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Australian Journal of Pharmacy : February 2005
asthma issues relate to both the types of medica- tions and the choice of appropriate deliv- ery systems (MDI versus breath-activated devices). Patient aspects to consider when choosing a delivery system include: • strength to operate, inspiratory flow, coordination, agility; • eyesight to read labels, ability to judge status (for example red ‘empty flags’ for turbuhaler fullness), small lettering on Accuhalers, MDI fullness/gas flows; • aids to delivery of medication, for example, Haleraids, spacers; • consistency of delivery device type— where possible, don’t mix MDIs, Turbuhalers and so on; • possible confusion of the roles of medications (for example preventers, relievers and symptom controllers), reinforce which medication should be taken and when; and • an understanding of nebulisers— beware of the reliance that some elderly patients place on nebulisers, and the false sense of security they may have, so that they do not seek medical attention appropriately. Dr Yates said older people should always use metered dose inhalers with some sort of spacer device. ‘Metered dose inhalers alone in the elderly people are a waste of time,’ Dr Yates said. ‘Breath-activated devises are generally better but some have relatively low flow.’ Choosing a breath-activated device that the patient can easily identify as being empty, or one they can easily load and know they have received the medication, can be tricky, Dr Yates said. ‘These are some of the issues with these sorts of things, it is a matter of looking at them and working out which is best for the patient,’ he said. ‘For example a red line appears on Tur- buhalers when they are nearly empty and some of the disc halers can’t be rolled for- ward when they are empty. ‘The disc haler is easier from the point of view that you don’t have to hold it upright and it comes to a dead stop when it is empty whereas the Turbuhaler does- n’t,’ Dr Yates said. Attention to vaccination and immuni- sation was particularly important for the older person with asthma and/or other respiratory diseases. • Pneumococcal immunisation is recommended every five years for all people 65 years and over. • Annual influenza vaccination is recommended for all people 65 years and over. Determining severity of the problem Another important consideration when dealing with the older person who has asthma is that the level of perception of the degree of airway obstruction decreases as people age. Director of the Woolcock Institute of Medical Research, Professor Norbert Berend, said that might be important from the point of view of action plans. ‘Action plans rely on the patients detecting a change in their airway func- tion. As you get older you may be less able to do that,’ Professor Berend said. Then there were the various clinical manifestations of ageing. ‘As you get older you respond to a lack of oxygen less well then when you are young, so elderly patients may slip into states when they have less oxygen without being aware of it, without having the nor- mal physiological responses to that. ‘So there is altered physiology in the elderly which alters the clinical expression of the disease and might make that disease look less severe than it really is and lead to underestimations of the degree of sever- ity and abnormalities. ‘The fact that the elderly are less likely to be able to use various inhalational devises is really important and there is a real opportunity for pharmacists to help here,’ Professor Berend said. Asthma 3+ Visit Plan After years of attempting to gain a formal role in the government’s major asthma initiative, the Asthma 3+ Visit Plan, phar- macy was able to step up to the plate last year by implementing a communications strategy. The success of the communications 92 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 FEBRUARY 2005 project, which was designed to inform and educate both pharmacists and phar- macy assistants about the Asthma 3+ Visit Plan and their role in that, was being measured at the time this story was going to print. The Pharmaceutical Society of Aus- tralia’s manager of practice programs, Matthew Ryan, said the role of the phar- macist and pharmacy assistant was to identify people currently involved in the plan, to encourage return visits and also identify people that would potentially benefit from the plan. ‘The Government has invested a lot in the plan but up until recently they were investing mainly in the GP side of things and left pharmacy alone,’ Mr Ryan said. ‘The PSA and the Guild are endeavour- ing to rectify that by, at the very least, hav- ing some funds allocated to informing and educating pharmacy about it and their potential role of contributing towards it. ‘Our communication strategy was obviously to enhance the knowledge about the plan but also the government’s aim was to get people more involved in it, getting more people back for their third visit and actually trying to get the full value out of the plan,’ Mr Ryan said. Chair of the NAC’s Pharmacists Asthma Group, Simon Appel, hopes pharmacy will be able to demonstrate its key role in this area. ‘Everybody was trumpeting the 3+ Plan in medicine but nobody knew it was happening and that was rather foolish and a waste of resources,’ Mr Appel said. ‘Whether there is a direct increase in application of the 3+ Plan, we will have to wait and see, but it hasn’t been a suc- cessful initiative from the consumer point of view and hopefully pharmacy can make a reasonable impact on that and refer people and encourage people to par- ticipate in the plan,’ Mr Appel said. The NAC’s chief executive officer Kris- tine Whorlow said the up-take on the Asthma 3+Visit Plan was ‘generally thought to be quite good’. Ms Whorlow said although there was no up-to-date information on uptake, about 90,000 3+ Visit Plans had been