The Role of Clinical Pharmacist in Asthma Disease (Research Paper Sample)

Critical Appraisal of the Role of a Clinical Pharmacist in Asthma Disease
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Critical Appraisal of the Role of a Clinical Pharmacist in Asthma Disease
Introduction
Asthma is a chronic inflammatory disease affecting the airways, and it is characterized by hyper-responsiveness to multiple stimuli. It occurs predominantly in early ages, and the broad types are allergic, idiosyncratic, and mixed group. Atopy is the most frequent risk factor for asthma, which is associated with family or personal allergic diseases (Lowe, Tannenbaum, Gautier, & Jimenez, 2009). Pathogenesis of an asthmatic diathesis is based on nonspecific hyperirritability and high reactivity that can be severe, and persistent, but responsive to pharmacological intervention. The inflammation renders the airway edematous, infiltrated with leucocytes, glandular hypertrophy, elevated capillary density, hyper-secretion, broncho-constriction, and a vicious inflammatory cycle without change in collagen content of the epithelial basement membrane (Hansbro, Kaiko, & Foster, 2011). The pathophysiology of asthma includes decreased diameter of the airway by edema, secretions, vascular congestion, and smooth muscle contraction. The net consequences of these changes are increased resistance in the airway, decreased air flow rate and forced expiratory volume, increased breathing work, hyperinflation, altered elastic recoil, function of respiratory muscles, ventilation-perfusion mismatch, arterial blood gas, respiratory alkalosis, hypocapnia, and universal hypoxia although frank ventilation failure is rare, (10-15%) of patients with acute exacerbations (Bell, 1994). Patients experience wheezing, dyspnea, cough, constriction in the chest, audibly harsh respiration, prolonged expiration, tachypnea, tachycardia, mild systolic hypertension, use of accessory respiratory muscles, paradoxical pulse, and overinflated lung evidenced by increased antero-posterior thoracic diameter. Diagnosis of asthma is made by establishing reversible obstruction of the airway and spirometric evaluation of the extent of obstruction (PEF, FEV1, FVC, and FEV1/FVC) prior and after administration of a short-acting broncho-dilator (Stearn, 2005). Significant ability to reverse airflow obstruction is determined by an increase of more than 12% and 200 mL in FEV1 or more than 15% and 200 mL in FVC following inhalation of a short-acting bronchodilator (Sanz, 1999). Other diagnostic tests are bronchial provocation test, arterial blood gas and pH assessment, skin sensitivity for allergen, and chest radiograph to show hyperinflation, bronchial wall thickening, and disappearing peripheral vascular shadows of the lung. According to the British Guideline on the Management of Asthma (2012), accredited by the National Health Service (NHS) Evidence provided by the National Institute for Health and Clinical Excellence (NICE), management of asthma is both non-pharmacological and pharmacological, and the choice of treatment is determined by symptoms versus control (Small, 2003). The guideline advocates for developing patient/family/clinician partnership, identifying and reducing exposure to risk factors such as allergens, assessing, treating, and monitoring asthma patients, as well as managing asthma exacerbations (Wilson, 2008). Pharmacological management is indispensable in controlling asthma disease, and the role of a clinical pharmacist is vital in ensuring optimal patient outcome. This paper aims to appraise critically the role of a clinical pharmacist in asthma disease by comparing the role of a clinical pharmacist in the United States (US) and the United Kingdom (UK) with evidence from respective guidelines.
The role of a clinical pharmacist in the UK
A clinical pharmacist has a role in patient safety, proper use of medication, and to monitor the outcome of pharmacological therapy (Parameswaran, & Hargreave, 2001). NHS statistics indicates that the mortality rate from asthma has remained constant at 1000 deaths per year because clinical pharmacists have played a contributory role in attending to admit patients and emergency cases (Practice Nurse, 2007). Clinical pharmacists control the exacerbation of asthma symptoms and their increased involvement in the clinical setup is expected to reduce the cost of asthma management in the UK, which is approximately one billion pounds annually. This is because 80% of this expenditure is spent on the 20% of asthma patients who present with severest symptoms. Pharmacist prescribers have a significant role in supporting outcome strategy for asthma published by NHS aimed at improving well being of communities in regard to asthma disease by providing long term management, engaging in risk profiling, patient self care, and integrated care team (Burns, 2008).
The Department of Health policy objectives was to improve care for patients, access, choice, and patient safety in the year 2000 by encompassing professional skills in flexible working team across the NHS. Pharmacists have been training since the year 2006 to assume an independent prescribing role in controlled drugs such as medications used in asthma disease. This role of clinical pharmacists in the UK has resulted in flexible patient oriented care, faster access to medicine, improved service efficiency, and time saving. The strategy is acceptable, clinically appropriate for asthma disease, safe, and beneficial to both clinicians and patients.
Clinical pharmacists are significant in ensuring the NICE guidelines for the management of asthma patients is adhered to in order to achieve control of the disease. This role entails amending inappropriate drug therapy, undertaking assessment on inhaler technique to deliver the correct dose, discussing the available therapeutic options, addressing adherence issues experienced by patients, to implement the guidelines into evidence based management, and to advise patients on ways of avoiding allergens. They inform asthma patients who are at risk of acute asthmatic attack or adverse drug reactions (Davies, Green, Mottram, & Pirmohamed, 2010). The role of providing medical advice and recommendations in tandem with the UK guidelines is best achieved by clinical pharmacists who comprehend pharmacological asthma disease therapies because it is their field of expertise. The professional advice on drugs is essential not only in managing asthma disease patients in a clinically effective manner according to the national guidelines but also in administering cost effective interventions as proposed by the NHS.
Education on asthma control and optimal medication use are necessary strategies outlined in the UK guidelines, and it is the role of clinical pharmacists to educate patients with the objective of achieving asthma control. They implement the strategy by emphasizing on adherence, identification of symptoms and signs, inhalation technique, and asthma disease education on pharmacotherapy. The clinician pharmacists also provide expertise recommendation to physicians, and nursing team especially in the emergency cases. In the UK, the role of a clinical pharmacist in improving asthma disease care encompasses educating patients on asthma drugs, instructing patients on the appropriate techniques of administering medication, monitor the use of medication through refill intervals to identify poorly controlled asthma patients, encouraging patients who depend on over the counter medication, to seek informed medical care, assist asthma patients in mastering the use of peak flow meters, and to intervene in discharge counseling, to enable patients comprehend their asthma management plan at home (Hogg, Ker, & Stewart, 2011).
The prescribing role for clinical pharmacists in the UK for asthma treatment adopts a 5 step approach to asthma management by pharmacological intervention. Step one treatment is for the mildest asthma while pharmacists preserve step five treatment for the most severe cases. This evidence based guideline makes the prescribing role in asthma for the clinical pharmacists in the UK straightforward and patients can be managed comfortably in primary care. Most of these patients require reliever therapies in the form of terbutaline and salbutamol (Jones & Scott, 2011). Clinical pharmacists ensure patient safety by avoiding adverse medication incidents involving drugs administration. The National Patient Safety Agency (NPSA) guideline provides directions on the role and actions of a clinical pharmacist aimed at minimizing medication incidents. The intervention has prevented these incidents since its implementation commenced, and has been recommended to healthcare organizations in different sectors. Special effective infrastructures should be established not only to promote but also oversee safe medication practice by pharmacists, including safety medical reports annually to confirm that the NPSA guideline is adhered to in the pharmacological management of asthma disease. The strategy is also applicable in preventing asthma deaths as a consequence of poor management of oxygen. The deaths prompted the NPSA to develop oxygen safety guidelines that guide clinical pharmacist in balancing inhaled medication and oxygen. Studies have shown that approximately 2000 patient safety incidents are reported daily to the NPSA (Cousins, Gerrett, & Warner, 2012). In order to manage this risk in asthma patients, clinical pharmacists play a significant role in mitigating the incidents by following the NICE, NHS, and NPSA guidelines while attending to patients (Mansell, 2007).
The NICE and NPSA published guidance in December of 2007 recommending clinical pharmacists to reconcile medication administered to admit patients. For pharmacists to accomplish this role, the cost of 12.9 million pounds was required per year for adult patients...