Pharmacists play a critical role in the improvement of medication adherence and self-management, particularly in the asthma space. Improper use and understanding of these medications may result in poorly controlled asthma, emergency room visits, or hospitalizations for younger children who have asthma. The use of color-coded labels to help patients differentiate between rescue and maintenance inhalers have not been explored; therefore, authors of a study published in PEC Innovation aimed to assess feasibility of labeling asthma inhaler medications at both local and regional pharmacies.
The procedures for labeling asthma inhalers were reviewed by the applicable pharmacy review boards of coalition partners prior to the participation of labeling efforts. Twenty-five pharmacies voluntarily participated in the coalition, but they did not receive any financial incentives other than supplies needed for coalition (eg, labels, educational materials, posters) that were provided free of charge. The labeling efforts of the community pharmacy asthma coalition were implemented over a 2-year period (2019 to 2020), with the coalition being disbanded in early 2021 because of the COVID-19 pandemic.
Pharmacies that participated were able to either develop their own labeling systems or utilize the medication-specific labeling suggested by the coalition. Two types of color-coded stickers with the goal of improving asthma self-management education were used, including a red sticker labeled “RESCUE” for all short-acting β-2 agonists medication inhalers and a green sticker labeled “USE EVERY DAY” for all inhaled corticosteroids (ICS) and combination ICS/long-acting β-2 agonist medication inhalers designated as controllers. The colors and text for each label were chosen using the collaborative inputs from pharmacists, physicians, and consensus from coalition members. Additionally, pharmacists placed the labels directly on each inhaler, and if a patient wanted an unlabeled inhaler, pharmacies were instructed to attach a color label to the inhaler box.
Each participating pharmacy was sent quarterly surveys that included questions on pharmacy asthma self-management education and inhaler labeling process measures, such as the number of written asthma action plans (AAPs) provided, number of controller and rescue medications labeled, as well as the number of unique patients helped by the pharmacy, delineated by age (children: 0-17 years; adults: ≥18 years). Additionally, surveys also included 2 qualitative questions that requested feedback from pharmacy customers and staff (“Please describe the patient compliments, suggestions, or success stories in more detail,” and “Do the pharmacists or staff at your location have any suggestions to improve this program?”).
According to the investigators, over 6000 rescue and 9000 controller medications were labeled. The findings demonstrated an increase in both the number of controllers and rescue inhalers labeled in quarters 1 and 2 of 2019, with a gap in reported data in quarters 3 and 4 of the same year. Additionally, coalition labeling efforts decreased significantly through 2020 because of the COVID-19 pandemic.
Key Takeaways
- Pharmacist-Driven Labeling Initiatives Improve Asthma Self-Management: A community pharmacy coalition successfully implemented a color-coded labeling system for asthma inhalers, enhancing patient education and self-management, particularly in differentiating between rescue and maintenance medications. Red labels marked “RESCUE” were used for short-acting β-2 agonists, while green labels marked “USE EVERY DAY” were applied to inhaled corticosteroids (ICS) and combination ICS/long-acting β-2 agonists.
- Critical Role of Pharmacists in Asthma Management: Pharmacists played a vital role in improving asthma medication adherence and self-management by providing asthma action plans (AAPs) and labeling inhalers. The study highlighted the importance of pharmacists in community settings, suggesting that financial incentives and collaborative efforts with health care providers could further enhance these services, notably in pediatric populations.
- Study Limitations and Future Research Directions: The study faced limitations, including inconsistent project coordination, incomplete data collection, and the impact of the COVID-19 pandemic. Future research should focus on expanding the participation of pharmacies, educating pharmacists on single maintenance and reliever therapy, and evaluating the impact of color-coded labels on asthma outcomes such as emergency room visits, hospitalizations, and school absenteeism.
The study’s main goal, according to the authors, was to improve select process measures, provide asthma self-management education. and labeling of inhalers, not to assess outcome measures (eg, improved quality of life, emergency room visits, asthma-related hospitalizations). Further, they note that the study demonstrated feasibility and challenges of creating and sustaining a pharmacy coalition to improve the self-management education and inhaler labeling services for patients who have asthma. Additionally, the initiative was primarily intended to target the pediatric population, but the pharmacies that participated served a greater number of adults than children. Additionally, they note that the survey did not delineate the age distribution of adult patients; therefore, there was no determined percentage of younger adult participants (aged 18 to 21 years) with asthma.
The pharmacist plays a key role in providing self-management education for patients who have asthma, which was demonstrated by the number of written AAPs provided as well as the number of inhalers labeled during the 2-year study. Additionally, health care providers should be aware of any potential financial incentives for pharmacists that may facilitate collaborative efforts to help improve asthma self-management education services in community pharmacy settings. Further, pharmacists might be interested in promoting services that deliver value to patients, such as pharmacist billing for medication therapy management. These services can be further enhanced through collaborative efforts with pediatricians and other prescribers.
According to the authors, study limitations include the inconsistent project coordination over the 2-year duration and the transitioned role of coalition coordinator throughout the study. In addition, several coalition participants did not provide data, and the extent of those labeling efforts were uncertain. There were also inconsistent reports from pharmacies, despite frequent requests from the data collection team via phone calls and email. Further, it is unknown whether each patient filled their prescriptions at more than 1 pharmacy, potentially resulting in either multiple written AAPs being provided by more than 1 pharmacy location or multiple AAPS that contain different instructions. The COVID-19 pandemic also impacted the study.
The investigators note that future research should be conducted and include expanding participation with additional pharmacies within the region. Additionally, this research should also educate pharmacists on single maintenance and reliever therapy, and ensure that pharmacy-provided written AAPs are reviewed by the patients’ primary care providers. Lastly, the impact of color-coded asthma medication labels on asthma outcomes—such as school absenteeism, emergency room visits, and hospitalization rates—should also be evaluated.
Reference
Dikranian LC, Irish DE, Shanley KE, Walker DR, de Waal Malefyt SK. Improving asthma self-management education through inhaler labeling. PEC Innovation. 2024:100330. doi:10.1016/j.pecinn.2024.100330
