BackgroundEngagement with exercise in adults with asthma is suboptimal. Limited information is available regarding factors affecting engagement with exercise.AimTo explore experiences of exercise and linked unmet needs in adults with asthma.Design & settingQualitative thematic analysis of posts in a UK asthma online community, written between 2015 and 2020.MethodPosts were identified using keywords searches. Posts in the ‘Exercise’ topic section were additionally included. Thematic analysis of posts was undertaken.Results143 relevant posts were analysed. 92 participants were identified through posts (11M, 33F, 48 gender not stated, aged 26–73 years). Emerging themes included: fear of experiencing asthma symptoms during exercise, lack of information about how to deal with symptoms, external barriers, emotional response, and involvement of healthcare providers. Environmental factors, concomitant life stressors, distrust of healthcare professionals and embarrassment of displaying asthma symptoms during exercise were barriers to engagement. Facilitators included experiencing positive health outcomes following exercise and positive discussions regarding exercise with healthcare professionals. Strategies participants developed to enable exercise were warming up, increasing reliever and preventer inhalers when exercising and finding exercises felt as enjoyable.ConclusionFuture interventions to address fears of exercise-induced physical symptoms, and clear instructions on the use of inhalers when exercising are needed. Exploring patients’ attitudes to exercise in clinical consultations, especially in primary care, may be beneficial.

BackgroundInhaler shortages were reported in the UK following declaration of the COVID-19 pandemic, prompting advice against stockpiling.AimTo understand experiences and behaviours of patients with asthma requesting prescriptions from primary care during asthma medication shortages.Design & SettingsUK asthma online community, between March and December 2020.MethodThematic analysis of posts identified using search terms ‘shortage’, ‘out of stock’, ‘prescribe’ and ‘prescription’.Results66 participants were identified (46 adults, 2 parents of children with asthma, 18 unstated). Factors leading to increased requests included: stockpiling, early ordering, realising inhalers were out-of-date, and doctors prescribing multiple medication items. Patients’ anxieties that could lead to stockpiling included fear of asthma attacks leading to admission and acquiring COVID-19 in hospital, lack of dose counters on some inhalers, and believing a lower amount of drug is delivered in the last actuations. Strategies adopted in relation to shortages or changes in treatment due to out-of-stock medications included starting stockpiling, ordering prescriptions early, contacting medical professionals for advice or alternative prescriptions, getting ‘emergency prescriptions’, ordering online or privately, seeking medications in different pharmacies, contacting drug manufacturers and keeping track of number of doses left in canisters. We found no evidence of anxiety-triggered asthma symptoms that required medications due to fear of COVID-19. Participants seemed to disregard advice against stock-piling.ConclusionsBetter preparation is a key lesson from COVID-19. Clinicians, the pharmaceutical industry, and policy makers should use insights from this work to plan how to better manage medication shortages in future emergency situations.

Introduction Intra-detrusor Botox injections for overactive bladder has shifted to being performed under local anaesthetic rather than general anaesthetic to improve cost and efficiency. However, it may cause the patient pain and discomfort. We aim to assess the feasibility of LA Botox injections in the outpatient setting and to evaluate patient satisfaction. Method Our first cycle assessed whether patients would consider intra-detrusor Botox injections under local anaesthetic in the outpatient setting. Our services were then restructured to run LA Botox clinics. Our second cycle then assessed the patient satisfaction of these clinics using the client satisfaction questionnaire (CSQ-8) template. Results The first cycle showed that 70% (14/20) of patients would consider having outpatient Botox injections under LA. A potential annual saving of £88,434 was estimated. The second cycle showed a high patient satisfaction rate with an average CSQ-8 score of 30/32 in 16 patients who had Botox injections in the outpatient setting. 9 patients reported being “very satisfied” with our service and the remainder reported being “mostly satisfied” Conclusions LA Botox injections in the clinic setting has a high patient satisfaction rate and can provide considerable cost savings. Suitable patients should have LA intra-detrusor Botox injections in the outpatient setting where possible.