If you visited my post-exacerbation respiratory clinic what one tip would you give me as a pharmacist prescriber?
Don’t wait for months to see me. People who have had a scary attack need a lot of reassurance very quickly especially as their current medication has let them down badly. Don’t get me wrong it may be the medication or my of the lack of adherence to it. I know this happens although I’m pretty damn good at taking the medication not everyone is.
There is a lot of conversation amongst professionals around salbutamol overuse. What is your view on salbutamol use?
Salbutamol is a life saver and it also gives you your life back to lead but there are other things that can be done to reduce the usage such a percussion physio on your chest and back. Breathing techniques are also another option. Unfortunately, it is the comfort blanket of almost instant relief, that is the big pull for some people with salbutamol. In fact, probably a lot of people to be fair. The other options are slow to arrange, initially costly and require multiple appointments. You also need the patient-doctor consultant all to buy into these other options too. But if they did it could save the NHS a lot of money in the future.
Do you feel salbutamol usage is a good indicator of asthma control?
As far as I’m concerned for most people, more than two puffs a week is an indication of poorly controlled asthma. However, there can be other factors at play too. How as a doctor or pharmacist do you actually know how often they are actually taken or are they just hoarded by the patient and never actually used? Until smart inhalers are in regular use and can be monitored and we have people with the time to do the monitoring, it’s difficult to use the salbutamol use as nothing more than a possible red flag but remember you can only work with what you have got.
In your view why are people still dying from asthma?
This is the million or billion dollar question and far greater minds than me have thought long and hard on it and not come up with the answer. I don’t think there is actually one answer and that may be the actual reason why people still die from asthma. It’s also worth remembering not everyone does what they are supposed to, to keep well. I know some asthmatic smokers, which to me is just plain stupid if not insane.
I came out of the hospital with no support network for the best part of 5 months. This was after six or more asthma attacks a day needing numerous nebulisers and monitoring for the best part of a month. How did I not relapse without the support I so badly needed and always remembering a relapse could have been fatal.
As asthmatics, we are constantly bombarded by doing this do that/ don’t do this don’t do that. For me targeted treatment plans for the individual is the best way forward. Forget about what Jack did or Sarah, it’s about what I need to do to stay well. This might be physio, vocal therapy, psychological help, change in medication, a planned back to a fitness routine, a change in diet or all or some these and even others that I haven’t yet stumbled across.
Aaron Foulds is an Asthma UK volunteer, severe asthma treatment campaigner and patient input advocate. Follow him on Twitter @Logical1966 .