relievers and preventers Side effects Use of spacers Corticosteroids Oxygen use

22. Lifestyle What lifestyle interventions should you be discussing?

23. Lifestyle interventions Stop smoking Weight management Exercise Self management plans Trigger avoidance Vaccination Advice on heart disease, anxiety, depression for COPD Pulmonary rehabilitation

24. Prevention of exacerbations Offer annual influenza / pneumococcal vaccination Give self management advice including use of rescue treatment where appropriate Optimise bronchodilator therapy with one or more long-acting bronchodilator Add inhaled corticosteroids (as combination) Use of breathing techniques

25. Education

26. CPPE support Inhaler technique workshops Focal point : Asthma iPDF: New medicines service asthma and COPD Inhaler technique videos Coming soon: Learning@lunch: COPD Focal Point: COPD

27. In Summary Respiratory diseases place a huge burden on the NHS and the wider economy There is mounting evidence that effective pharmacy-based interventions , particularly involving inhaler technique, can have a large impact on outcomes for both patients and the NHS Pharmacy technicians are well placed to support people with these long term conditions SIMPLE!