2. Areas to cover Analysis of information Recruitment Review

3. Key Areas For Analysis Inhaler technique Dosing regimens Compliance with regimen Overuse of SABA Over/underuse of combination inhalers Assessing patient knowledge

4. Key Areas For Analysis Management plans Target those DNA’s Is patient using correct inhaler? Assessing pts. for ‘step down’ therapy Switching COPD pts. from Seretide Evohaler to Accuhaler if appropriate

5. Possible causes of poor control Adherence(Compliance) Education/understanding of condition Poor Inhaler Technique Medication issues Management issues

6. Methods

7. Check symptom control- 3 RCP questions?? - Have you difficulty sleeping because of your asthma symptoms? - Have you had you usual asthma symptoms during the day?(cough, wheeze, tightness in chest or breathless) - Has your asthma interfered with your usual activities? (all Pts. with asthma over 16 years)

8. ACT Test

9. CAT Test

10. Knowledge - Their knowledge of condition, treatment and management - Information you can give them - CHECK THEY UNDERSTAND!!!

11. Understanding Asthma is not enough Facts, figures and overload of information is not enough to reduce morbidity on its own. Asthma education is not just about understanding the condition. The key issues are:- - educating what to do and - when to do it

12. Visual

13. Practical

14. History

15. Improving Compliance!!!!

16. 2 important aspects

17. Making Asthma/COPD more fashionable!!

18. New devices!!! Elipta Genuair Dry powder devices Breezhaler Many more coming to market!! Assess eaches position within context of guidelines!!

19. Inhaler technique??? 150 professionals asked to demonstrate how to self admin a pMDi-doctors, nurses, hosp. and comm. staff. 74 –primary care 76 –secondary care. Marked against standard checklist set by Manu. and Health Ed. 113 (75%) of part. involved in teaching of inhaler technique. Of these 113 – only 11!!!(9%) could demonstrate all the recognised steps. Small study whose results cannot be overstated but think about checking your own technique.

20. Questioning

21. Side effects Oral thrush Sore throat/hoarseness Coughing Fast heart beats Taste Osteoporosis/Brittle bones risk (worse if smoker) Increase risk of cataracts in elderly?

22. Questions Your concerns Smoker? Spacer use? Information sharing?

23. Answer their queries

24. Guidelines BTS/SIGN When updating?? What do they suggest? step up / down How/when to step down? Newer medications suggests need for review of treatment options. Both Asthma and COPD

25. Management Plans

26. Key issues addressed Active participation in the control and management Ability to recognise the signs and symptoms of worsening asthma Ability to follow medication prescribed Ability to use inhaler devices correctly To identify any obstacles preventing compliance with treatment plan

27. Training GSK Almirall AstraZeneca Cheisi Napp Asthma UK BTS/GINA guidelines

28. Conclusions/Outcomes Better understanding of what Asthma/COPD is and is not Better understanding of importance of each inhaler Improved management understanding Poor inhaler technique corrected Is there a good time to ‘step down’ Patients benefited from a more qualitative review

29. Going Forward… Quick reference guide Reassess each patient Be concerned for patients on high dose ICS Don’t forget ‘Step 2’ COMPLIANCE EDUCATE QUESTION ‘Step down’ guidelines??

30. Getting the Basics right first Patient in ‘control’ of Asthma not it ‘controlling’ them!!!

31. Tips!!! If possible sit beside patient Ask for honesty Use positive body language LISTEN Explain slowly and with terms that they can understand Try not to over load with info, yet aim to improve knowledge and understanding Be confident!!! Don’t be afraid to make recommendations Reflect on ways forward

32. Thank you