Pharmacist Counseling Improves Salbutamol Asthma Treatment

By educating nurses, counseling physicians, and providing feedback on inhalation technique, pharmacists can reduce issues related to salbutamol treatment for asthma and bronchitis, according to research findings published in BMC Health Services Research.

Researchers examined 225 patients with salbutamol prescriptions who had been admitted to a pediatric unit due to bronchial obstruction or asthma. Their study was comprised of 4 consecutive groups:

1) Control group, which involved routine care without additional support.

2) Counseling group, which implemented an internal guideline on appropriate salbutamol dosing and trained nurses on preventing problems in inhalation technique, while pharmacists counseled physicians on problems in salbutamol prescribing.

3) Feedback group, which added to the previous intervention a pharmacist-led feedback service for physicians on the quality of inhalation technique.

4) Follow-up group, which terminated all additional support and reverted back to routine care.

The nurses’ 60-minute education session involved reaching “best practice” in inhalation techniques. During the session, a pharmacist explained inhalation-handling guidelines and provided additional background information on clinical outcomes from inhalation technique.

For the physicians’ counseling services, pharmacists assessed salbutamol prescriptions on a daily basis and then described methods to resolve drug-related problems (DRPs). Information on each patient’s personal inhalation ability and clinical condition allowed for patient-specific recommendations on salbutamol prescribing.

The percentage of patients who experienced a DRP decreased from 55% in the control group to 43% in the counseling group. The feedback service produced an even greater reduction in the number of patients with DRPs (25%). After all additional support was terminated in the follow-up stage, the percentage of affected patients increased again to 48%.

“Implementation of a guideline and a counseling service addressing salbutamol prescription performed by a pharmacist decreased the high rate of DRPs. The breakthrough, however, was achieved by providing additional feedback to physicians addressing the inhalation technique of the patient assessed by a monitoring,” the authors wrote. “By providing a counseling service at the point of prescription based on a newly developed and implemented guideline, DRP rates and elevated doses in salbutamol prescription decreased.”

Noting that the percentage of study subjects with DRPs under routine care was alarming, the researchers concluded that salbutamol and other inhaled drugs require a pharmacist’s consideration of administration technique and appropriate dosage.