Asthma & MURs

In the world of treatment often it is the most simple that is overlooked. Doctors fulfil their difficult duty of diagnosing the patient and scheduling treatment but then the rest is left for the patient to manage themselves. At least that’s a common belief shared amongst many nowadays. I am here as pharmacy specialist to tell you that is not the case.

The UK guidelines set 70% of pharmacy MURs to be conducted on high risk groups this includes those recently discharged from hospital, those on high risk medications ( such as anticoagulants), those on four cardiovascular medications and finally those on at least two respiratory condition management medicines.

But before I explain to you the significant role they carry, what is an MUR?

A Medicines Use Review is a free NHS service offered by UK pharmacies. Anytime, as you collect you prescription, you can request for an appointment with a local pharmacist in a private consultation room. This appointment is designed to address a number of issues. How you are finding your medicines, do you understand how to use them and why they have been prescribed, as well as if you are satisfied with your current treatment. At the end of the consultation a set of adjustments may be agreed upon in form of an action plan to resolve any issues, such as adherence to medications, change of dose, form, strength or type, or even arranging targets to alter lifestyle choices. With your consent, a copy would be sent to the GP and any other health professionals, updating their medical records.

Now back to why I feel MURs play a fundamental role in asthma treatment.

Asthma for many is a chronic condition which requires careful management. It is also at times unpredictable, with new triggers leading to exacerbations which call for adjustments in current set dose regimens. Professionals are there to support those with these conditions, so they are not alone in their daily struggle.

This is where MURs come in, allowing asthma to be crucially maintained in follow ups. Unfortunately, despite the high calibre and knowledgeable pharmacists in this country possesses, many fail to connect to effectively deliver advice to the patient. When sitting in the consultation room, it is easy to turn the appointment into a tick box exercise, but did the patient understand everything you explained. Many when faced with the question “do you need me to go over anything? Or “do you have any questions” although seemingly innocuous questions may seem intimidated when confronted with it, the easiest way to opt out is to just say “yes”. This is probably why it is the most common answer. Change the question to “so can you please recap on our targets, so I can see that you understand” and it will give you a better view into what the patient is thinking.

And it has been found that over 70% were not fully aware how to use their inhalers. This statistic at first glance had quite truly baffled me. It shocked me so, that I shared the news with my family members, to which my sister admitted that when she was given her first brown inhaler she too was not given the clear purpose of it, “merely that it should help.”

Well, for those out there who have also been a victim of poor communication I will explain. The blue inhaler is a short acting B2 agonist ( salbutamol or its brand name ventolin) which is the reliever  for immediate use during exacerbations. In the case of an attack you should be told to use it every 5 minutes for 30 minutes whilst someone or you call for help.

The second in a brown inhaler (Beclomethasone dipropionate, corticosteroid) needs to be used twice a day. It is the preventer and used for maintenance, it stops asthma attack which may in essence cause damage to the fragile lung tissue. Key counselling points that you should have received is that it is vital that it is taken not ONCE but TWICE, giving you that crucial 24 hour dosing coverage. A great way to ensure dosing fits around you daily routing is that you can choose to take it before brushing your teeth twice a day. Not only will that prevent you missing doses, but it also reduces the chances of developing oral thrush of throat conditions side-effect associated with taking the corticosteroid, Beclomethasone.

The third inhaler is a green inhaler long acting B2 agonist ( salmeterol) and is prescribed usually to better manage the asthma condition. It is usually found that sufferers reach optimal management of their condition by using this inhaler in combination with the other two. Although this may seem a daunting prospect and cumbersome to adhere to dosing with three different inhalers, when the asthma condition is not managed with two inhalers a step up is required. Some may suggest increasing the strength of the corticosteroid, brown inhaler but this would increase the risk of developing at times painful oral thrush which would have subsequent impact on treatment compliance. So to prevent the patient from withdrawing from his medication all together which is likely to be the case if they develop side effects, instead the third inhaler is prescribed.

Hopefully that gave a general insight into Asthma treatment and answered some questions with regards to why MURs can be very useful tools in the management of this chronic condition.  A tacit nod from our patients is not enough to show understanding, and if there was ever a case where our communication skills would prove invaluable allowing us to surpass our potential successor, the robot, it would be here. The hallmarks of the condition of it being unpredictable with many triggers require counselling and careful consideration of all alternatives and taking into account side-effects. Finally we must approach each patient as individuals with a case by case mindset instead.