Managing asthma is both complicated and costly for patients, so pharmacists play a unique role in helping them navigate how to use their treatments effectively and prevent exacerbations. Keeping up with ever-evolving treatment strategies, guidance, medications, and patient experiences is key.
Guidelines are continually updated to reflect new research, and Cleveland Clinic primary care clinical pharmacist Giavanna Russo-Alvarez, PharmD, BCACP, suggests making it a personal goal to review guidelines annually, and even regularly in between.
“I look for guideline changes,” Russo-Alvarez says. “We as pharmacists can be really helpful in reaching out to practices. We can provide small in-services to keep them informed, as well.”
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Sometimes, changes are frequent and clinicians can’t keep up—even with major changes. Russo-Alvarez notes that some clinicians weren’t even aware of a major recent change that shifted decades of asthma treatment.
This change was the recommendation made in April 2019 by the Global Initiative for Asthma (GINA) to no longer treat teens and adults with asthma with short-acting bronchodilators alone. The recommendation has been hailed as a fundamental change to three decades of asthma management, but was made as a result of concerns over the effects of treating asthma with short-acting ß2-agonists (SABA) alone.
GINA was established in 1993 by the World Health Organization and the National Heart Lung and Blood Institute to improve global asthma prevention and management, and suggested in its latest annual report that teens and adults with asthma should receive symptom-driven or daily inhaled corticosteroid-containing (ICS) treatments as a way to reduce the risk of serious exacerbations.
SABA risks were first identified in the 1980s and 1990s, according to GINA’s annual report, with evidence supporting an association between over-use of SABA and an increased risk of asthma-related deaths. Randomized controlled trials found no evidence to support the efficacy of regular, compared to as-needed, (PRN) use of SABA. Most guidelines were updated in the 1990s to support PRN rather than regular SABA use as a result of this research.
Trials have also shown that low-dose ICS treatment could reduce exacerbations by up to 50% and help control symptoms, but daily uptake of ICS has been slow-going over physicians concerns about the side effects of corticosteroids, according to the report. The concerns about ß2-agonists were then shifted to long-acting varieties, and short-acting varieties remained widely used as initial therapy for mild asthma. GINA began looking into the issue more extensively in 2007 and found a host of data to support a link between regular use of SABAs alone, and higher rates of exacerbations and asthma-related deaths.
The paper goes on to list specific treatment recommendations, and Diana M. Sobieraj, PharmD, assistant professor of pharmacy practice at the University of Connecticut, says the new guidelines could result in a shake-up at the pharmacy counter.
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