Many pharmacists are probably busy reviewing inhaler use and technique as part of their medicines use reviews and new medicine service processes for patients with asthma and chronic obstructive pulmonary disease (COPD).
The long-acting beta-2 agonist formoterol is a common ingredient in step-up therapy for asthma after an inhaled corticosteroid inhaler (e.g. in Fostair or DuoResp products). Glycopyrronium, umeclidinium and aclidinium are also now used for initial regular therapy for COPD (the long-acting muscarinic antagonists in Seebri, Eklira and Incruse inhalers).
All these bronchodilators have rapid onset, typically around 5 minutes, peaking from around 30 minutes to 120 minutes. This is not as quick as salbutamol (3 to 5 minutes), but is more than adequate for a patient who is not in acute respiratory distress.
I have been making a point of making sure that patients use their new inhaler and wait at least 15 to 30 minutes for the bronchodilation effect to kick in before considering using their short-acting bronchodilators. During follow-up reviews, patients tell me they did not need their short-acting beta-2 agonists (SABA) since they started using their new inhaler. One patient was so enthusiastic that he instructed his father to see his GP to request the same inhaler.
Many asthma and COPD patients are still requesting (and being issued) salbutamol alongside their long-acting bronchodilator and there is a real opportunity to make an intervention here because many are just using their SABA routinely ‘two puffs four times a day’ — according to the dispensing label.
I have now amended the label for the SABA inhalers to say ‘When required, use two puffs…’ and discussing how frequently they are being used by the patient every time I hand a SABA out. Most patients dislike using many medicines, so most are delighted with their simplified regimen.