June 16, 2025 • 34 mins
Asthma management continues to evolve, with updated guidelines emphasizing personalized care, smart inhaler use, and early intervention. This episode reviews key pharmacotherapy updates, stepwise treatment strategies, and practical counseling tips to support adherence and inhaler technique. Tune in to strengthen your role in improving outcomes for patients living with asthma.
BONUS: With this episode, you also get exclusive, FREE access to beautifully designed clinical charts and practice resources from our friends at Pyrls, that you can use in your everyday practice. Click here to access these practical tools!
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Rachel Maynard, PharmD
Lead Editor
Pyrls
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe current guideline-recommended pharmacologic treatments for asthma, including stepwise therapy approaches.
2. Identify key counseling points for improving inhaler technique, adherence, and asthma control in patients.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-214-H01-P
Initial release date: 6/16/2025
Expiration date: 6/16/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Josh Kinsey (00:07):
Hey, CEimpact subscribers, welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, andas always, I'm excited about
our conversation today.
Asthma remains a common yetoften mismanaged condition, with
poor control leading topreventable symptoms,
hospitalizations and reducedquality of life.
In today's episode, we'll coverrecent treatment updates,
(00:30):
counseling strategies and thepivotal role pharmacists play in
helping patients breathe easierand live better.
Before I introduce today'sguest, I wanted to share that
we've launched a special pilotseries in collaboration with our
friends at Pyrls, a modern druginformation resource and app.
These crossover episodes,called Game Changing Pyrls see
(00:51):
what we did there combine Pyrls'trusted, evidence-based
clinical tools with CEi mpact'sexpertise in pharmacy education
and accreditation, bringing youtimely, actionable content that
supports both your practice andyour professional development.
It's a privilege to workalongside the Pearls team and we
are excited to kick off thispilot series with today's
(01:12):
episode focused on themanagement of asthma, and
representing Pyrls today isRachel Maynard.
It's so great to have you asour guest today, rachel, welcome
.
Rachel Maynard (01:20):
Thanks so much, josh, so excited to be here.
Josh Kinsey (01:22):
Yeah, and I know that you have a busy schedule,
so we are so grateful that youtook time out of your schedule
to sit with us today and talkabout asthma.
And for our listeners, sinceit's probably the first time
they've met you or heard fromyou, if you want to take a
couple minutes to tell us alittle bit about yourself and
how you started in pharmacy andsome of your passions, and just
tell us all about yourself.
Rachel Maynard (01:48):
Yeah, sure.
So, yes, my backgroundoriginally was in community
pharmacy.
I started working as atechnician while getting my
undergrad degree and that's whatdrove me to go to pharmacy
school.
After pharmacy school, I did acommunity pharmacy residency and
practiced as a staff pharmacistfor a few years and also
providing clinical services fora grocery store chain and also
managing those services for aregional group of chains.
(02:08):
So after that I then sort ofmoved into the drug information
and education space writing,creating content for healthcare
professionals and I have donethat for now over a decade, and
most recently I've been withPearls in again a very similar
role, sort of helping to managethe editorial process, our
content development process, andto really ensure that we're
(02:32):
providing resources andeducation and tools for
clinicians to help them optimizepatient care.
And that's really what I'mpassionate about is knowing what
it's like in a communitypharmacy and how challenging
that can be, making sure theyhave the tools they need to
practice to the best of theirability.
And for our topic today, likeasthma, is one of those topics
that I think we see so manypatients with and we can make
(02:54):
such an impact on their lives,and so I'm super excited to be
here to chat about that.
Josh Kinsey (03:00):
Yeah, that's great, and a lot of our discussion for
today is going to focus aroundsome of those things that you
can do with the patient at thecounter and like making sure to
improve adherence and whatever.
But in general, you know,asthma is one of those disease
states that every pharmacist,regardless of what role they're
in, it's probably hasencountered a patient with it,
(03:20):
and so even you know some ofthese nuggets that we're going
to share today.
You know they can be implementedanywhere in your practice
setting.
So just I'm really excited.
I feel like asthma is one ofthose things that is super
important and really detrimentalto a patient's quality of life,
and I just I feel likesometimes we don't talk about it
enough because you know it's.
I just feel like we need toelevate it more and really focus
(03:42):
on how can we make the qualityof life for these patients
better.
So super excited about our talktoday.
So thanks again for joining us.
We really appreciate it andjust really excited about this
partnership with Pyrls.
So all right, so let's go andjump in, just as I always like
to do lay the groundwork and thefoundation, make sure
everybody's on the same page.
So let's just have a briefreview of asthma in general and
(04:05):
maybe just a reminder of youknow how is that different than
you know a chronic perspectiveof that like COPD and whatever,
like you know, because sometimesthose kind of get blurred
because inhalers are used forboth sometimes.
So let's just kind of have aquick review of asthma and just
kind of talk a little bit aboutthat and lay the groundwork
there.
Rachel Maynard (04:28):
Sure.
So in a nutshell, it's, as yousaid, chronic inflammatory
condition of the airways.
And so if you think about howasthma is diagnosed, there's
really sort of two components ofthat.
It's these respiratory symptoms, which are sort of those
classic symptoms you think of,like wheezing, cough, shortness
of breath, and then there's thisvariable expiratory airflow, so
you know, assessing whetherthere's reduced ability to
exhale because of thatinflammation, and so that's why
(04:50):
it makes sense that inhaledcorticosteroids are a
foundational treatment forasthma, because of that
inflammation and that variableairflow.
Josh Kinsey (04:59):
Sure.
Rachel Maynard (05:00):
In terms of differentiating from COPD.
That can be tricky becausethere are, you know, there's
overlap in symptoms with thecough, the shortness of breath.
I think some of thedifferentiators are things like
if you're waking up at nightwith symptoms, that's more
indicative of asthma.
If you have a patient who alsohas allergies, for example like
(05:20):
allergic rhinitis or eczema,those can also be sort of cues
that it might be more related toasthma, whereas if you have an
older patient, that can bechallenging because you know
there's sometimes some overlapthere.
But also thinking about ahistory of smoking, and if you
know, copd is almost alwaysassociated with a history of
smoking and so that's anothercue to think about.
(05:42):
But I will say, you know,smoking is also a trigger for
asthma symptoms too, and so eventhough there's overlap, there
can also be this people can haveboth, they can have features of
both and even though there'svariable expiratory airflow with
asthma, if you've had asthmafor a long time, some adults may
have more persistent airflowproblems and that can also be
(06:02):
more similar to COPD, wherethere's this more persistent
airflow problems, and that canalso be more similar to COPD,
where there's this morepersistent airflow limitations.
So that's why it's tricky, Iwill say.
In the most recent updatedasthma guidelines that we'll
chat about a little bit more,they actually called out what
term to use.
So you may have heard this termasthma, copd, overlap, and that
(06:24):
was sort of the term that weused to use because it was, you
know, just a way to think aboutthese two conditions overlapping
and the fact that they havesimilar symptoms and diagnostic
process and that sort of thing.
They are now encouraging peopleto use the term asthma plus
COPD so that it's not seen aslike a separate condition.
It's more so that people havefeatures of both, and so I
(06:44):
thought that was just sort of aninteresting nuance that they're
calling out asthma plus COPDversus overlap, because that's
inherent, but really thesepatients have features of both
asthma and COPD.
Josh Kinsey (06:56):
Yeah, and I think, rachel, one of the things that I
don't know that I thought this,but I feel like it was.
I feel like the generalpopulation thinks that sometimes
is that asthma is for kids andCOPD is for adults, and that is
we need to like make sure thatwe're not on that wavelength,
because that is not true,correct.
I mean, there are adults thathave asthma, and only asthma,
(07:18):
and maybe, like you said,overlap as well, but but that is
not the case, like you can'tjust look at it as children have
asthma and adults have COPDwhen they get older.
Rachel Maynard (07:27):
So I mean I'll say that I think that you can
use that as a differentiator tohelp again sort of figure out
what the patient has.
Sure, because asthma is COPD.
Josh Kinsey (07:35):
Is their age Right right?
Rachel Maynard (07:37):
But yeah, for I looked up some stats when
thinking about this topic, and9% of adults in the adults in
the US have asthma, versus 7% ofkids, and so you know it's very
common in adults and so, yes, Ithink that's a good distinction
to make.
Josh Kinsey (07:53):
Yeah, yeah, very good, okay.
So, and as you mentioned, thiskind of a great kind of lead in
here, it does affect millions ofpatients across different age
groups.
You gave some great stats there9%, 7%.
I mean, that's that's quitesignificant when you think of
that, and I think, justreiterating the fact that why
we're here today is to talkabout how proper management can
(08:14):
significantly increase thequality of life, decrease
hospitalizations, reducehealthcare utilization in
general, funding cost whatever,and just an overall reason for
us as pharmacists to jump in,because we have great access to
the patients, they have greataccess to us and these slight
little tweaks can really make adifference.
(08:37):
So I think that's really whatI'm excited to dig into today is
how just these a few littlethings that you can do and can
really change the patient'squality of life.
So, with that, what are some ofthe roles of the pharmacist?
So I know we're going to diginto them deeper, but what do
you feel like?
Where do you feel likepharmacists can interject
themselves here with asthma andwith asthma patients?
Rachel Maynard (08:59):
Yeah, so I think there's so many opportunities
again, regardless of yourpractice setting.
But one of the keys with asthmais that it's not just a set it
and forget it sort of condition.
It's something that you know.
Patients need to be assessedand their medications reviewed
and adjusted as needed, sort ofon this you know, cyclical basis
(09:19):
.
And so the idea that, like yousay, patients are coming in for
refills or even, you know, forwhatever reason, into the
pharmacy and just having thatopportunity to have these
frequent touch points with them,it's just such a prime
opportunity to reassess howtheir asthma is being managed,
how they're using their inhalers, if they're using it properly.
I would say that's one of thebiggest opportunities is just
(09:46):
thinking about those frequenttouch points and the fact that
we can really make an impact onadherence to medications, but
also how to use thosemedications properly and also,
you know, keeping an eye onthings like vaccinations and
preventing triggers and, youknow, other comorbid conditions
that can worsen asthma, likeobesity or GERD.
You know, all of these thingssort of are just a prime
opportunity for us, I think.
Josh Kinsey (10:06):
Yeah, I'm glad you mentioned vaccines, because
that's a big one.
You know, the guidelines callout specifically that section of
the population and there are,you know, certain things that
are recommended for them, and soI think that's really important
too and I love the idea.
I mean, we should be doingcyclical type interventions with
our patients in every diseasestate.
(10:27):
But this one, you know,certainly, and also thinking
about too again, especially ifit's a child who has asthma, as
they grow, as their body changes, as their hormones change and
the way that they metabolize, Imean we may have to adjust doses
as they grow older.
So you know just things.
Thinking about that too, likeyou can't just be like, okay,
they're on a maintenance inhalerand they're on a rescue inhaler
(10:50):
and they're good till they're25 or whatever, like that's just
not going to be the case.
Rachel Maynard (10:54):
So well and honestly sorry, josh.
I mean, I think one of thethings is, even like a decade
ago, the way we thought aboutmanaging asthma is very
different than I think whatguidelines are recommending now?
Whether or not all of thosechanges to the guidelines can be
implemented in practice isanother story, but yeah, there's
.
There's been quite a change inthinking over the last few years
(11:15):
and so, even if a patient'sbeen on therapy for a while, if
they're not well managed, itcould be an opportunity to
relook at that and see ifthere's an opportunity to
improve.
Josh Kinsey (11:24):
Yeah, that's great and you bring us.
Let's talk about guidelines.
So one of the opportunities forpharmacists is to make sure
that we are up to date on theguidelines for the treatment and
management of asthma.
So let's talk a little bitabout what that looks like, and
I know that we're going toutilize a wonderful resource
(11:45):
from Pearl, so I'll let you kindof guide me on when to share
that screen.
But, yeah, let's talk a littlebit about the importance of the
guidelines and making sure thatwe're up to date on those.
Rachel Maynard (11:54):
Sure.
So the guidelines are the onesthat I think many clinicians are
following these days are fromthe Global Initiative for Asthma
, or GINA guidelines, and thoseare nice because they come out
every year, and so they justcame out in May, a couple of
weeks ago and it allows us tosort of keep on top of what's
(12:14):
changing, what evidence iscoming out, how can we improve,
you know, standard of care andeven little things, like I
mentioned, that asthma plus COPDversus asthma, copd overlap and
some preferred terminology,that sort of thing.
They address that too.
So I think that's typicallywhere people are following.
Are these GINA guidelines?
(12:40):
There were guidelines, and GINAis international, so it's not
country specific, whereas thereare US-based guidelines that you
might remember from theNational Health, lung and Blood
Institute from like 2007, soalmost 20 years ago, and those
are still in place.
They did come out with a morefocused update in 2020, looking
at just a few key things, and sothat was sort of where the
(13:02):
concept of smart therapy, whichI'm sure we'll talk about, came
out on the US side of things,and then again, gina has sort of
been iterating on that over thepast few years as well.
So I just say that becausethere's a couple different sets
of guidelines, but I think, justfrom a frequency of updates
perspective, the Gina guidelinesare where a lot of us tend to
rely on, and so, yeah, to thatend, what we've been working on
(13:25):
at Pearls just recently isupdating our pharmacotherapy
review, which is like a quicknote sort of how you approach a
patient with asthma, andupdating that to reflect these
most recent guidelines that justcame out.
Josh Kinsey (13:39):
Yeah, that's great, that's great.
Do you want to jump into someof those?
Yeah, let's go for it.
Rachel Maynard (13:46):
And so, yeah, you can share the chart that we
have, which is, as you said,sort of a stepwise approach, and
we have it outlined for bothadolescents and adults, so 12
and older, and then also foryounger children.
But in terms of just thinkinggenerally, especially about this
broad population of ouradolescents and adults, you can
(14:08):
see there's sort of thispreferred approach and then also
an alternative approach, andthe preferred approach is really
where Agena recommends thatmost patients start and the
focus is on making sure thatpatients at diagnosis or soon
thereafter are incorporating aninhaled steroid into their
therapy in some way, and that'sto again help reduce that
inflammation and help manage andalso prevent symptoms and
(14:32):
exacerbations going forward.
So, with either the preferredor the alternative approach, the
idea is that the patient willhave both a controller
medication and a relievermedication, and so the
controller, as the name implies,it, helps to manage those
symptoms and prevent futuresymptoms.
That reliever is to help with,as needed, you know, when
(14:54):
wheezing, coughing, those asthmasymptoms crop up, to help
provide that quick relief.
But I will say this is anotherthing that I sort of learned as
we were doing this most recentupdate the idea of controller
versus maintenance is that I wasthinking of them as sort of
synonymous, and again, I thinkthat's because we've had this
(15:14):
idea that you know you have yourquick relief inhaler and then
you also have your maintenanceinhaler that you take every day
to prevent symptoms along withyour reliever, and whether
that's a short-acting betaagonist or a long-acting beta
agonist, like for motorolspecifically, the idea is
(15:38):
helping the patient get thatinhaled steroid at the same time
they're getting their quickrelief medication.
So the idea of a controllercould actually be something that
a patient is using only asneeded.
If they have their inhaledsteroid for motorol combo and
they're only using it as needed.
If they have their inhaledsteroid promoter or combo and
they're only using it as neededfor more mild asthma, it's still
(15:58):
helping to control theirsymptoms, right?
It's not something they need touse every day, and so I thought
that was a really interestingdistinction just this idea of
controller versus maintenancenot being interchangeable and
sort of this new paradigm aboutincorporating inhaled steroids
and more of that, you know, evenas needed therapy.
Josh Kinsey (16:18):
Yeah Well, I was going to ask because I used the
term rescue inhaler earlier.
I was going to ask if that'sbeen replaced with reliever.
So is that?
Is that the case, like is thatpretty much.
Rachel Maynard (16:28):
You know that's a good question.
They I didn't see anything inthe guidelines about that
specifically.
They do say that people oftendo you refer to it as a rescue
inhaler.
It's really just for that quickrelief of symptoms.
I think the what I've heard inthe past about the concern with
the term rescue is that, like,it's not meant to be.
Yes, it relieves your symptomsquickly, but it's not meant to
(16:49):
be used Like if you're having anacute exacerbation you might
need you know to go to thehospital or something.
So but with, with the, the, thegrowth of sort of these combo
inhalers with a formotorol withinhaled steroid, or even the
more recent product that's comeout in the last couple of years,
which has albuterol with aninhaled steroid, the idea is
(17:12):
that hopefully it will be less.
You know, rescue, becauseyou're getting that, that
steroid, along with your quickrelief.
Josh Kinsey (17:21):
I appreciate that approach in the sense of rescue
kind of indicates, you know,like, oh, this takes care of an
emergency situation, as opposedto it really shouldn't Like if
there's's, if it's a really diresituation, you should be
seeking emergent care.
Um, and so reliever is yeah,okay, I can see that that makes
sense.
Uh, okay, well, also, thesecharts are so good, I mean,
(17:45):
they're just, they're so.
I mean, I am your typical typea pharmacist who just loves you.
You know colors and flow and Ialways my family and friends
whenever they visit or wheneverwe go on a trip, I have a
color-coded itinerary for ourtrip.
Rachel Maynard (18:03):
And so I always.
Josh Kinsey (18:05):
I always get poked fun at for all of my color
coding and I even like work inlike this is when we're relaxed
in the room.
Rachel Maynard (18:12):
Oh, wow.
Josh Kinsey (18:16):
So I love these charts Like this just this
speaks my language right hereand they're just, they're so
good and they're so easy to haveon hand just to help with your
patients as you're managingasthma, and this is just one
disease state where we'relooking at something that Pearls
has.
So these are just so great.
And for the listeners, I didn'treally mention it, but all the
(18:41):
charts that we're showing, allthe handouts and resources that
we're showing, are going to beavailable in your profile.
So be sure to grab these,you'll be able to have access to
them.
Be sure to grab these, you'llbe able to have access to them,
so okay.
So with that, let me get back tomy notes here.
So let's talk a little bitabout we've kind of gone over
the importance of the guidelinemaking sure that understanding.
(19:04):
Why is that important for thepharmacist to stay up to date on
it?
Because, like you've said, theychange every year and sometimes
those nuances are, you know.
It's important to note them.
So let's talk about the role ofpharmacists in counseling,
specifically with inhalertechnique, to ensure that
patients are getting the rightdelivery of the medication, and
(19:27):
you know I've seen so manypatients over the years just do
it so wrong over the years justdo it so wrong and it's so sad
because you know it's just asimple, a simple discussion that
can be had and showing oftechniques.
So let's, I'd like for you totalk a little bit about the
importance of that.
Rachel Maynard (19:45):
Yeah, I mean, I think you're spot on.
It seems like something thatit's.
It seems like something that itit's simple but not necessarily
easy.
Right, like so the idea thatlike it's something that we
should be able to tackle andpatients should be able to
tackle.
But you know, every inhaler isdifferent.
(20:06):
They all have their littlenuances in terms of preparation
and cleaning, and you know andit's not super intuitive, like
you know.
Josh Kinsey (20:13):
sometimes I've even looked at a new one and been
like what know?
And it's not super intuitive,like you know.
Sometimes I've even looked at anew one and been like what do I
do?
You know.
Rachel Maynard (20:19):
Right, right, yeah, and thinking about like
limited time too.
We all have limited time and soto like have to open up a
package and open up the labeland like help a patient walk
through that, that can be a bigbarrier.
And so, yeah, I think in theguidelines I think they said
like up to 70 or 80% of patientshave trouble using their
inhaler, don't use it properly.
So it's like a huge, hugenumber.
(20:40):
But also that many healthcareprofessionals, as you said,
don't always know how toproperly instruct if they're not
intimately familiar with theproduct either.
So, yeah, actually, so withinthe Pearl's Drug Summary pages,
in our counseling points, youknow we have these key
counseling points to just drillin on that you're going to focus
on with the patient.
And right in there is theadministration guide for these
(21:02):
inhalers, so you can just popthat up with that again, having
to like open up their packageand sort through the label.
So just open that up and thenwalk through it with the patient
.
But I would say, like you know,it's sort of that classic teach
back method, so walking themthrough the steps as you would
normally counsel a patient andthen having them teach you back
(21:23):
how they would do it and thenpointing out any errors or
opportunities for correction.
But I mean, it's, each inhaleris different, as we said.
And then there's the meter doseinhalers, which are a little
different from the dry powderinhalers and require different
techniques.
Josh Kinsey (21:48):
And so, yeah, it's definitely a challenge, but
something that is just rightwithin our wheelhouse and such a
good opportunity to impactAbsolutely.
And you know I'd be remiss ifwe didn't talk about, during
counseling, reiterating theimportance of adherence, you
know.
Rachel Maynard (21:56):
Oh, absolutely, yeah, yeah.
Josh Kinsey (21:59):
Yeah, that is going to be something that is super
important for specifically thisdisease state, because if
they're adherent on, you knowthe regular, what is it?
Rachel Maynard (22:08):
now their controller controller.
Josh Kinsey (22:15):
If you're adherent with their controller
medications now, then you knowthey're going to be able to use
less and less of those relieverproducts and have less and less
exacerbations that require, youknow, some sort of emergent care
, hospitalization whatever,which is our goal, like we're
trying to improve the quality oflife and reduce the burden on
healthcare, you know so yeah, soadherence is also super
(22:36):
important to talk about withpatients, along with the
technique.
Rachel Maynard (22:41):
And so just to like expand on that a little bit
, because again, this concept ofhow asthma is managed has
changed in the last decade or soa little bit, and so, like the
idea of your inhaled steroid isyour controller, you do that
every day and then you have youralbuterol, which is your quick
reliever, and you're doing thosetogether.
But really the guidelines in thepast few years have encouraged
(23:03):
this smart therapy, so singleinhaler, maintenance and
reliever therapy all in oneinhaler, and so that makes it so
much easier for patientsbecause it's just one inhaler.
They don't have to think about,well, I use this for this and
this for this.
It's one inhaler and they canuse that combo inhaler for their
quick relief of symptoms andfor their daily maintenance, and
(23:26):
so that hopefully helps tosimplify things.
But also, you know, if you havea patient with more mild asthma
and maybe they're not on aninhaler every day, but they are
using it when they have symptomsand they're getting that
inhaled steroid dose becausethey're taking that combo
product Adherence means a littledifferently there, but it's
(23:47):
like making sure that they areusing it when they have symptoms
and they know they can.
You know, they know thatthey're using that instead of
maybe they had albuterol in thepast and you know understanding
why they're maybe now using thatcombo inhaler.
So, yeah, it's.
I will say, also thinking aboutadherence, though, even though
(24:08):
the smart therapy has been sortof, you know, the preferred
treatment, now I think cost andinsurance issues can be a
barrier.
So, you know, if you're usingsmart therapy and you're using
your maintenance dose, butyou're also supposed to be using
it as a reliever, thensometimes insurance will pay for
that additional dosing and so,yeah, we have right, because you
(24:32):
would, you would run out, itrun out of it sooner than what,
yeah, like how do you monitorthat day's supply?
Josh Kinsey (24:37):
yeah, exactly, and again that goes back to your
point earlier where you weretalking about.
This is a cyclical managementfor these patients, because you
know what.
If you see like, oh, they'recoming in every 18 days for this
, then clearly maybe maybe thedose is not right, maybe they're
not as controlled as we thought.
(24:57):
You know, because they're usingit so much more often and you
know that's what we aspharmacists can see.
We can see when they'rerequesting the refill too soon.
Or you know if we're on theprovider side of it.
We can see when you know therefills are coming in as
requests to send and things likethat.
So, yeah, like in an AmCaresetting or whatnot, where we're
(25:20):
working to actually, you know,manage the care.
So yeah, that's great.
The other thing to talk about Ithink that's important in
adherence is also talk about incounseling.
Along with adherence is alsothe importance of trigger
avoidance.
Can you speak a little bit tothat?
Is there anything you want totalk about in counseling?
Along with adherence is alsothe importance of trigger
avoidance.
Can you speak a little bit tothat?
Is there anything you want totalk about there?
Rachel Maynard (25:37):
Yeah.
So again, that's a greatopportunity for us to be
listening to what patients aretalking about, just even in
conversation, as you're justchatting with them about other
things.
Right now, allergy season issort of in full swing and that
can be a trigger for manypatients with asthma.
So, being aware of that, again,smoking can be a trigger.
So if a patient does smoke orvapes, you know, pointing out
(26:02):
that this could be contributingto the worsening of your
symptoms and helping them onthat journey to quit if possible
.
There's also, you know, a viralinfection that could be a
trigger.
So helping patients stayhealthy again through
vaccination.
And so, yeah, I mean, again,there's seeing patients and
(26:23):
they're getting, you know, anover the counter histamine or
something, or you see themsneezing and you know these
sorts of things can be a cue tobe like hey, did you also know
that this could be?
This could impact your, yourasthma management too.
And maybe we need to thinkabout, you know, monitoring
closely if you're having somesort of viral infection or
allergies or whatever the casemay be Absolutely, absolutely.
Josh Kinsey (26:43):
Yeah, those are all great points.
So let's, I think we've kind ofhit on our major points that I
wanted to be sure we talkedabout today.
I want to also show your othercouple of resources that are
going to be available tolisteners.
So let's, I'll just kind ofshare and you can kind of just
quickly let us know what we'relooking at here.
Rachel Maynard (27:05):
Yeah, so so we at Pyrls we have this really
fabulous inhaler chart thatcompares the dose
categorizations for inhaledsteroid combo products, so
various inhalers that haveinhaled steroids.
You can sort them into low,medium or high dose and that's
based on the GINA guidelines.
And it can be challenging tosort of quickly compare what
(27:30):
dose a patient might be on andwhat they might need to switch
to.
And again, this goes back tothe idea of like adherence and
making sure we're overcomingcost barriers for patients,
because insurance plans change,insurance formulas change and
patients may all of a sudden benot able to get the inhaler that
they've taken for years, and sothis part allows you to very
(27:50):
quickly compare.
Okay, if a patient's onmometasone and they're going to
switch to fluticasone at amedium dose, here's how you
would do it with the number ofpuffs per day and it's again
sorted by ages 12 and older andpediatrics.
So a very quick and easy way tohelp those patients switch if
formulary issues come up.
And I will just say, with boththe step therapy chart and this
(28:15):
corticosteroid comparison chart,it is meant and is used as a
way to keep it very simple, butalso being aware that, like
after any switch.
We also still want to encouragepatients to be monitoring their
(28:38):
symptoms, being aware of anyworsening of asthma, because
everyone's going to responddifferently to their particular
product.
So it's just a good reminder to, after any switch or when
starting, circling back withthat patient again to see how
they're doing.
Josh Kinsey (28:53):
Yep.
So it's a great guidancedocument.
It is not the gospel truth, youknow exactly.
And then this one, which I alsolove again, love the color
coding, love the flow ofeverything, and just the summary
of it's just so good.
So I'll let you kind of speakto this one really quick too,
yeah.
Rachel Maynard (29:11):
So this is an inhaler comparison chart and,
like you say, it's just, it'svery nice to look at.
You know, there's not a lot ofthe things that you're looking
at on paper that you're like, oh, this looks nice to look at.
But this, I would say, is it'svery, like you say, color coded.
It's sorted by class, soinhaled steroids versus labas
versus Lama labas and combos, sovery easy to quickly find what
(29:33):
you might be looking for interms of which drugs are in a
specific class.
It also notes which ones areapproved for asthma versus COPD.
So helping with that indicationand also with the approved age
ranges.
And then there's dosecategorizations in there too.
So helping again if you need toswitch between doses of
particular steroids, helps withthat conversion as well.
(29:54):
And it also, by the way, noteswhich products are available as
generics or authorized generics.
Josh Kinsey (29:59):
So, again, if you're running into insurance
issues, that could be anotherclue to help with those, those
barriers absolutely yeah, andone thing you mentioned earlier
and I'll just this is kind ofjust to summarize and reinforce
the importance of counseling andadherence and, you know,
talking about the triggers andthat kind of thing.
One thing you mentioned wasvaping and I heard recently the,
(30:20):
the percentage of patients thatand it's staggering and just,
and you know, like, just I feellike we're back in that cycle of
you know the whole, like whatwas it?
Probably the sixties andseventies when, when smoking,
you know the whole, like whatwas it?
Probably the 60s and 70s, whensmoking, you know the issues
really came to light, reallystarted, you know downplaying it
and whatever.
But I just felt like we're backthere again in a similar
(30:43):
situation.
So I love that you pointed thatout because that, you know,
that's a trigger for thosepatients and that's something
that we need to be sure thatwe're talking about, because I
don't feel like we're alwaystalking about.
You know, we always mentionsmoking right, people, people
who vape don't think they smokeright, so it's so making sure to
point out the vaping, I think,is just really important.
(31:03):
So, yeah, yeah, okay.
Well, this has been so muchgreat information, rachel, like
just so good, uh, and uh, justso excited to have you on today
and to discuss this and to showhow these great resources from
Pearls just can really help ourpharmacists out.
That's our whole goal is tomake it easier for our
(31:25):
pharmacists, because we knowthat they're overworked, we know
that their workflow isdifficult, we know that they
have limited time, and so ifthere's anything that we can do
to make that time more specialand more dedicated to that
patient, and if we can trainthem in certain ways to be able
to be more effortless with thatcounseling, then that's our goal
(31:48):
.
So these are just such greatsupplements to the education
that we already provide.
So this is great.
Such great supplements to theeducation that we already
provide.
So this is great.
So what?
I always ask everyone, all myguests, at the end?
We've given lots of nuggetstoday that I hope our listeners
walk away with.
But what would you say?
Rachel is our game changer here.
So what is our, what's our realbig take home as pharmacists in
(32:10):
, you know, in the space ofasthma management?
Rachel Maynard (32:13):
Well, I think you know we can't say it enough
that those touch points that aresort of built in naturally to
some of our interactions withpatients are just the prime
opportunity to be able toreassess inhaler technique,
reassess adherence, help correctany issues that might be coming
up, identifying triggers, allof those things.
We didn't specifically say this, I don't think.
(32:34):
But another thing that tiesinto that is, before
recommending any change intherapy or encouraging a patient
to change their dosing orsomething like that, always
assessing inhaler technique andadherence before recommending
any change to a colleague orprescriber, because it could
just be a little correction canhelp them get the most benefit
(32:56):
from the medication and reallyimprove their symptoms.
So, and prevent thoseexacerbations and ED visits.
Josh Kinsey (33:02):
So that's a great point in that.
You know, don't always jump tothe fact that you need to up the
drug, because it could, ifthey're not getting it Exactly
and on the flip side.
Rachel Maynard (33:13):
I'll just throw in one more point here.
So we talk about often steppingup therapy, but also, if you
have a patient who's wellmanaged and after a few months
is stable, think about steppingdown too.
You know it's a step.
Steps go both ways.
So that's also something thatthe guidelines were, you know
consider when you may be able tostep down if a patient's doing
well, especially if they changedtherapy recently.
Josh Kinsey (33:35):
Great point, and that's not something that is
super common with a lot of thedisease states that we manage is
like, okay, well, let's justtake them off the stock.
So that's really a great pointto highlight.
So thank you Well again, Rachel.
So good, it's been great tohave you on this week.
Thank you so much for joiningus.
We really appreciate thepartnership and we appreciate
(33:57):
your time today.
Rachel Maynard (33:57):
Thank you so much.
This was fun, glad to be hereand glad to support girls here
with CE Impact.
Josh Kinsey (34:02):
Great, thank you.
If you're a CE Plan subscriber,be sure to claim your CE credit
for this episode of GameChangers by logging in at ce
impact.
com and, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game changing topic with
you again.
Hey, CEimpact subscribers, welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, andas always, I'm excited about
our conversation today.
Asthma remains a common yetoften mismanaged condition, with
poor control leading topreventable symptoms,
hospitalizations and reducedquality of life.
In today's episode, we'll coverrecent treatment updates,
(00:30):
counseling strategies and thepivotal role pharmacists play in
helping patients breathe easierand live better.
Before I introduce today'sguest, I wanted to share that
we've launched a special pilotseries in collaboration with our
friends at Pyrls, a modern druginformation resource and app.
These crossover episodes,called Game Changing Pyrls see
(00:51):
what we did there combine Pyrls'trusted, evidence-based
clinical tools with CEi mpact'sexpertise in pharmacy education
and accreditation, bringing youtimely, actionable content that
supports both your practice andyour professional development.
It's a privilege to workalongside the Pearls team and we
are excited to kick off thispilot series with today's
(01:12):
episode focused on themanagement of asthma, and
representing Pyrls today isRachel Maynard.
It's so great to have you asour guest today, rachel, welcome
.
Rachel Maynard (01:20):
Thanks so much, josh, so excited to be here.
Josh Kinsey (01:22):
Yeah, and I know that you have a busy schedule,
so we are so grateful that youtook time out of your schedule
to sit with us today and talkabout asthma.
And for our listeners, sinceit's probably the first time
they've met you or heard fromyou, if you want to take a
couple minutes to tell us alittle bit about yourself and
how you started in pharmacy andsome of your passions, and just
tell us all about yourself.
Rachel Maynard (01:48):
Yeah, sure.
So, yes, my backgroundoriginally was in community
pharmacy.
I started working as atechnician while getting my
undergrad degree and that's whatdrove me to go to pharmacy
school.
After pharmacy school, I did acommunity pharmacy residency and
practiced as a staff pharmacistfor a few years and also
providing clinical services fora grocery store chain and also
managing those services for aregional group of chains.
(02:08):
So after that I then sort ofmoved into the drug information
and education space writing,creating content for healthcare
professionals and I have donethat for now over a decade, and
most recently I've been withPearls in again a very similar
role, sort of helping to managethe editorial process, our
content development process, andto really ensure that we're
(02:32):
providing resources andeducation and tools for
clinicians to help them optimizepatient care.
And that's really what I'mpassionate about is knowing what
it's like in a communitypharmacy and how challenging
that can be, making sure theyhave the tools they need to
practice to the best of theirability.
And for our topic today, likeasthma, is one of those topics
that I think we see so manypatients with and we can make
(02:54):
such an impact on their lives,and so I'm super excited to be
here to chat about that.
Josh Kinsey (03:00):
Yeah, that's great, and a lot of our discussion for
today is going to focus aroundsome of those things that you
can do with the patient at thecounter and like making sure to
improve adherence and whatever.
But in general, you know,asthma is one of those disease
states that every pharmacist,regardless of what role they're
in, it's probably hasencountered a patient with it,
(03:20):
and so even you know some ofthese nuggets that we're going
to share today.
You know they can be implementedanywhere in your practice
setting.
So just I'm really excited.
I feel like asthma is one ofthose things that is super
important and really detrimentalto a patient's quality of life,
and I just I feel likesometimes we don't talk about it
enough because you know it's.
I just feel like we need toelevate it more and really focus
(03:42):
on how can we make the qualityof life for these patients
better.
So super excited about our talktoday.
So thanks again for joining us.
We really appreciate it andjust really excited about this
partnership with Pyrls.
So all right, so let's go andjump in, just as I always like
to do lay the groundwork and thefoundation, make sure
everybody's on the same page.
So let's just have a briefreview of asthma in general and
(04:05):
maybe just a reminder of youknow how is that different than
you know a chronic perspectiveof that like COPD and whatever,
like you know, because sometimesthose kind of get blurred
because inhalers are used forboth sometimes.
So let's just kind of have aquick review of asthma and just
kind of talk a little bit aboutthat and lay the groundwork
there.
Rachel Maynard (04:28):
Sure.
So in a nutshell, it's, as yousaid, chronic inflammatory
condition of the airways.
And so if you think about howasthma is diagnosed, there's
really sort of two components ofthat.
It's these respiratory symptoms, which are sort of those
classic symptoms you think of,like wheezing, cough, shortness
of breath, and then there's thisvariable expiratory airflow, so
you know, assessing whetherthere's reduced ability to
exhale because of thatinflammation, and so that's why
(04:50):
it makes sense that inhaledcorticosteroids are a
foundational treatment forasthma, because of that
inflammation and that variableairflow.
Josh Kinsey (04:59):
Sure.
Rachel Maynard (05:00):
In terms of differentiating from COPD.
That can be tricky becausethere are, you know, there's
overlap in symptoms with thecough, the shortness of breath.
I think some of thedifferentiators are things like
if you're waking up at nightwith symptoms, that's more
indicative of asthma.
If you have a patient who alsohas allergies, for example like
(05:20):
allergic rhinitis or eczema,those can also be sort of cues
that it might be more related toasthma, whereas if you have an
older patient, that can bechallenging because you know
there's sometimes some overlapthere.
But also thinking about ahistory of smoking, and if you
know, copd is almost alwaysassociated with a history of
smoking and so that's anothercue to think about.
(05:42):
But I will say, you know,smoking is also a trigger for
asthma symptoms too, and so eventhough there's overlap, there
can also be this people can haveboth, they can have features of
both and even though there'svariable expiratory airflow with
asthma, if you've had asthmafor a long time, some adults may
have more persistent airflowproblems and that can also be
(06:02):
more similar to COPD, wherethere's this more persistent
airflow problems, and that canalso be more similar to COPD,
where there's this morepersistent airflow limitations.
So that's why it's tricky, Iwill say.
In the most recent updatedasthma guidelines that we'll
chat about a little bit more,they actually called out what
term to use.
So you may have heard this termasthma, copd, overlap, and that
(06:24):
was sort of the term that weused to use because it was, you
know, just a way to think aboutthese two conditions overlapping
and the fact that they havesimilar symptoms and diagnostic
process and that sort of thing.
They are now encouraging peopleto use the term asthma plus
COPD so that it's not seen aslike a separate condition.
It's more so that people havefeatures of both, and so I
(06:44):
thought that was just sort of aninteresting nuance that they're
calling out asthma plus COPDversus overlap, because that's
inherent, but really thesepatients have features of both
asthma and COPD.
Josh Kinsey (06:56):
Yeah, and I think, rachel, one of the things that I
don't know that I thought this,but I feel like it was.
I feel like the generalpopulation thinks that sometimes
is that asthma is for kids andCOPD is for adults, and that is
we need to like make sure thatwe're not on that wavelength,
because that is not true,correct.
I mean, there are adults thathave asthma, and only asthma,
(07:18):
and maybe, like you said,overlap as well, but but that is
not the case, like you can'tjust look at it as children have
asthma and adults have COPDwhen they get older.
Rachel Maynard (07:27):
So I mean I'll say that I think that you can
use that as a differentiator tohelp again sort of figure out
what the patient has.
Sure, because asthma is COPD.
Josh Kinsey (07:35):
Is their age Right right?
Rachel Maynard (07:37):
But yeah, for I looked up some stats when
thinking about this topic, and9% of adults in the adults in
the US have asthma, versus 7% ofkids, and so you know it's very
common in adults and so, yes, Ithink that's a good distinction
to make.
Josh Kinsey (07:53):
Yeah, yeah, very good, okay.
So, and as you mentioned, thiskind of a great kind of lead in
here, it does affect millions ofpatients across different age
groups.
You gave some great stats there9%, 7%.
I mean, that's that's quitesignificant when you think of
that, and I think, justreiterating the fact that why
we're here today is to talkabout how proper management can
(08:14):
significantly increase thequality of life, decrease
hospitalizations, reducehealthcare utilization in
general, funding cost whatever,and just an overall reason for
us as pharmacists to jump in,because we have great access to
the patients, they have greataccess to us and these slight
little tweaks can really make adifference.
(08:37):
So I think that's really whatI'm excited to dig into today is
how just these a few littlethings that you can do and can
really change the patient'squality of life.
So, with that, what are some ofthe roles of the pharmacist?
So I know we're going to diginto them deeper, but what do
you feel like?
Where do you feel likepharmacists can interject
themselves here with asthma andwith asthma patients?
Rachel Maynard (08:59):
Yeah, so I think there's so many opportunities
again, regardless of yourpractice setting.
But one of the keys with asthmais that it's not just a set it
and forget it sort of condition.
It's something that you know.
Patients need to be assessedand their medications reviewed
and adjusted as needed, sort ofon this you know, cyclical basis
(09:19):
.
And so the idea that, like yousay, patients are coming in for
refills or even, you know, forwhatever reason, into the
pharmacy and just having thatopportunity to have these
frequent touch points with them,it's just such a prime
opportunity to reassess howtheir asthma is being managed,
how they're using their inhalers, if they're using it properly.
I would say that's one of thebiggest opportunities is just
(09:46):
thinking about those frequenttouch points and the fact that
we can really make an impact onadherence to medications, but
also how to use thosemedications properly and also,
you know, keeping an eye onthings like vaccinations and
preventing triggers and, youknow, other comorbid conditions
that can worsen asthma, likeobesity or GERD.
You know, all of these thingssort of are just a prime
opportunity for us, I think.
Josh Kinsey (10:06):
Yeah, I'm glad you mentioned vaccines, because
that's a big one.
You know, the guidelines callout specifically that section of
the population and there are,you know, certain things that
are recommended for them, and soI think that's really important
too and I love the idea.
I mean, we should be doingcyclical type interventions with
our patients in every diseasestate.
(10:27):
But this one, you know,certainly, and also thinking
about too again, especially ifit's a child who has asthma, as
they grow, as their body changes, as their hormones change and
the way that they metabolize, Imean we may have to adjust doses
as they grow older.
So you know just things.
Thinking about that too, likeyou can't just be like, okay,
they're on a maintenance inhalerand they're on a rescue inhaler
(10:50):
and they're good till they're25 or whatever, like that's just
not going to be the case.
Rachel Maynard (10:54):
So well and honestly sorry, josh.
I mean, I think one of thethings is, even like a decade
ago, the way we thought aboutmanaging asthma is very
different than I think whatguidelines are recommending now?
Whether or not all of thosechanges to the guidelines can be
implemented in practice isanother story, but yeah, there's
.
There's been quite a change inthinking over the last few years
(11:15):
and so, even if a patient'sbeen on therapy for a while, if
they're not well managed, itcould be an opportunity to
relook at that and see ifthere's an opportunity to
improve.
Josh Kinsey (11:24):
Yeah, that's great and you bring us.
Let's talk about guidelines.
So one of the opportunities forpharmacists is to make sure
that we are up to date on theguidelines for the treatment and
management of asthma.
So let's talk a little bitabout what that looks like, and
I know that we're going toutilize a wonderful resource
(11:45):
from Pearl, so I'll let you kindof guide me on when to share
that screen.
But, yeah, let's talk a littlebit about the importance of the
guidelines and making sure thatwe're up to date on those.
Rachel Maynard (11:54):
Sure.
So the guidelines are the onesthat I think many clinicians are
following these days are fromthe Global Initiative for Asthma
, or GINA guidelines, and thoseare nice because they come out
every year, and so they justcame out in May, a couple of
weeks ago and it allows us tosort of keep on top of what's
(12:14):
changing, what evidence iscoming out, how can we improve,
you know, standard of care andeven little things, like I
mentioned, that asthma plus COPDversus asthma, copd overlap and
some preferred terminology,that sort of thing.
They address that too.
So I think that's typicallywhere people are following.
Are these GINA guidelines?
(12:40):
There were guidelines, and GINAis international, so it's not
country specific, whereas thereare US-based guidelines that you
might remember from theNational Health, lung and Blood
Institute from like 2007, soalmost 20 years ago, and those
are still in place.
They did come out with a morefocused update in 2020, looking
at just a few key things, and sothat was sort of where the
(13:02):
concept of smart therapy, whichI'm sure we'll talk about, came
out on the US side of things,and then again, gina has sort of
been iterating on that over thepast few years as well.
So I just say that becausethere's a couple different sets
of guidelines, but I think, justfrom a frequency of updates
perspective, the Gina guidelinesare where a lot of us tend to
rely on, and so, yeah, to thatend, what we've been working on
(13:25):
at Pearls just recently isupdating our pharmacotherapy
review, which is like a quicknote sort of how you approach a
patient with asthma, andupdating that to reflect these
most recent guidelines that justcame out.
Josh Kinsey (13:39):
Yeah, that's great, that's great.
Do you want to jump into someof those?
Yeah, let's go for it.
Rachel Maynard (13:46):
And so, yeah, you can share the chart that we
have, which is, as you said,sort of a stepwise approach, and
we have it outlined for bothadolescents and adults, so 12
and older, and then also foryounger children.
But in terms of just thinkinggenerally, especially about this
broad population of ouradolescents and adults, you can
(14:08):
see there's sort of thispreferred approach and then also
an alternative approach, andthe preferred approach is really
where Agena recommends thatmost patients start and the
focus is on making sure thatpatients at diagnosis or soon
thereafter are incorporating aninhaled steroid into their
therapy in some way, and that'sto again help reduce that
inflammation and help manage andalso prevent symptoms and
(14:32):
exacerbations going forward.
So, with either the preferredor the alternative approach, the
idea is that the patient willhave both a controller
medication and a relievermedication, and so the
controller, as the name implies,it, helps to manage those
symptoms and prevent futuresymptoms.
That reliever is to help with,as needed, you know, when
(14:54):
wheezing, coughing, those asthmasymptoms crop up, to help
provide that quick relief.
But I will say this is anotherthing that I sort of learned as
we were doing this most recentupdate the idea of controller
versus maintenance is that I wasthinking of them as sort of
synonymous, and again, I thinkthat's because we've had this
(15:14):
idea that you know you have yourquick relief inhaler and then
you also have your maintenanceinhaler that you take every day
to prevent symptoms along withyour reliever, and whether
that's a short-acting betaagonist or a long-acting beta
agonist, like for motorolspecifically, the idea is
(15:38):
helping the patient get thatinhaled steroid at the same time
they're getting their quickrelief medication.
So the idea of a controllercould actually be something that
a patient is using only asneeded.
If they have their inhaledsteroid for motorol combo and
they're only using it as needed.
If they have their inhaledsteroid promoter or combo and
they're only using it as neededfor more mild asthma, it's still
(15:58):
helping to control theirsymptoms, right?
It's not something they need touse every day, and so I thought
that was a really interestingdistinction just this idea of
controller versus maintenancenot being interchangeable and
sort of this new paradigm aboutincorporating inhaled steroids
and more of that, you know, evenas needed therapy.
Josh Kinsey (16:18):
Yeah Well, I was going to ask because I used the
term rescue inhaler earlier.
I was going to ask if that'sbeen replaced with reliever.
So is that?
Is that the case, like is thatpretty much.
Rachel Maynard (16:28):
You know that's a good question.
They I didn't see anything inthe guidelines about that
specifically.
They do say that people oftendo you refer to it as a rescue
inhaler.
It's really just for that quickrelief of symptoms.
I think the what I've heard inthe past about the concern with
the term rescue is that, like,it's not meant to be.
Yes, it relieves your symptomsquickly, but it's not meant to
(16:49):
be used Like if you're having anacute exacerbation you might
need you know to go to thehospital or something.
So but with, with the, the, thegrowth of sort of these combo
inhalers with a formotorol withinhaled steroid, or even the
more recent product that's comeout in the last couple of years,
which has albuterol with aninhaled steroid, the idea is
(17:12):
that hopefully it will be less.
You know, rescue, becauseyou're getting that, that
steroid, along with your quickrelief.
Josh Kinsey (17:21):
I appreciate that approach in the sense of rescue
kind of indicates, you know,like, oh, this takes care of an
emergency situation, as opposedto it really shouldn't Like if
there's's, if it's a really diresituation, you should be
seeking emergent care.
Um, and so reliever is yeah,okay, I can see that that makes
sense.
Uh, okay, well, also, thesecharts are so good, I mean,
(17:45):
they're just, they're so.
I mean, I am your typical typea pharmacist who just loves you.
You know colors and flow and Ialways my family and friends
whenever they visit or wheneverwe go on a trip, I have a
color-coded itinerary for ourtrip.
Rachel Maynard (18:03):
And so I always.
Josh Kinsey (18:05):
I always get poked fun at for all of my color
coding and I even like work inlike this is when we're relaxed
in the room.
Rachel Maynard (18:12):
Oh, wow.
Josh Kinsey (18:16):
So I love these charts Like this just this
speaks my language right hereand they're just, they're so
good and they're so easy to haveon hand just to help with your
patients as you're managingasthma, and this is just one
disease state where we'relooking at something that Pearls
has.
So these are just so great.
And for the listeners, I didn'treally mention it, but all the
(18:41):
charts that we're showing, allthe handouts and resources that
we're showing, are going to beavailable in your profile.
So be sure to grab these,you'll be able to have access to
them.
Be sure to grab these, you'llbe able to have access to them,
so okay.
So with that, let me get back tomy notes here.
So let's talk a little bitabout we've kind of gone over
the importance of the guidelinemaking sure that understanding.
(19:04):
Why is that important for thepharmacist to stay up to date on
it?
Because, like you've said, theychange every year and sometimes
those nuances are, you know.
It's important to note them.
So let's talk about the role ofpharmacists in counseling,
specifically with inhalertechnique, to ensure that
patients are getting the rightdelivery of the medication, and
(19:27):
you know I've seen so manypatients over the years just do
it so wrong over the years justdo it so wrong and it's so sad
because you know it's just asimple, a simple discussion that
can be had and showing oftechniques.
So let's, I'd like for you totalk a little bit about the
importance of that.
Rachel Maynard (19:45):
Yeah, I mean, I think you're spot on.
It seems like something thatit's.
It seems like something that itit's simple but not necessarily
easy.
Right, like so the idea thatlike it's something that we
should be able to tackle andpatients should be able to
tackle.
But you know, every inhaler isdifferent.
(20:06):
They all have their littlenuances in terms of preparation
and cleaning, and you know andit's not super intuitive, like
you know.
Josh Kinsey (20:13):
sometimes I've even looked at a new one and been
like what know?
And it's not super intuitive,like you know.
Sometimes I've even looked at anew one and been like what do I
do?
You know.
Rachel Maynard (20:19):
Right, right, yeah, and thinking about like
limited time too.
We all have limited time and soto like have to open up a
package and open up the labeland like help a patient walk
through that, that can be a bigbarrier.
And so, yeah, I think in theguidelines I think they said
like up to 70 or 80% of patientshave trouble using their
inhaler, don't use it properly.
So it's like a huge, hugenumber.
(20:40):
But also that many healthcareprofessionals, as you said,
don't always know how toproperly instruct if they're not
intimately familiar with theproduct either.
So, yeah, actually, so withinthe Pearl's Drug Summary pages,
in our counseling points, youknow we have these key
counseling points to just drillin on that you're going to focus
on with the patient.
And right in there is theadministration guide for these
(21:02):
inhalers, so you can just popthat up with that again, having
to like open up their packageand sort through the label.
So just open that up and thenwalk through it with the patient
.
But I would say, like you know,it's sort of that classic teach
back method, so walking themthrough the steps as you would
normally counsel a patient andthen having them teach you back
(21:23):
how they would do it and thenpointing out any errors or
opportunities for correction.
But I mean, it's, each inhaleris different, as we said.
And then there's the meter doseinhalers, which are a little
different from the dry powderinhalers and require different
techniques.
Josh Kinsey (21:48):
And so, yeah, it's definitely a challenge, but
something that is just rightwithin our wheelhouse and such a
good opportunity to impactAbsolutely.
And you know I'd be remiss ifwe didn't talk about, during
counseling, reiterating theimportance of adherence, you
know.
Rachel Maynard (21:56):
Oh, absolutely, yeah, yeah.
Josh Kinsey (21:59):
Yeah, that is going to be something that is super
important for specifically thisdisease state, because if
they're adherent on, you knowthe regular, what is it?
Rachel Maynard (22:08):
now their controller controller.
Josh Kinsey (22:15):
If you're adherent with their controller
medications now, then you knowthey're going to be able to use
less and less of those relieverproducts and have less and less
exacerbations that require, youknow, some sort of emergent care
, hospitalization whatever,which is our goal, like we're
trying to improve the quality oflife and reduce the burden on
healthcare, you know so yeah, soadherence is also super
(22:36):
important to talk about withpatients, along with the
technique.
Rachel Maynard (22:41):
And so just to like expand on that a little bit
, because again, this concept ofhow asthma is managed has
changed in the last decade or soa little bit, and so, like the
idea of your inhaled steroid isyour controller, you do that
every day and then you have youralbuterol, which is your quick
reliever, and you're doing thosetogether.
But really the guidelines in thepast few years have encouraged
(23:03):
this smart therapy, so singleinhaler, maintenance and
reliever therapy all in oneinhaler, and so that makes it so
much easier for patientsbecause it's just one inhaler.
They don't have to think about,well, I use this for this and
this for this.
It's one inhaler and they canuse that combo inhaler for their
quick relief of symptoms andfor their daily maintenance, and
(23:26):
so that hopefully helps tosimplify things.
But also, you know, if you havea patient with more mild asthma
and maybe they're not on aninhaler every day, but they are
using it when they have symptomsand they're getting that
inhaled steroid dose becausethey're taking that combo
product Adherence means a littledifferently there, but it's
(23:47):
like making sure that they areusing it when they have symptoms
and they know they can.
You know, they know thatthey're using that instead of
maybe they had albuterol in thepast and you know understanding
why they're maybe now using thatcombo inhaler.
So, yeah, it's.
I will say, also thinking aboutadherence, though, even though
(24:08):
the smart therapy has been sortof, you know, the preferred
treatment, now I think cost andinsurance issues can be a
barrier.
So, you know, if you're usingsmart therapy and you're using
your maintenance dose, butyou're also supposed to be using
it as a reliever, thensometimes insurance will pay for
that additional dosing and so,yeah, we have right, because you
(24:32):
would, you would run out, itrun out of it sooner than what,
yeah, like how do you monitorthat day's supply?
Josh Kinsey (24:37):
yeah, exactly, and again that goes back to your
point earlier where you weretalking about.
This is a cyclical managementfor these patients, because you
know what.
If you see like, oh, they'recoming in every 18 days for this
, then clearly maybe maybe thedose is not right, maybe they're
not as controlled as we thought.
(24:57):
You know, because they're usingit so much more often and you
know that's what we aspharmacists can see.
We can see when they'rerequesting the refill too soon.
Or you know if we're on theprovider side of it.
We can see when you know therefills are coming in as
requests to send and things likethat.
So, yeah, like in an AmCaresetting or whatnot, where we're
(25:20):
working to actually, you know,manage the care.
So yeah, that's great.
The other thing to talk about Ithink that's important in
adherence is also talk about incounseling.
Along with adherence is alsothe importance of trigger
avoidance.
Can you speak a little bit tothat?
Is there anything you want totalk about in counseling?
Along with adherence is alsothe importance of trigger
avoidance.
Can you speak a little bit tothat?
Is there anything you want totalk about there?
Rachel Maynard (25:37):
Yeah.
So again, that's a greatopportunity for us to be
listening to what patients aretalking about, just even in
conversation, as you're justchatting with them about other
things.
Right now, allergy season issort of in full swing and that
can be a trigger for manypatients with asthma.
So, being aware of that, again,smoking can be a trigger.
So if a patient does smoke orvapes, you know, pointing out
(26:02):
that this could be contributingto the worsening of your
symptoms and helping them onthat journey to quit if possible
.
There's also, you know, a viralinfection that could be a
trigger.
So helping patients stayhealthy again through
vaccination.
And so, yeah, I mean, again,there's seeing patients and
(26:23):
they're getting, you know, anover the counter histamine or
something, or you see themsneezing and you know these
sorts of things can be a cue tobe like hey, did you also know
that this could be?
This could impact your, yourasthma management too.
And maybe we need to thinkabout, you know, monitoring
closely if you're having somesort of viral infection or
allergies or whatever the casemay be Absolutely, absolutely.
Josh Kinsey (26:43):
Yeah, those are all great points.
So let's, I think we've kind ofhit on our major points that I
wanted to be sure we talkedabout today.
I want to also show your othercouple of resources that are
going to be available tolisteners.
So let's, I'll just kind ofshare and you can kind of just
quickly let us know what we'relooking at here.
Rachel Maynard (27:05):
Yeah, so so we at Pyrls we have this really
fabulous inhaler chart thatcompares the dose
categorizations for inhaledsteroid combo products, so
various inhalers that haveinhaled steroids.
You can sort them into low,medium or high dose and that's
based on the GINA guidelines.
And it can be challenging tosort of quickly compare what
(27:30):
dose a patient might be on andwhat they might need to switch
to.
And again, this goes back tothe idea of like adherence and
making sure we're overcomingcost barriers for patients,
because insurance plans change,insurance formulas change and
patients may all of a sudden benot able to get the inhaler that
they've taken for years, and sothis part allows you to very
(27:50):
quickly compare.
Okay, if a patient's onmometasone and they're going to
switch to fluticasone at amedium dose, here's how you
would do it with the number ofpuffs per day and it's again
sorted by ages 12 and older andpediatrics.
So a very quick and easy way tohelp those patients switch if
formulary issues come up.
And I will just say, with boththe step therapy chart and this
(28:15):
corticosteroid comparison chart,it is meant and is used as a
way to keep it very simple, butalso being aware that, like
after any switch.
We also still want to encouragepatients to be monitoring their
(28:38):
symptoms, being aware of anyworsening of asthma, because
everyone's going to responddifferently to their particular
product.
So it's just a good reminder to, after any switch or when
starting, circling back withthat patient again to see how
they're doing.
Josh Kinsey (28:53):
Yep.
So it's a great guidancedocument.
It is not the gospel truth, youknow exactly.
And then this one, which I alsolove again, love the color
coding, love the flow ofeverything, and just the summary
of it's just so good.
So I'll let you kind of speakto this one really quick too,
yeah.
Rachel Maynard (29:11):
So this is an inhaler comparison chart and,
like you say, it's just, it'svery nice to look at.
You know, there's not a lot ofthe things that you're looking
at on paper that you're like, oh, this looks nice to look at.
But this, I would say, is it'svery, like you say, color coded.
It's sorted by class, soinhaled steroids versus labas
versus Lama labas and combos, sovery easy to quickly find what
(29:33):
you might be looking for interms of which drugs are in a
specific class.
It also notes which ones areapproved for asthma versus COPD.
So helping with that indicationand also with the approved age
ranges.
And then there's dosecategorizations in there too.
So helping again if you need toswitch between doses of
particular steroids, helps withthat conversion as well.
(29:54):
And it also, by the way, noteswhich products are available as
generics or authorized generics.
Josh Kinsey (29:59):
So, again, if you're running into insurance
issues, that could be anotherclue to help with those, those
barriers absolutely yeah, andone thing you mentioned earlier
and I'll just this is kind ofjust to summarize and reinforce
the importance of counseling andadherence and, you know,
talking about the triggers andthat kind of thing.
One thing you mentioned wasvaping and I heard recently the,
(30:20):
the percentage of patients thatand it's staggering and just,
and you know, like, just I feellike we're back in that cycle of
you know the whole, like whatwas it?
Probably the sixties andseventies when, when smoking,
you know the whole, like whatwas it?
Probably the 60s and 70s, whensmoking, you know the issues
really came to light, reallystarted, you know downplaying it
and whatever.
But I just felt like we're backthere again in a similar
(30:43):
situation.
So I love that you pointed thatout because that, you know,
that's a trigger for thosepatients and that's something
that we need to be sure thatwe're talking about, because I
don't feel like we're alwaystalking about.
You know, we always mentionsmoking right, people, people
who vape don't think they smokeright, so it's so making sure to
point out the vaping, I think,is just really important.
(31:03):
So, yeah, yeah, okay.
Well, this has been so muchgreat information, rachel, like
just so good, uh, and uh, justso excited to have you on today
and to discuss this and to showhow these great resources from
Pearls just can really help ourpharmacists out.
That's our whole goal is tomake it easier for our
(31:25):
pharmacists, because we knowthat they're overworked, we know
that their workflow isdifficult, we know that they
have limited time, and so ifthere's anything that we can do
to make that time more specialand more dedicated to that
patient, and if we can trainthem in certain ways to be able
to be more effortless with thatcounseling, then that's our goal
(31:48):
.
So these are just such greatsupplements to the education
that we already provide.
So this is great.
Such great supplements to theeducation that we already
provide.
So this is great.
So what?
I always ask everyone, all myguests, at the end?
We've given lots of nuggetstoday that I hope our listeners
walk away with.
But what would you say?
Rachel is our game changer here.
So what is our, what's our realbig take home as pharmacists in
(32:10):
, you know, in the space ofasthma management?
Rachel Maynard (32:13):
Well, I think you know we can't say it enough
that those touch points that aresort of built in naturally to
some of our interactions withpatients are just the prime
opportunity to be able toreassess inhaler technique,
reassess adherence, help correctany issues that might be coming
up, identifying triggers, allof those things.
We didn't specifically say this, I don't think.
(32:34):
But another thing that tiesinto that is, before
recommending any change intherapy or encouraging a patient
to change their dosing orsomething like that, always
assessing inhaler technique andadherence before recommending
any change to a colleague orprescriber, because it could
just be a little correction canhelp them get the most benefit
(32:56):
from the medication and reallyimprove their symptoms.
So, and prevent thoseexacerbations and ED visits.
Josh Kinsey (33:02):
So that's a great point in that.
You know, don't always jump tothe fact that you need to up the
drug, because it could, ifthey're not getting it Exactly
and on the flip side.
Rachel Maynard (33:13):
I'll just throw in one more point here.
So we talk about often steppingup therapy, but also, if you
have a patient who's wellmanaged and after a few months
is stable, think about steppingdown too.
You know it's a step.
Steps go both ways.
So that's also something thatthe guidelines were, you know
consider when you may be able tostep down if a patient's doing
well, especially if they changedtherapy recently.
Josh Kinsey (33:35):
Great point, and that's not something that is
super common with a lot of thedisease states that we manage is
like, okay, well, let's justtake them off the stock.
So that's really a great pointto highlight.
So thank you Well again, Rachel.
So good, it's been great tohave you on this week.
Thank you so much for joiningus.
We really appreciate thepartnership and we appreciate
(33:57):
your time today.
Rachel Maynard (33:57):
Thank you so much.
This was fun, glad to be hereand glad to support girls here
with CE Impact.
Josh Kinsey (34:02):
Great, thank you.
If you're a CE Plan subscriber,be sure to claim your CE credit
for this episode of GameChangers by logging in at ce
impact.
com and, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game changing topic with
you again.
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