PHCY310 W03 ASTHMA

Student Instructions

Activity Time
Introduction 5 min
Activating prior knowledge; Kahoot 15 min
Case 1 – Adult Asthma (new diagnosis) 40 min
30 min prep, 10 min feedback
Case 2 – Adult Asthma (non-compliance 15 min
with preventer) 10 min prep, 5 min feedback
Case 3 – Paediatric Asthma (non- 30 min
compliance with reliever) 20 min prep, 10 min feedback
Total 110 min

Assessable tasks:

1. Recommend pharmacological and non-pharmacological approaches for the

treatment of asthma
2. Develop a care plan for someone with newly diagnosed asthma
3. Explain reasons for non-compliance with inhalers
4. Be aware of different situations where you might sell an emergency supply of a
salbutamol inhaler and know what legislation allows you to

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Learning outcomes:

LO SLO Description of Learning Outcome

L3.4 Describes and integrates the principles of physiology, pathology,
microbiology, pharmacoepidemiology and pharmacotherapy in
relation to disease control.
3.4.2 Describes the influence of disease on the underlying physiological
processes, including signs and symptoms
3.4.5 Explains the influence of drugs as symptom managers at the
disease and whole body level
L3.7 Develops and implements a person-centred care plan.
3.7.1 Assesses person information (see also LO 3.1) and identifies
person related clinical issues
3.7.3 Assesses each medicine for appropriateness, effectiveness,
safety, and adherence
3.7.6 Generates therapeutic options in accordance with the person’s
goals and evidence-based practice
3.7.7 Determines the therapeutic option that maximizes the health
benefits in accordance with the person’s goals and evidence-
based practice
3.7.9 Develops a monitoring plan to assess goal attainment
3.7.9a Determines the response measure that reflects the goals of
treatment
3.7.9c Determines the likelihood of attaining the goals of treatment
given the current response
3.7.9d Determines when to refer a person to another healthcare
professional
3.7.9e Determines the best management strategy (e.g., no change,
adjustment, referral for reassessment) to achieve the desired
response
L5.6 Dispenses medicines in accordance with legal requirements,
professional responsibilities and safety of the person.
5.6.2 Describes the legal requirements and professional responsibilities of
dispensing non-controlled and controlled medicines.

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Kuracloud/Lt pre-workshop preparation for students:

 Pre-reading: Pharmacotherapy principles & practice, Chisholm-Burns; Asthma

chapter
 TED-Ed YouTube clip How Asthma Works
 Asthma Action Plans – become familiar with the different documents
 Asthma first aid – become familiar with the document
 Te Whare Tapa Whā – revision of model of health
Linked sessions:

 Skills 1 - Communication OSCE station

o Emergency salbutamol (asthma) supply
o Motivational interviewing steroid inhaler (asthma) non-adherence
 Skills 2 - Dispensing & Documentation (SOAP note)
o Emergency salbutamol (asthma) supply
 Skills 4 - Communication OSCE station
o Counselling on inhaler technique
o MI nonadherence due to parent concerns about steroid inhaler ADRs
 Lecture
o Background – Sarah Hook
o Medicinal Chemistry – Andrea Vernall
o Clinical Pharmacology – Stephen Duffull
o Therapeutics - PPF
o Respiratory laboratory tests – Stephen Duffull

 Workshop
o Respiratory inhaler techniques workshop – James Windle
o PHCY220 mouth conditions workshop

Assessment:

 Final exam

Introduction to Workshop 5 min

Activating Prior Knowledge - Kahoot 15 min

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Case 1: Adult asthma (opportunistic review) – 40 min

Hōhepa Rangi
Hōhepa, is a 25-year old male, and is from Tāmaki Makaurau (Auckland). Hōhepa has
just finished university and started a new job as an accounts manager and is feeling the
stress of the new workplace. Hōhepa regularly runs 5km 3 times per week and he has
recently joined his brothers’ touch rugby team.
Hōhepa is a current smoker (for 5 years) and smokes about 20 cigarettes/day. His
weight is 95kg, and height is 185cm.
Hōhepa presents to your pharmacy to collect his regular medicines for asthma, and as
his community pharmacist, you take the opportunity to review how he is getting on with
his asthma. You discover;

 Poor inhaler technique

 Increased use of salbutamol, especially when exercising. He had to sub off rugby
last week because he was coughing and had chest tightness
 Often forgets to use fluticasone inhaler at night
Current medical conditions

 Asthma (diagnosed 2 years ago)

 Seasonal hay fever
Current medications

 Salbutamol 100 mcg, 1-2 puffs up to QID prn

 Fluticasone 125 mcg, 1 puff BD regularly
Allergies

 Shellfish
Hōhepa’s goal: to get rid of this cough so he can play a good game of rugby.
Pharmacist’s goals: to provide optimal pharmacotherapy with minimal or no adverse
effects, support his exercise plan, find out if he needs any smoking cessation support
and to find out about his mental health status.

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Hōhepa Rangi

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STUDENT information:
In your group, work through the care plan template below, ensuring that you
write your pharmacological and non-pharmacological treatments to address
both Hōhepa’s and your goals to help improve his asthma. Use Te Whare Tapa
Whā to base your approach. Hint: There are 4 (or more) problems - think
holistically.

Look at the 4 Step Asthma Action plan and consider what information to
review with Hugo.

The care plan will be discussed as a group.

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Writing a Care Plan: Identifying Issues, Clinical Reasoning and Judgement

Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
Treatment/ Therapy
Priority‡ problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana:
Exercise
1
induced
asthma

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana: Poor Hōhepa:

2 inhaler
technique Pharmacist:

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana: Hōhepa:
3
Smoking Pharmacist:

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Hinengaro/
whānau:
Mental health Hōhepa:
3
check: is Pharmacist:
stressed at
work

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana/hineng
aro
/whānau / Hōhepa:
4 wairua:
Pharmacist:
If Hōhepa
ceased
exercising

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Case 2: Adult asthma (non-compliance with preventer) – 15 min

Aarav Singh
Aarav and his brother pop into your pharmacy to collect Aarav’s asthma inhalers. Aarav
is needing some help because he is feeling wheezy again and thinks he is getting a
chesty cough.
During the consultation you discover that Aarav has stopped using his preventer inhaler
as he doesn’t think he needs it, and he especially doesn’t want to be taking steroids as
these are what body builders’ use.
Current medication:

 Terbutaline 250 mcg 1-2 puffs QID prn

 Beclomethasone dipropionate 200mcg 1 puff BD

Aarav’s goal: to get rid of this cough so he can continue his new exercise routine.

Pharmacist’s goals: prevent Aarav from having an asthma attack and any complications
associated with asthma (e.g. lower respiratory tract infection).

STUDENT information
 Why does Aarav not want to use his preventer?
 What can you do to educate Aarav and his whānau on using his inhalers?
 What crucial information is missing?

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Case 3: Paediatric asthma (acute attack and non-compliance) – 30 min

Maia Jones. 8 years old. 25kg.

Maia and her Mum present to your pharmacy to collect Maia’s regular medicines for
asthma. Maia’s Mum said that Maia had been a bit wheezy overnight and her
symptoms seem to be getting worse, which is confirmed with Maia not able to complete
sentences due to shortness of breath. During the consultation, you discover;

 Maia needs to use her reliever inhaler now, but they don’t have one with them.
 Maia usually uses a spacer with her preventer, and is compliant with BD dosing.
 Maia brushes her teeth after using the preventer.
 Maia occasionally needs her reliever inhaler when doing sports at school, and has
been getting teased when she uses it.
Current medical conditions

 Asthma (diagnosed 3 years ago)

Current medicines

 Fluticasone 50 mcg inhaler, twice daily regularly

 Salbutamol 100 mcg inhaler, one to two puffs up to QID when required

Allergies

 Cats, horses, dairy.

Maia’s goal: to be able to breathe normally
Pharmacist’s goal: prevent asthma attack and potential hospital admissions. Problem
solve the teasing situation at school.

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STUDENT information
In the care plan template below, write your pharmacological and non-
pharmacological treatments to address both Maia’s and your goals to help
improve Maia’s asthma. Use Te Whare Tapa Whā holistic approach to this care
plan.

Hint: There are 6 (or more) problems - think holistically. Once this is
completed, the care plan will be discussed as a group.

Questions
 What information do you need to gather to provide an emergency
supply of the inhaler?
 What legislation allows you to provide an emergency supply of a
salbutamol inhaler?
 What would you do if the person needed an ambulance? Or they hadn’t
been prescribed salbutamol by a NZ prescriber? Or they don’t have
current symptoms of an asthma attack? Or they have purchased a few
inhalers recently?

What information do you need to gather to provide an emergency supply of the

inhaler?

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Writing a Care Plan: Identifying Issues, Clinical Reasoning and Judgement

Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
Treatment/ Therapy
Priority‡ problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana: acute Maia:

1
asthma attack Pharmacist:

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana/
hinengaro/
whānau:
Maia:
2 Non-
Pharmacist:
compliance
with reliever
inhaler

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana:
Maia:
3 Potential for
poor inhaler Pharmacist:
technique

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana:
Maia:
4 Potential for
not fully Pharmacist:
vaccinated

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Tinana:
Maia:
5 Potential for
poor cleaning Pharmacist:
of spacer

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Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine
related Treatment Monitoring/ Patient
‡ Treatment/ Therapy
Priority problem Options Recommendation Counselling
Goals Follow-up
Considered Points
(actual or potential)

Maia:

Pharmacist:

Whenua:

Potential for
house to be
6 contributing to
asthma (e.g.
mould,
smoking, cold)

‡ Once all drug therapy problems are identified prioritise them in order of importance / severity, where 1 = the most urgent / important

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