The Potential Role of Local Pharmacies to Assess Asthma Control: an Italian Cross-sectional Study

Abstract

Background. Asthma control and monitoring still represents a challenge worldwide. Although the international guidelines suggest the interplay with primary care as an effective strategy to control the disease, community pharmacies’ are seldom involved in asthma control assessment. The present cross-sectional study aimed at providing a picture of the relationship between asthma severity and control in community pharmacies of the health district of the city of Verona (Veneto Region, North-Eastern Italy).Methods. A call for participation was launched through the Pharmacists’ Association of Verona. Patients referring to the participating pharmacies with an anti-asthmatic drug medical prescription and an asthma exemption code were asked to complete the Asthma Control Test (ACT) and a brief questionnaire collecting information on their age, sex, smoking status, aerobic physical exercise and usual asthma therapy, which also defined asthma severity. A multinomial logistic regression model was fitted to investigate the risk of uncontrolled as well as poorly controlled vs. controlled asthma (base). Results were expressed as relative risk ratios (RRR) with 95% confidence interval (95%CI).Results. 57 community pharmacies accepted to participate and 584 asthmatic patients (54% females; mean-age: 51 ± 19 years) were consecutively recruited from 1st January to 30th June 2018 (6 months). Based upon ACT score 50.5% patients had a controlled asthma, 22.3% a poorly controlled and 27.2% uncontrolled. A variable proportion of patients with uncontrolled asthma were observed for every level of severity, although more frequently with mild persistent form of asthma. Most patients (92%) reported regular compliance with therapy. At multinomial regression analysis, patients under regular asthma treatment course (RRR=0.33; 95%CI: 0.15; 0.77) were less likely to have an ACT<16 compared to those not taking medications regularly.Conclusions. Overall, our findings highlighted an unsatisfactory asthma control in the general population, independently of the severity level of the disease. Community pharmacies could be a useful frontline interface between patients and the health care services, supporting an effective asthma management plan, from disease assessment and monitoring treatment compliance to referral of patients to specialist medical consultancies.

Uncontrolled Asthma: Unmet Needs in the Management of Patients

“…Together with ERs, community pharmacies also represent a first-line health care service, which seems to be more easily accessed by asthmatics when compared to respiratory medicine specialists or general practitioners. 1 , 35 , 36 Patients easily refer to the pharmacy to get reliever medications or inhaled drugs in general and bypass the medical follow-up visit. However, a recent large study including community pharmacies confirmed that non-optimal asthma control was more frequent among patients with mild-to-moderate asthma and that low treatment adherence was the only determinant of poorly controlled asthma.…”

“…However, a recent large study including community pharmacies confirmed that non-optimal asthma control was more frequent among patients with mild-to-moderate asthma and that low treatment adherence was the only determinant of poorly controlled asthma. 36 …”

“… 35 As they are much more accessible for the patient compared with outpatient clinics, they can be involved in different activities including asthma control assessment, educational interventions or counselling. 1 , 35 , 36 …”