RightBreathe to help with inhaler prescribing and technique

Transcription

1 RightBreathe to help with inhaler prescribing and technique Dr Azhar Saleem GP Respiratory Lead, Lambeth CCG GP Specialist NHS London Procurement Partnership Clinical Lead RightBreathe

2 Declarations for Azhar Saleem Research Support/P.I. Employee Consultant Major Stockholder Speakers Bureau Honoraria Scientific Advisory Board Astra Zeneca, Boehringer Ingelheim, Pfizer, Chiesi, NAPP, TEVA No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare TEVA, Pfizer, Astra Zeneca, MEDA, NAPP, Sandoz Boehringer Ingelheim

3 Inhaler costs to England 50.00m 45.00m 40.00m 35.00m Monthly cost of inhalers in England 74m per month 30.00m 25.00m 20.00m 15.00m 10.00m 5.00m.00m LABA ICS LAMA LAMA LABA LABA ICS SABA NHS Business Services Authority, Prescription Cost Analysis, Feb 2017

4 Inhaler costs to England m m m Annualised cost of inhalers in England 883m per year m m m m m.00m 77.74m 57.83m 17.30m 23.70m LABA ICS LAMA LAMA LABA LABA ICS SABA NHS Business Services Authority, Prescription Cost Analysis, Feb 2017

5 Asthma treatment BTS SIGN guideline for Asthma 2016

6 Lots of inhalers How many inhalers in total are there on the UK market? How many unique inhaled devices are available to prescribe? Source: rightbreathe.com

7 Memorise how all 17 devices are used

8 Odds ratio Association between Healthcare Resource Use and just one Critical Inhaler Error Hospital admissions Emergency department visits Antimicrobic courses Corticosteroid courses Melani AS, et al. Respiratory Medicine 2011;105:

9 Odds ratio Association between Disease Control and just one Critical Inhaler Error Limited everyday life due to respiratory symptoms Frequency of shortness of breath Use of rescue inhaler Respiratory disease control Sleep disturbance due to respiratory symptoms Melani AS, et al. Respiratory Medicine 2011;105:

10 What would help? Which inhaler for which patient? ADMIT recommends dissemination of information on the correct inhalation technique for each model of device by the use of an accessible dedicated literature base or website... There is also a need for standardisation of prescribing practices throughout Europe. Regular checking of inhalation technique by prescribers is crucial as correct inhalation is one of the keystones of successful Asthma [and COPD] management. Crompton GK et al. Respir Med, 2006

11 Inhaler standards No inhaler should be prescribed without knowing that the person receiving it can use it. This may involve watching, instructing, reinforcing and repeating. It should be agreed who is undertaking the role Initiating inhaler therapy: the healthcare professional must be able to demonstrate device technique correctly and clearly to the patient and/or carers. Repeat prescriptions: the prescriber must be confident that an appropriate assessment of continued need and ability to use has been made. UK Inhaler Group. Inhaler standards and competency document. 2016

12 Four-step plan to improve inhaler technique Check Use an technique at effective mode Choose the every of training most suitable opportunity physical device for the everyone in demonstration individual respiratory better than patient care is written responsible! instruction Inhaler skills training must be repeated for both patients and healthcare professionals Various resources such as apps, websites and other smartphone resources can help with teaching correct inhaler technique Price D. Expert Review Available at:

13 Written instructions alone are not enough 7 steps to get the correct inhaler technique for a pmdi 1. Take off the cap and shake the inhaler 2. Breathe out gently 3. Put the mouthpiece in your mouth 4. Begin to breath in slowly and deeply 5. While breathing in, press canister and continue inhaling steadily and deeply 6. Remove the inhaler from your mouth and hold your breath for 10 seconds (or for as long as is comfortable) then breathe out gently 7. If you need a second dose, wait 30 seconds and repeat the steps above. How to use a metered dose inhaler. Asthma UK.

14 It s a challenge even with the force Image provided by speaker