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2017 HCHB_digital

Asthma and COPD Asthma

Asthma and COPD Asthma New Zealand has one of the highest prevalences of asthma in the world and over 460,000 people regularly take medication for asthma. An estimated one in seven children and one in nine adults are affected, and only a small number of children appear to grow out of the condition. Common symptoms include wheezing (a whistling sound most obvious when breathing out), shortness of breath, tightness in the chest, difficulty speaking, and a persistent dry cough (usually at night or after exercise). Over time this cough may become more productive. A cough may be the only symptom in young children. These symptoms may occur suddenly as an asthma “attack”, or they can be present most of the time. During an “attack”, breathing becomes very difficult due to inflammation and contraction of the smooth muscle within the airway, excessive mucous secretion, and swelling of the smaller airways. Permanent damage of the airways can result from untreated asthma. It is common for asthmatics to also suffer from hay fever or eczema, and/or to have a family history of these conditions. The cause of asthma is unknown; however, many common triggers have been identified, including animal dander (especially cats), cigarette smoke, cold air, exercise, house dust mites, pollen, stress, strong perfume, viral infections (eg, a cold) and some medicines (eg, aspirin and NSAIDs). Asthma cannot be cured but TREATMENT OPTIONS Category Examples Comments Relievers (short-acting bronchodilators) Preventers Short-acting muscarinic antagonists (SAMA) or long-acting muscarinic antagonists (LAMA) Symptom controllers: long-acting beta2 agonists (LABA) Combination therapy Spacers Beta2-agonists [PRESCRIPTION MEDICINE] eg, salbutamol inhaler (Asthalin, SalAir, Salamol, Respigen, Ventolin) eg, terbutaline (Bricanyl) eg, salbutamol liquid (Ventolin) Inhaled corticosteroids (ICS) [PRESCRIPTION MEDICINE] eg, beclomethasone (Beclazone, Qvar), budesonide (Pulmicort), fluticasone propionate (Floair, Flixotide) Mast cell stabilisers and others [PRESCRIPTION MEDICINE] eg, nedocromil (Tilade), sodium cromoglycate (Intal Spincaps/Forte), montelukast (Singulair) [PRESCRIPTION MEDICINE] eg, ipratropium (Atrovent, Univent) tiotropium (Spiriva), glycopyrronium (Seebri), umeclidinium (Incruse Ellipta), aclidinium (Bretaris) [PRESCRIPTION MEDICINE] eg, eformoterol (Foradil, Oxis), indacaterol (Onbrez), salmeterol (Meterol, Serevent) [PRESCRIPTION MEDICINE] eg, eformoterol + budesonide (Symbicort Smart, Vannair), glycopyrronium + indacaterol (Ultibro Breezhaler), ipratropium + salbutamol (Duolin HFA), salmeterol + fluticasone propionate (RexAir, Seretide), tiotropium + olodaterol (Spiolto Respimat), umeclidinium + vilanterol (Anoro), vilanterol + fluticasone furoate (Breo) eg, e-chamber, Volumatic Children aged six or less eg, e-chamber mask Reliever inhalers are used to treat the acute symptoms of asthma (ie, the difficulty in breathing). They provide relief within a couple of minutes. Most reliever inhalers are blue. Anyone using a reliever more than three times a week or waking at night with symptoms should go to the doctor. If a person finds his bronchodilator has become less effective, it may indicate worsening asthma and the need to initiate an action plan or to visit the doctor to review therapy. Preventer inhalers contain ICS. They do not have an immediate effect, so nothing is felt after inhalation; however, when used regularly they reduce the underlying inflammation of the airways and help reduce the incidence and severity of asthma attacks and hospitalisations. Most preventer inhalers are either brown, orange or dark red. Reduce risk of oral thrush by using a spacer and rinsing the mouth with water after using ICS. Mast cell stabilisers (ie, nedocromil, sodium cromoglycate) are not commonly used since they are less effective than ICSs. May be useful for preventing exercise-induced asthma. Sodium cromoglycate needs to be taken anywhere from four to eight times daily. They may take up to six weeks to take effect. Montelukast is a leukotriene receptor antagonist that may be used in addition to ICSs for an additive effect. Can be of benefit in exercise-induced asthma and in people who also have rhinitis. Special Authority needed. Ipratropium reduces mucous secretions and relaxes airway muscle. It is short-acting and has a slower onset of action than beta2-agonists so is used more in COPD, although certain asthma patients may benefit. Longer acting antimuscarinic bronchodilators include tiotropium, glycopyrronium, umeclidinium, and aclidinium. Long-acting bronchodilators. Do not treat the underlying inflammation but may be beneficial in mild to moderate asthma instead of using higher doses of ICS. Used in conjunction with an ICS. Not useful for acute asthma attacks since they do not open airways immediately. Do not exceed recommended dose. Combination agents may aid adherence to recommended preventative regimens. Please refer to detailed product information as well as asthma guidelines to distinguish when combination inhalers should be used, and which combinations are recommended depending on the severity of the asthma or COPD. Dispense Ventolin ® The original blue inhaler that Kiwis know and trust 2 Help to improve delivery of MDIs to the lungs, reduce adverse effects of ICSs. Wash once a week with warm water and a squirt of detergent and allow to completely drip dry. This leaves a slight residue of detergent on the inside of the spacer which reduces static and stops the medicine in the inhaler sticking to the sides. Replace every six to 12 months (tiny scratches or abrasions can prevent the spacer working as effectively). VENTOLIN Asthma Symptom Relief doesn’t need to involve an unpleasant aftertaste. 1 DISPENSE ALCOHOL FREE VENTOLIN 2 Page VEN_XXXX_Ventoline 16 HEALTHCARE Strip Ad Marc HANDBOOK 17 V3.indd 1 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Te Hã Ora: The Breath Of Life Te Hã Ora is New Zealand's National Respiratory Strategy launched in November 2015. Respiratory disease (including asthma, bronchiectasis, COPD, lung cancer, obstructive sleep apnoea, and pneumonia) affects almost 700,000 people in New Zealand but despite improvements in medical treatments and health care, respiratory illness rates here continue to worsen. Te Hã Ora aims to: •• reduce the incidence and impact of respiratory disease in New Zealand •• eliminate inequalities in respiratory health, particularly among Maori, Pacific peoples and low income families. The full National Respiratory Strategy document can be found at asthmafoundation.org.nz most people are able to manage it with medicine so that it does not interfere with their day-to-day life. Education is vital to help sufferers recognise symptoms of worsening asthma and to avoid severe attacks by taking early action. Symptoms that indicate worsening asthma include a dry, persistent cough, usually at night and after exercise, and increasing use of “reliever” medicine. Home-use of a peak flow meter (a device that measures maximum flow of air from the lungs) may help identify deteriorating lung function. Common treatment options include beta-2 agonists, corticosteroids, mast cell stabilisers, and leukotriene receptor antagonists. COPD (Chronic Obstructive Pulmonary Disease) COPD is an umbrella term used to describe several different progressive lung diseases, such as emphysema and chronic bronchitis. COPD is more likely to develop in people over the age of 40 and symptoms include breathlessness, coughing, and increased phelgm. The major difference between COPD and asthma is that COPD is generally irreversible, although most symptoms can be controlled and further deterioration in lung function prevented with early treatment. Some people have both COPD and asthma. Ninety per cent of people who develop COPD have previously smoked; other causes include environmental pollutants and genetic deficiencies (eg, Alpha-1 Antitrypsin Deficiency). Treatments include oxygen, antimuscarinics, beta-2 agonists, corticosteroids, theophylline, antibiotics, and pulmonary rehabilitation programmes. Initial assessment The majority of customers with asthma or COPD require life-long medications so will regularly come into your pharmacy to collect these. Pay attention to the way they usually look, and if you notice any deterioration in their health, breathing, or if talking or walking appears difficult, ask if they would like to talk to a pharmacist. Always involve a pharmacist in cold or flu medicine requests, as lung function can quickly become compromised with illness. Types of delivery devices and spacers Metered dose inhalers (MDIs) – also called “puffers” are the most common devices available for delivery of medications used to treat asthma or COPD. However, many Refer to PHARMACIST If someone collapses and appears to have difficulty breathing, CALL AN AMBULANCE IMMEDIATELY, whether or not the person is known to have asthma or COPD. All other people presenting with asthma symptoms should be referred to the pharmacist, who should: • ASSESS the severity of the episode and call 111 if severe • SIT the person down and get them to lean forward • TREAT with six puffs of a blue “reliever” inhaler, preferably through a spacer (use patient’s own if available) • HELP by calling an ambulance if the person does not improve • MONITOR for improvement and repeat doses if needed • ALL OK. Stay with them until they are free from wheeze, cough and breathlessness then refer them to their doctor. older and younger patients find them difficult to use since good coordination is required between activation of the MDI and inhalation. Most MDIs require regular cleaning, preferably weekly, and should be shaken before use. Dry powder inhalers are breath-activated inhalers. They require less coordination and there is no need to use a spacer. However, they may be unsuitable if the person’s ability to inhale is too weak. Nebulisers are machines that convert liquid into a mist that can be inhaled into the lungs. Spacers are specially designed plastic tubes that are designed to be used with MDI (puffer) inhalers. They bypass the need for patients to coordinate activation of the inhaler with inhalation, and also help prevent the occurrence of oral thrush. Spacers can be very helpful during an acute asthma episode and some are available fully funded (see Treatment options). Advice for customers • Ensure customers know what each inhaler is for and how to use them. • Advise people with asthma to use paracetamol instead of NSAIDs because NSAIDs may precipitate an asthma attack in some people. • Ensure they have talked with their doctor about what to do if their asthma worsens and they have an Asthma Self-management plan. • Treat allergies and avoid known asthma triggers wherever possible, including cigarette smoke. • Warm up and use a reliever before exercise if they get exercise-induced asthma. References: 1. Gillies J et al. NZ Med J. 2005:118(1220):79-83. 2. Ventolin Data Sheet, GSK New Zealand. Ventolin ® (salbutamol; available as an alcohol-free and CFC-free Inhaler,100mcg per actuation) is a Prescription Medicine. Ventolin is a short acting bronchodilator (selective beta-2 adrenoreceptor agonist) for relieving symptoms in patients with asthma and for bronchodilation in patients with reversible airways obstruction due to asthma, chronic bronchitis and emphysema. Ventolin is a partially funded medicine. Dosage: Acute bronchospasm – 1 or 2 puffs, Chronic therapy – may take up to 2 puffs four times daily. This medicine has risks and benefits. Contraindications: Hypersensitivity to this medicine or to any of its components. Warnings and Precautions: Increasing use to control symptoms indicates deterioration of asthma control. Under these conditions, the patient’s therapy plan should be reassessed. Hypokalaemia may occur, particularly in acute severe asthma, potentiated by xanthine derivatives, steroids, diuretics and hypoxia. Caution in hyperthyroidism, hypertension, cardiovascular diseases and diabetes. Avoid beta-blockers, tricyclic antidepressants, MAOIs, digitalis. Common Side Effects: Headache, mild tremor, mouth and throat irritation, tachycardia and peripheral vasodilation, paradoxical bronchospasm. Before prescribing Ventolin, please review the Data Sheet at www. medsafe.govt.nz. Ventolin is a registered trade mark of the GlaxoSmithKline group of companies. Marketed by GlaxoSmithKline NZ Limited, Auckland. Adverse events involving GlaxoSmithKline products should be reported to GSK Medical Information on 0800 808 500. TAPS DA1728IG/17MA/SLB/0001/17 Page 17 17/03/17 12:10 PM

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  • Page 5 and 6: Index Common Disorders Acne--------
  • Page 7 and 8: Asthma and COPD CONTINUING OTC EDUC
  • Page 9 and 10: Head and scalp • Condition of hai
  • Page 11 and 12: HELP KIDS BE THEMSELVES AGAIN NEW L
  • Page 14 and 15: NUROFEN ZAVANCE* IS ABSORBED UP TO
  • Page 16 and 17: Acne Acne is a common skin problem
  • Page 18 and 19: Allergies An allergy occurs when th
  • Page 22 and 23: Baby Feeding Breastfeeding is best
  • Page 24 and 25: Bites and Stings Bites and stings c
  • Page 26 and 27: Bruises, Scars, Spider Veins Bruise
  • Page 28 and 29: Childhood Diseases and Immunisation
  • Page 30 and 31: Childhood Diseases and Immunisation
  • Page 32 and 33: Childhood Diseases and Immunisation
  • Page 34 and 35: Childhood Diseases and Immunisation
  • Page 36 and 37: Childhood Pain and Baby Teething Pa
  • Page 38 and 39: Colds A cold is a contagious viral
  • Page 40 and 41: Cold Sores Cold sores are fluid-fil
  • Page 42 and 43: Constipation Constipation is the te
  • Page 44 and 45: Contraception & Sexual Wellbeing Co
  • Page 46 and 47: Contraception: Emergency Emergency
  • Page 48 and 49: Coughs: Dry Coughs are called dry o
  • Page 50 and 51: Coughs: Productive Coughs are consi
  • Page 52 and 53: Cuts, Abrasions and Blisters This t
  • Page 54 and 55: Cystitis [Bladder Infection] Cystit
  • Page 56 and 57: Dandruff Dandruff is a common condi
  • Page 58 and 59: Dermatitis/Eczema Dermatitis is a g
  • Page 60 and 61: Diabetes Diabetes is a condition in
  • Page 62 and 63: Diarrhoea and Vomiting Diarrhoea an
  • Page 64 and 65: Dry Skin Dry skin is skin that lack
  • Page 66 and 67: Ear Conditions Our ears allow us to
  • Page 68 and 69: Eye Conditions Almost two-thirds of
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    Eye Conditions (continued) Type Sym

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    Eyes: Contact Lenses Contact lenses

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    Fever What is fever Fever is define

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    Foot Care Common foot problems incl

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    Fungal Infections: Superficial Supe

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    Fungal Nail Infections (Onychomycos

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    Gout Historically known as the “d

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    Haemorrhoids Haemorrhoids (also cal

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    Hair Loss Alopecia is the medical t

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    Hay Fever Hay fever (also called in

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    Hay Fever (continued) TREATMENT OPT

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    Headache Headaches are common and c

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    Head Lice Head lice (pediculosis ca

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    Heart Health Cardiovascular (CV) di

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    Indigestion, Heartburn and Gastriti

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    Influenza Influenza (flu) is a comm

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    Influenza (continued) TREATMENT OPT

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    Iron Deficiency Iron is an essentia

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    Irritable Bowel Syndrome Irritable

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    Menopause Menopause - the “change

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    Migraine Migraines are a type of se

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    Muscular Aches, Pains and Tightness

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    Nappy Rash Nappy rash is a red rash

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    Oral Health Oral health disorders i

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    Osteoarthritis Osteoarthritis is th

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    Osteoporosis Osteoporosis (meaning

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    Period Pain and Endometriosis Perio

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    Poisonings Any substance that has t

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    Pregnancy Tests and Supplements Hom

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    Preventive Health There are certain

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    Probiotics and Prebiotics Probiotic

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    Psoriasis Psoriasis is a long-term

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    Scabies Scabies is a very contagiou

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    Shingles Shingles (herpes zoster) i

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    Sinus and Nasal Problems Sinuses ar

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    Sleep Problems and Snoring Sleep is

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    Smoking Cessation Almost 5000 New Z

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    Sore Throat Sore throats are very c

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    Strains and Sprains Sprains and str

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    Sun Care Sunburn Sunburn occurs fro

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    Sun Care: Eye Protection Protecting

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    Sweating: Excessive (Hyperhidrosis)

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    Toothache Toothache is the term use

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    Travel Health (including Vaccinatio

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    Travel Sickness Travel, or motion,

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    Urinary Incontinence Urinary incont

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    Urticaria (Hives) Urticaria refers

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    Vaginal Health The vagina is a clos

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    Varicose Veins and Support Stocking

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    Vitamins and Dietary Supplements Vi

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    Warts Warts are benign (non-cancero

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    Weight Loss Obesity has reached epi

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    Worms Pinworms (Enterobius vermicul

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    Wound Care Our skin acts as a barri

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    Wound Care (continued) Wound type M

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    Glossary WHAT DOES THAT WORD MEAN?

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    Chapter References (continued) Diar

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    Chapter References (continued) Gord

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    Significant learning opportunity: W

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    PharmacyToday A part of your everyd

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    OTC Medicines: Interactions When se

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Adverse Effects OTC

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Drugs in Sport Treating Athletes Me

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    Drugs in Aviation AVIATION - PRECAU

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    Drugs in Pregnancy Drug use in preg

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    NZ Support Groups ADHD Association

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    NZ Support Groups New Zealand AIDS

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    HEAT or INFLAMMATION Unlike heat ru

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    OTC Products Over-the-counter produ

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    OTC Products Index Foot Care - Fung

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    »» Acne CRYSTADERM CREAM AFT PHAR

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    »» Childhood Pain and Baby Teethi

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    »» Colds BONNINGTON’S IRISH MOS

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    CODRAL RELIEF MAX STRENGTH COLD & F

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    OTRIVIN JUNIOR GLAXOSMITHKLINE CONS

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    DULCOLAX SANOFI CONSUMER HEALTHCARE

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    BENADRYL MUCUS RELIEF DOUBLE ACTION

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    »» Dandruff COCO-SCALP AFT PHARMA

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    EAR CLEAR WILSON CONSUMER PRODUCTS

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    »» Foot Care - Fungal Infections

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    TELFAST ORAL LIQUID SANOFI CONSUMER

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    NUROFEN ZAVANCE RECKITT BENCKISER (

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    MOOV HEAD LICE SOLUTION DOUGLAS PHA

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    GAVISCON DUAL ACTION LIQUID RECKITT

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    CODRAL COLD & FLU + COUGH JOHNSON &

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    »» Irritable Bowel Syndrome GASTR

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    VOLTAREN EMULGEL GLAXOSMITHKLINE CO

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    TURMERIC EXTRA STRENGTH GOOD HEALTH

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    PREGNOSIS EARLY PREGNANCY TEST DIP

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    »» Sexual Wellbeing - Contracepti

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    SUDAFED PE SINUS DAY + NIGHT RELIEF

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    NICORETTE INHALATOR JOHNSON & JOHNS

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    STREPSILS PLUS LOZENGES RECKITT BEN

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    TRAVACALM TRAVEL BAND WILSON CONSUM

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    CRYSTADERM CREAM AFT PHARMACEUTICAL

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    An ENHANCED ELearning Experience As

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    Product Index ANIME LUBRICANT 50ML-

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    Manufacturer’s Index AFT Pharmace

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    Topiramate Actavis Topiramate 25mg,

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