The Pharmacist’s Role in Aiding Patients With Asthma and Allergies

In 1984, the Asthma and Allergy Foundation of America (AAFA) declared May to be National Asthma and Allergy Awareness Month because it is peak season for individuals with these conditions. More than 25 million Americans suffer from these conditions, making them some of the most common chronic diseases.^1,2

Despite the availability of effective therapies, there are significant challenges for adequate management of these disease states, indicating a need for improved treatment approaches. Pharmacists in all health care settings are in a unique position to improve management and outcomes of these individuals through addressing patient-related factors, participating in continuing education programs, delivering education/counseling, and providing OTC medication recommendations.

Pharmacists are often the first point of contact with a health care provider in community settings and their ability to provide direct patient care activities make their role crucial in improving clinical outcomes. The most commonly reported patient-related factors associated with poor asthma control are a lack of adherence to treatment and poor inhaler technique.³

Pharmacists can address this by assessing inhaler technique at every refill, which is likely more frequent than the patient’s follow-up with their prescriber—as well stress the importance of adherence—and work with the patient to tackle any barriers they are experiencing. In the inpatient setting, pharmacists can address these factors with a focus on ensuring that patients have their medications at discharge and are ideally set up for successful management following an exacerbation.

In all health care settings, pharmacists can address elements that affect asthma control, such as minimizing trigger exposure (allergens and cigarette smoke), optimizing management of comorbid conditions, and increasing physical activity. For example, the rate of depression and anxiety is high in patients with asthma; pharmacists should be aware of this correlation and increase their screening for these conditions in this patient population.³

It is important to note that providing individuals with tailored education and counseling can overcome barriers of low literacy and result in the improvement of asthma self-management. One of the earliest illustrations of this was demonstrated in The Asheville Project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma (DOI: 10.1331/154434506776180658) that regular long-term follow-up by pharmacists using scheduled consultation, monitoring, and recommendations to prescribers led to sustained improvement (up to 5 years) in all objective and subjective measures of asthma control.⁴

There are many resources pharmacists can take advantage of to enhance counseling sessions. These include using asthma education checklists and completion of certified asthma educator programs, such as those offered by the National Asthma Educator Certification Board (NAECB).^5,6

Pharmacists can aid in medication access issues by helping identify and apply for prescription assistance programs (PAPs) for low-cost or free access to asthma medications. Interestingly, telemedicine has increased in prevalence in the past 2 years, allowing for pharmacists to meet more conveniently with individual patients and/or their prescribers, provide counseling, and adjust treatment as needed, thus further increasing the accessibility of the profession to patients.

Individuals with asthma have a high likelihood of also having allergies. The pharmacist’s role in helping to manage these may overlap significantly with asthma management.⁸

As with asthma, it is imperative that counseling be conducted for the patient, family members, and other health care providers. This is particularly important in allergies, as many patients participate in self-care, potentially without a prescriber’s awareness.

Allergies such as hay fever, can typically be treated OTC with a variety of oral, nasal, and ocular. Patients may not realize that OTC medication selection should be individually optimized in the same way prescribed medications should be.

These OTC options can still pose important drug-drug or drug-disease interactions or adverse effects that can be minimized with a routine assessment. Pharmacists are also in a position to recognize when self-care is not an appropriate option for allergy management and can make appropriate referrals to the patients who trust their judgement.

Special attention should be provided to any patient requiring prescriptions in the setting of life-threatening allergies. For example, anytime an epinephrine rescue pen is dispensed, pharmacists can and should discuss proper use, trigger avoidance, and how to recognize anaphylaxis.

Ideally, these medications may be dispensed more than they are required to be administered, and repetition in these instructions is often helpful to many patients. With asthma and allergies being among the most prevalent medical conditions in the United States, it is necessary for pharmacists to continue to increase patient care activities to significantly improve clinical outcomes, adherence, health literacy, reduce hospitalizations, and decrease health care costs in their patients with these diagnoses.

This May, take some time helping your patients breathe easier.

References

1. AAFA. Asthma and Allergy Foundation of America. (n.d.). Retrieved April 9, 2022, from https://www.aafa.org/asthma-and-allergy-awareness-month/
2. Essential role of pharmacists in asthma ... - sage journals. (n.d.). Retrieved April 9, 2022, from https://journals.sagepub.com/doi/full/10.1177/0897190020927274
3. Www.ncbi.nlm.nih.gov. (n.d.). Retrieved April 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562572/bin/plantbiotechnology-38-3-21.0715a-s001.pdf
4. The Asheville Project: Long-Term Clinical, Humanistic, and Economic Outcomes of a Community-Based Medication Therapy Management Program for Asthma. Define_me. (n.d.). Retrieved April 28, 2022, from https://www.japha.org/article/S1544-3191(15)31554-5/fulltext
5. Journals-SAGEPUB-com.ezproxy3.lhl.uab.edu. (n.d.). Retrieved April 28, 2022, from https://journals-sagepub-com.ezproxy3.lhl.uab.edu/doi/pdf/10.1177/0022219411426860
6. Certified asthma educator (AE-C). Pharmacy Students. (n.d.). Retrieved April 28, 2022, from https://www.pharmacystudents.org/multidisciplinary-certification/certified-asthma-educator-ae-c
7. Pat Bass, M. D. (2020, August 11). Prescription assistance programs for asthma drugs. Verywell Health. Retrieved April 28, 2022, from https://www.verywellhealth.com/patient-assistance-program-for-asthma-medication-200788
8. Mayo Foundation for Medical Education and Research. (2021, May 14). Allergies and asthma: Double trouble. Mayo Clinic. Retrieved April 9, 2022, from https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/allergies-and-asthma/art-20047458