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How To Do an ECO Medication Review

This is the last of 3 videos starting with the climate crisis explained by a general practitioner, going into more detail about green inhaler prescribing and the environmental impact of inhalers ending with how to do a proper ECO medication review. Our pharmacist, Layla Siebert, explains more about green inhalers and how to switch patients to a dry powder inhaler.

1. Which Patients to Focus on?

The outcome of any review should be optimising asthma or COPD care. People that are likely to benefit from this and potentially a switch to a DPI, are those whose symptoms or medication use indicate that current therapy isn’t working so well.

Patients to focus on are: Those collecting or more SABA inhalers in a year, have had two or more courses of prednisolone in a year, are under-ordering their treatment/preventer inhaler, have had one or more asthma or COPD related admission to hospital in past year.

2. Communication

Once we have invited in for review, there are some key tips on getting the most out of the review and optimising inhaler therapy: The review should be face to face where possible.

Getting a true picture of what’s happening with the person and getting inhaler technique right are the most important aspects. Tricky to achieve over the phone, although a bit easier on video. As the HCP, get to know the type of DPIs recommended in your local guidelines.

There are lots different DPIs on the market, but being knowledgeable about the few recommended in your guidelines will empower you to help your patients.

3. Get Inhaler Technique Right

Ask patients to bring their inhalers with them – you will get a good feel for how they are getting on with using them by asking for a demonstration.

Give patients permission to be honest about how they do or don’t use their inhalers by using open questions like ‘ tell me how you use you inhalers’ or by asking ‘ Do you use them every day or just on some days?’ ‘It’s good to know if you aren’t always using your inhaler, as that helps with moving forward’

It’s good to show the person a range of DPIs so that they feel that they have a choice. Let them use a number of placebos if they want to get a feel for what might best suit them You will need to demonstrate using the new inhaler, potentially multiple times or show the person a video.

Lots of videos available on the asthma UK or rightbreathe sites.

Observe the person using the new DPI placebo, from start to finish. Being able to hold the inhaler, activate it, breathe out, a deep forceful breath in and then holding ones breath for 5 s are all equally important in using the DPI correctly.

4. Why are DPIs Better?

Explain the advantages of the DPI over an MDI. Some advantages include all DPIs having a dose counter, DPI versus MDI means not having to coordinate compressing the canister whilst breathing in so easier to get good technique, and also not needing to use an aerochamber.

5. Troubleshooting

Ensure that the patient has at least a telephone review with you or another trained person 2-4 weeks after the change.

Inhaler technique can slip or be forgotten once the person leaves the practice, so do not assume that the patient ‘not getting on with’ the new inhaler or feeling more symptomatic is due to the inhaler change per se – it may be that inhaler technique needs correcting.

Overall, the message is that initiating an DPI or changing from an MDI to a DPI should only be carried out as part of a holistic review of the persons condition, carried out by a trained professional, with the aim of optimising care, ensuring that the person can effectively use their inhaler and therefore have sustained improvements to their treatment.

And don’t forget, if it is appropriate to stay with an MDI – document your choice, and remind the patient to use it until empty, and take it back to the chemist for proper disposal. - Part 1 - Climate Crisis Explained by GP - Part 2 - Green Inhaler Prescribing

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