More than one million people are overusing their reliever inhalers with those in the poorest communities most likely to miss out on getting the support they need to manage their asthma effectively, says Dr Andy Whittamore, who is clinical lead at Asthma + Lung UK

Key facts:

• Asthma affects around 5.4 million people
• About half of these have asthma that is poorly controlled – more than 1 million patients overuse reliever inhalers
• The UK has one of the worst asthma death rates in Europe.

People with asthma should be managing their condition by using their preventer medication every day, to help reduce inflammation in the airways and prevent asthma attacks.

By contrast, reliever medication should only be needed to treat occasional symptoms and asthma attacks... but this is simply not happening.

Research by Asthma + Lung UK shows that more than one million people are overusing their reliever inhalers, using more than six full inhalers a year. Someone with well controlled asthma will need fewer than two reliever inhalers a year.

Overusing reliever inhalers can be dangerous, because, unlike preventers, they treat the symptoms and not the underlying inflammation that leads to symptoms and asthma attacks.

This is extremely concerning given that asthma deaths have increased by more than a quarter in the past decade. The UK now has one of the worst asthma death rates in the whole of Europe.

One of the main reasons behind this reliever inhaler overuse is that many people do not get the support they need to manage their asthma effectively.

Two in three people surveyed by Asthma + Lung UK said they didn’t think they had been given enough information to understand their condition or their treatments in the past year, while less than one in three said they had their inhaler technique checked.

Poorest missing out

Sadly, it is people in the poorest communities who are most likely to miss out. The Taskforce for Lung Health has found that people from disadvantaged backgrounds are one-and-a-half times more likely to have never had their inhaler technique checked.

This is worrying because asthma flare-ups are more prevalent among people in deprived communities as they are more likely to be exposed to causes and triggers such as smoking and air pollution.

Shockingly, a person is seven times more likely to die from a lung condition if they are from the poorest communities in the UK compared to the richest.

Community pharmacies could hold the key to tackling this appalling disparity, as we know that 99 per cent of the most deprived communities live within a 20-minute walk of a community pharmacy. 

With additional funding, these services could be a vital resource to support people with the information they need to understand their condition and take their medication effectively. 

That is why the taskforce is calling for more funding to enable community pharmacies to deliver annual inhaler technique checks.

We also want to see clearer guidelines from NICE to help support healthcare professionals to prescribe preventer inhalers.

Assessment acronym

When assessing a patient, we recommend using a helpful acronym like SIMPLES, published in the Primary Care Respiratory Journal:

• Support to stop smoking: Smoking can worsen asthma control, so ask your patient if they smoke. If the answer is yes, offer support for smoking cessation.
• Inhaler technique check: It is vital people with asthma are using their inhalers correctly and effectively, so talk through and demonstrate how a patient should use their inhaler. If they are on a metered dose inhaler, offer the patient a spacer to help them get their medicine into their lungs more effectively.
• Monitoring: Teach the patient how to monitor their symptoms by taking peak flow readings and asking themselves questions about how their symptoms are affecting their life, such as: “Is my asthma waking me up at night?” and “Is my asthma stopping me from doing anything?” If the answer is yes, then it should prompt the patient to check they are using their preventer inhaler regularly and correctly.
• Pharmacotherapy: Patients do not always take their preventer medication, so this should be checked and discussed at every review. Try to address poor adherence by adapting the medication to their lifestyle. Some patients may have better adherence with a different inhaler type, or different dosing of maintenance and reliever therapy (MART).
• Lifestyle advice: Ask questions and advise on lifestyle including diet, alcohol consumption and known triggers. It is also important to enquire into co-morbidities such as gastro- oesophageal reflux, anxiety and rhinitis.
• Education: Make sure your patient understands what they should do in an emergency and how they should be monitoring their symptoms and taking their medications day-to-day. A written asthma action plan can help with this.
• Support: Make sure you review your patient to check their asthma control has improved and that their medicines are suiting them. Ensure they know who to contact if they develop poor control again.

How often do you check inhaler technique? Tell us at pm@1530.com

References

Asthma + Lung UK April 2022 research:

• blf.org.uk/sites/default/files/Fighting%20back_V3.pdf
• blf.org.uk/support-us/campaign-with-us/our-latest-work