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 between secondary and primary care services 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 within 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 Fifty-seven 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%) self-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.

Community pharmacist counseling improves adherence and asthma control: a nationwide study

“…Appropriate use of maintenance medication is key in successful asthma management and optimal control reduces the need for reliever medication. In addition, the role of community pharmacies in supporting the asthma management plan was confirmed in a recent study [ 31 ].…”

Uncontrolled Asthma: Unmet Needs in the Management of Patients

“…[31][32][33][34] 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 The above-mentioned information suggests that first-line health care services, namely ERs and community pharmacies, in addition to GPs and specialists, should be involved in detecting asthmatic patients at risk of asthma exacerbations due to inadequate adherence to pharmacological treatment and follow-up programmes. In fact, a recent study reported that among patients admitted to the ER for an asthma attack, most were classified with white to yellow codes, according to the triage severity scoring system; 31 this suggests that those admissions were related to poorly controlled and not to truly severe asthma, and were probably preventable by simply optimizing treatment adherence and by providing patients with a personalized asthma action plan.…”

“…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 Active involvement of patients in the management of their disease plays also a pivotal role. The selection of the most appropriate treatment is for sure a doctor's decision, based on complex clinical evaluations.…”

Actualización del papel del farmacéutico comunitario en el manejo del paciente asmático

“…El ACT presenta una validación más detallada en sus puntos de corte, una puntuación de 20 o superior indica asma controlada, de 16 a 20 parcialmente controlada, e inferior a 15 un asma mal controlada. Se han reportado estudios como el de Carminati et al (17) (2021) que demuestran que el uso del ACT podría ser una herramienta muy útil para evaluar el grado de control del paciente asmático desde la farmacia comunitaria. En este estudio los 57 FC italianos participantes evaluaron el grado de control del asma de 584 pacientes, identificando las puntuaciones por debajo de 16 puntos con pacientes asmáticos que no usaban un tratamiento regular de base.…”