Community pharmacies ‘hold the key’ to levelling up lung health inequalities

Respiratory experts are now calling for additional funding so pharmacies can provide life-saving support to people with asthma and COPD.

New survey finds people in England’s poorest communities are most at risk of experiencing terrifying symptoms such as struggling to breathe because they've never been shown how to use their inhaler correctly to ensure the medication reaches their lungs, according to the Taskforce for Lung Health.

More than 100,000 people die every year from lung conditions in the UK1. People in the poorest neighbourhoods are seven times more likely to die of a lung condition than those in the wealthiest and 1.5x more likely to never have had an inhaler technique check[i].

The Taskforce for Lung Health, a collaboration of over 40 different charities, organisations and patients working to improve lung health, are also calling for regular reviews with a GP to be part of the care every patient with a lung condition receives, to make sure inhaled medication is always used safely and effectively.

More than three quarters[ii] of respondents with asthma and COPD in England did not have their annual inhaler check last year despite national guidelines2 recommending a yearly review. That’s an estimated 3.3 million people missing out on learning how to use their inhalers as intended. Asthma and chronic obstructive pulmonary disease (COPD) flare ups are more prevalent within deprived communities as they are more likely to be exposed to causes and triggers such as smoking and air pollution3.

Inhalers are a life-saving treatment for asthma and COPD. Correct inhaler technique can be tricky, especially as models differ, yet only 43%[iii] of survey participants reported acknowledgment from their health care professional of correct use before the technique check was over. It is essential patients are given guidance to ensure they get the full benefit of the medication to manage their condition well and prevent it from worsening. Access to these crucial checks is likely to have been impacted by COVID-19 as all primary care services are currently experiencing backlogs, with the NHS not having enough capacity or the sufficient workforce to see and support all of the patients who need care.

Darush Attar-Zadeh, a community pharmacist and Executive Committee Member of the Primary Care Respiratory Society, a Taskforce member, said: “We know that up to 90% of people4 who use inhalers can't use them correctly so health care professionals should be taking the opportunity to teach best practice every time a patient is seen to make sure that they are getting the best from their inhalers.

“Worryingly a study found that out of 150 health care professionals5, only 7% could correctly use a meter dosed inhaler, known as a ‘puffer’, showing a real need for us to improve training around inhaler technique to confidently deliver up to date information to patients. Patient outcomes will not improve unless the practitioners themselves improve and deliver patient education.

“Good inhaler technique prevents patients needing to use higher dose inhalers, makes them less likely to be admitted to hospital due to better control of their condition and generally gives the patient a better quality of life.”

With more than 1.6 million people visiting a community pharmacy each day, pharmacists are also well placed to help patients with their inhaled medication. The Taskforce is calling for community pharmacies to be funded to provide annual inhaler technique checks to address the huge unmet need in lung disease in England.

Pharmacies also offer a convenient and less formal environment for those who cannot easily access other kinds of health service. Pharmacies need further integrating into the patient pathway to work with the rest of the NHS to reduce the existing health inequalities in lung disease.

Lottie Renwick, Vice-Chair of the Taskforce for Lung Health and Senior Policy Officer at Asthma + Lung UK said: “It is unacceptable that a significant proportion of people with asthma or COPD are not accessing the crucial care and support they need to avoid a potentially life-threatening asthma attack or exacerbation. We know that 99% of the most deprived communities live within a 20-minute walk of a community pharmacy so could hold the key to provide much needed care and reduce health inequalities by being easily accessible and highly valuable to those in these communities. Community pharmacies need to be recognised as a vital resource and used to support people living with lung conditions at a time when health services are increasingly stretched.

“Regular check-ins provide patients the opportunity to be shown the optimal delivery of their medicine and gives them the best chance of managing their condition well and avoiding flare ups or hospital admissions. With additional funding and support for community pharmacists to provide inhaler technique checks, the Taskforce sees a real opportunity to make this service more accessible and improve its uptake among people with lung disease.”

88%[iv] of the survey respondents who had an inhaler technique check said they found it helpful and as a result, 41%[v] of those receiving feedback changed the way they used their inhaler. Support in the delivery of their medication led to two thirds feeling more confident, with a clear understanding of their inhaler and having reduced exacerbations from their condition.

Yasmeen Ahmed, 25, is a nurse living and working in East London, with severe asthma: "Asthma didn’t really affect my day to day life until I was about 19. I was on a nursing shift at the hospital and started to experience increased breathlessness. I was sent home but rushed back as a patient a few hours later. This was my first asthma attack.

“I now have appointments every five to six months with an asthma nurse and consultant. Together we monitor my inhaler technique alongside my medication and review my action plan.

“I find the checks helpful because it stops any bad habits forming. I was given a spacer to use with my inhalers to increase the amount of medication directly reaching my lungs and my nurse will help me if I am using it wrong. If you breathe in too quickly you aren’t breathing in as much medicine as you should. It is really quite a skill.”

Latest annual asthma deaths data shows that 1,2806 people died from an asthma attack in 2019 and over 30,5777 were admitted to hospital for emergency treatment during 2020 to 2021.

Emma Rubach, Head of Health Advice at Asthma + Lung UK said: “Good inhaler technique, whether using a preventer or reliever inhaler, helps patients to breathe the medicine straight into their lungs, where it’s needed. When the incorrect technique is used, patients can experience uncomfortable side effects such as oral thrush as well as increase their risk of a serious asthma attack or exacerbation.

“Often, people think their inhaler technique is OK but we know common mistakes are easily made so there’s always room for improvement to ensure the most is being received from the medication.

“If you use inhaled devices, at your next annual review or appointment, ask your GP, asthma nurse or pharmacist to check your inhaler technique. In the meantime you can also check and improve your technique in just three minutes with short educational videos available on the Asthma + Lung UK website.”

Instructional videos on how to use an inhaler properly and better manage respiratory symptoms are available here: https://www.asthma.org.uk/advice/inhaler-videos/

 

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For interview requests or additional information, please contact Suzy Kennedy at 02076885571, skennedy@asthmaandlung.org.uk

Notes to editors: 

References

  1. Asthma + Lung UK. Lung conditions kill more people in the UK than anywhere in Western Europe. https://www.asthmaandlung.org.uk/lung-conditions-kill-more-people-in-the-uk-than-anywhere-in-western-europe/
  2. National Review of Asthma Deaths (NRAD). Why Asthma Kills. 2015. https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
  3. Asthma + Lung UK.  On the edge: How inequality affects people with asthma. https://www.asthma.org.uk/support-us/campaigns/publications/inequality/#:~:text=Asthma%20is%20more%20prevalent%20within,as%20smoking%20and%20air%20pollution
  4. Device errors in asthma and COPD: systematic literature review and meta-analysis. 2017. https://pubmed.ncbi.nlm.nih.gov/28373682/
  5. Do healthcare professionals have sufficient knowledge of inhaler techniques in order to educate their patients effectively in their use? 2010. https://thorax.bmj.com/content/thoraxjnl/65/Suppl_4/A117.3.full.pdf
  6. Office for National Statistics (ONS). Deaths from asthma, bronchitis, emphysema, pneumonia, and influenza from 2015 to 2019 in the UK. https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/deathsfromasthmabronchitisemphysemapneumoniaandinfluenzafrom2015to2019intheuk
  7. Inhale - Interactive Health Atlas of Lung conditions in England. Accessed 2022. https://fingertips.phe.org.uk/inhale#gid/8000003/ati/15