North London Partners in health and care

What I do and why I care!

Nisha
Paediatric Pharmacist, Whittington Hospital

Asthma is one of the most common chronic childhood illnesses, affecting around 1 in 11 children in UK. Respiratory symptoms such as, Wheeze, Breathlessness, Chest tightness and Coughs are one of the most common reasons for hospital admission, especially during the winter months.

Asthma in children can be extremely frightening for child and parents, and the current COVID pandemic is an added anxiety for these vulnerable patients and their families, which require our support and reassurance.

The aim of management in children as per national guidance includes: being free from symptoms (coughing, wheezing and breathlessness), be able to attend school regularly and participate in all activities especially sports, sleep restfully, grow and develop normally, minimise acute asthma attacks and avoid hospitalisation and to reduce medication related side-effects, and I believe pharmacists are in a prime position to make a difference….so what can we do?

My role involves taking accurate medication history’s from the parents and patients (where appropriate) and linking them to GP prescriptions and patients notes. This helps us to identify any prescribing discrepancies, as well as frequent repeat prescribing (overuse) or infrequent prescriptions suggesting the possibility of compliance issues. Often presentations of uncontrolled asthma can be result of poor compliance to prescribed medications which patients/parents may or may not always disclose, rather than disease progression.

During the consultation, I am keen to confirm not only what medication they take, but also how often they take it, when do they require their inhalers the most, what makes the asthma worse (trigger factors), how they manage it at home, their understanding of their medication and any identified allergies. It is also a key opportunity to assess inhaler technique. Poor inhaler technique is often the main reason for poorly controlled asthma and it is important to identify any factors that may contribute to difficulties in taking medication correctly. I also look out for signs of overuse and potential adverse effects and where possible try and gain an understanding of the patient’s lifestyle, which may affect their asthma control. I feel my role involves asking patients and parents all the relevant questions including difficult but essential ones, such as about smoking. This is also a great opportunity to offer parents Smoking Cessation referral/advice if they want it.

But this is not just about us asking questions. It’s also a chance for them to ask us questions and clarify any problems.

Any intervention that supports parents/patients by educating and increasing their confidence on administration of medication can have a significant impact of asthma management. Furthermore we can also provide advice on general wellbeing as well as reinforce the need for immunisations, including the annual flu vaccine.