Breathe Easier: The Compounding Pharmacist’s Role in Promoting More Effective Asthma Treatment
Your patient could be anywhere when it happens—at work, at school, at home, far from a medical facility. It starts with tightness in the chest, shortness of breath, the wheezing and coughing making it more and more difficult to draw air in through the lungs. With the right compound medication, an asthma sufferer can manage and survive many such asthma attacks in their lifetime. Without effective treatment, asthma can be more devastating.
More than 23 million children and adults suffer from asthma in the United States. As much as the prevalence of asthma is a public health issue that results in an estimated 10 million missed workdays and 13 million missed school days, the personal toll can range from inconvenient to life-threatening. Any pharmacist who has worked with asthma sufferers before knows that managing asthma symptoms can be the difference between living a normal life and being at the mercy of unpredictable and uncontrollable attacks. As with many chronic conditions, pharmacists have a strong role to play in providing compound medications (such as fluticasone propionate) and helping their patients manage asthma.1
Providing Compound Medications for Asthma Treatment
The National Asthma Education Prevention Program’s (NAEPP) Guidelines for Diagnosis and Management of Asthma recommends that pharmacists adopt a step-by-step approach to treatment, assessing patient needs and condition severity between each step up on the scale.
Asthma medications generally come in two forms: preventive medicine to reduce or control symptoms, usually taken daily; and quick-relief or “rescue” medications formulated for immediate relief of symptoms, usually during an asthmatic attack. Pharmacists should actively compound both types for best effects, including to get the fastest-acting, shortest-duration, and most effective anti-inflammatory results. Most asthma medication is compounded to be delivered via nebulizers, especially relief drugs that must be fast-acting and reach peak effect within five to 20 minutes after first dosing.2
Current NAEPP guidelines recommend long-term treatment with inhaled corticosteroids like fluticasone propionate, supplemented with short-acting beta antagonists compounded for use in rescue inhalers.3 Fluticasone propionate, specifically a glucocorticoid receptor agonist, works as the active ingredient in inhalers by triggering synthesis of anti-inflammatories like leukotrienes. In studies, fluticasone did not increase overall congenital defect risks for first trimester pregnancies, an important hurdle for pharmacists to comfortably compound fluticasone to be acceptable for women who are or may become pregnant.4
Pharmacists should consider specific patient assessments when working with short-acting inhaled beta-agonists like albuterol, bitolterol, and terbutaline, as all of them affect patients in different ways and several are not recommended for women who are pregnant or may become pregnant, patients with diabetes, or heart rhythm disorders. For patients who prove less responsive to inhaled bronchodilators overall, pharmacists can consider a short regimen of compounded oral corticosteroids, specifically for treating acute flare-ups of the patient’s asthma.5
Pharmacists can also ensure that asthma sufferers are able to manage and treat their symptoms even during drug shortages, such during the 2011 shortage of Flonase, a brand name for compound fluticasone. By having a strong relationship with a high-quality provider of APIs like fluticasone propionate, compound pharmacies can ensure that children and adults who need compound fluticasone asthma treatments continue to have access to them even when major manufacturers’ supply cannot keep pace with the demand of millions of asthma sufferers.6
The Role of the Pharmacist in Patient Education
When it comes to chronic conditions like asthma, pharmacists can play a larger role than simply putting together compounds for use in inhalers. With the changing face of health care, more and more individuals are not under the direct supervision of a primary care physician, so providers at all levels of the health care system may be in a position to advise patients on treatment.
Pharmacists have a specific opportunity to educate and instruct patients on how to manage asthma. Children especially can be overwhelmed with initial diagnoses, and pharmacists can play a central role in teaching them proper management of their condition that will benefit them for the rest of their lives. Educating asthma sufferers (or their parents) on the differences between preventive medications such as inhaled corticosteroids and medications for immediate relief like short-acting inhaled beta-agonists can ensure that they are properly used.
It can also improve therapy outcomes if pharmacists take an active role in showing patients how to use instruments like metered-dose inhalers or rescue inhalers. Particularly for pharmacists whose patients present with poorly controlled symptoms despite being treated with fluticasone propionate, fluticasone furoate, or other correctly compounded medications, a brief session on how to self-deliver medications can sometimes improve response to therapy. Pharmacists can also assess whether a patient might find a valved spacer device beneficial, especially those who cannot master an inhaler for optimal dosing.
Pharmacy operators can also connect their business with millions of asthma patients by promoting a more asthma-friendly environment through specific pharmacist training, and child- and adult-appropriate marketing materials detailing the services offered.7
Asthma symptoms can be terrible and even deadly, but it is a very manageable condition with the use of medications like inhaled corticosteroids formulated with fluticasone propionate. High-quality APIs are the best building blocks for the most effective asthma treatment, and compounding ensures that any child or adult with asthma is able to receive treatment for their condition. Pharmacists are in a unique position to help patients with managing this condition, not only by providing effective compound treatments, but also by educating patients on how to use inhalers and medication to ensure they receive the best results and can live as fully as possible.
Pharmaceutica North America is the leading provider of high-quality pharmaceutical compounds like fluticasone propionate for pharmacists to help treat their patients’ asthma. Contact us to learn more about our bulk APIs and how they can help you provide better asthma treatments for your patients.
- “Most Recent Asthma Data,” Oct. 2, 2015, http://www.cdc.gov/asthma/most_recent_data.htm ↩
- “The Chemistry of Asthma Inhalers,” accessed Oct. 24, 2015, http://www.compoundchem.com/2014/11/25/asthma/ ↩
- “The Role of the Pharmacist in Improving Asthma Care,” accessed Oct. 24, 2015, http://msdh.ms.gov/msdhsite/_static/resources/2106.pdf ↩
- “Safety of Fluticasone Propionate Prescribed for Asthma During Pregnancy,” 2015, http://www.jaci-inpractice.org/article/S2213-2198(15)00253-6/pdf ↩
- “Albuterol,” accessed Oct. 24, 2015, http://www.drugs.com/albuterol.html ↩
- “Fluticasone Nasal Spray,” Oct. 26, 2011, http://www.ashp.org/menu/DrugShortages/ResolvedShortages/Bulletin.aspx?id=628 ↩
- “Asthma Friendly Pharmacies: A Model to Improve Communication and Collaboration among Pharmacists, Patients and Healthcare Providers,” Feb. 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042067/ ↩