Home' Australian Pharmacist : Australian Pharmacist September 2016 Contents Australian Pharmacist September 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
1. Choose the CORRECT statement about
a) Upon actuation of a dry powder inhaler
(DPI) the propellant drives the delivery of
drug particles to the lungs.
b) Most pressurised metered dose inhalers
(pMDIs) have specific mechanisms for
loading the dose into a respirable slot.
c) Soft mist inhalers use the torque from a
mechanical screw to create a fine mist.
d) The Turbuhaler device must be held
horizontal when loading.
2. Research has indicated that the time
period after which inhaler technique
should be re-assessed is:
a) 2–3 months.
b) 6 months.
c) 12 months.
d) 24 months.
3. Breath hold after inhaler use is
recommended for almost all inhaler
devices. The purpose of the breath
hold is that it:
a) Allows the drug to act faster.
b) Allows the drug to be cleared from the
c) Prevents exhalation of extra fine particles
d) Prevents the drug from diffusing into
lower lung areas.
4. The best way of engaging patients
at the counter to discuss inhaler
a) Telling them that you doubt they use
their inhaler well.
b) Allowing them to gauge whether they derive
the maximal benefit from their inhaler.
c) Simply asking how they are going with
d) Telling them inhaler technique is a very
difficult skill to learn.
In conclusion, appropriate inhaler
technique underpins successful asthma
symptom control. However, a majority of
patients do not use their inhalers correctly.
Community pharmacy is a strategic
venue to engage patients in dialogue and
demonstration regarding their inhaler
technique and use. Just verbal questioning
is not adequate. Patients should be
encouraged to show their inhaler technique,
and correct technique tailored to their
specific device should be demonstrated live
by the counselling pharmacist.
After correct demonstration patients need
to re-demonstrate their inhaler use until
they can correctly demonstrate all steps.
This process needs to occur frequently rather
than being a one-off.
At-risk patients should be proactively
identified and individualised options
for improving their inhaler technique
provided. Internet platforms such as
YouTube videos can serve as patient
Pharmacies intending to provide this
service need to have a set of resources
such as placebo devices, checklists,
dexterity aids, information sheets, and
age who are prescribed/dispensed pMDIs
should use a spacer along with a mask.
Older children can use a spacer with
their pMDI without the need for a mask.
Personalising the device (e.g. with stickers)
may engage children with the treatment.
Dexterity aids such as the Haleraid for pMDI
and a base grip for the Turbuhalers may be
available from manufacturers. Other factors
to consider may be patient preference.
Patients may prefer a particular device; this
can be elicited at the counselling session and
a recommendation made to the prescriber.
In the case of inhalers containing Pharmacist
Only medicines (e.g. salbutamol), the
Pharmacy Board of Australia Guidelines on
practice-specific issues reminds pharmacists
that particular statutory obligations relating
to the supply of Pharmacist Only medicines
must be observed. The pharmacist must be
satisfied that there is a therapeutic need.
This means more than agreeing to supply
the medicine on request, or merely asking
patients if they have used the medicine
previously and know how to use it.
The Board also has regard to the Standards
for the Provision of Pharmacy Medicines and
Pharmacist Only Medicines in Community
Pharmacy (produced by PSA) and
any substance-specific protocols and
quality-assurance standards. For example,
the section titled Assess and demonstrate
technique in the PSA Guidance for the
provision of a Pharmacist Only medicine –
short-acting beta-agonists (salbutamol and
terbutaline), in the Australian Pharmaceutical
Formulary and Handbook (APF23).
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theory to practice. Respir Med 2013;107:495–502.
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and particle engineering in dry powder inhalation technology.
Curr Top Med Chem 2016;16(18):1990–2008.
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between leadership style and provision of the first Danish
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14. National Asthma Council Australia. Information paper for health
professionals. Inhaler technique for people with asthma and
COPD. At: www.nationalasthma.org.au/living-with-asthma/
15. Kaae S1, Nørgaard LS. How to engage experienced medicine
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16. Pharmacy Board of Australia. Guidelines on practice-specific issues.
2015. At: www.pharmacyboard.gov.au/Codes-Guidelines.aspx
17. Guidance for the provision of a Pharmacist Only medicine
– short-acting beta-agonists (salbutamol and terbutaline).
In: Sansom LN, ed. Australian pharmaceutical formulary and
handbook. 23rd edn. Canberra: PSA; 2015.
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