2017 HCHB_digital

Asthma and COPD
CONTINUING OTC EDUCATION
Asthma
present most of the time. During an “attack”, breathing becomes very difficult
New Zealand has one of the highest prevalences of asthma in the world and over due to inflammation and contraction of the smooth muscle within the airway,
460,000 people regularly take medication for asthma. An estimated one in seven excessive mucous secretion, and swelling of the smaller airways. Permanent
children and one in nine adults are affected, and only a small number of children damage of the airways can result from untreated asthma.
appear to grow out of the condition.
It is common for asthmatics to also suffer from hay fever or eczema, and/or to
Common symptoms include wheezing (a whistling sound most obvious when have a family history of these conditions.
breathing out), shortness of breath, tightness in the chest, difficulty speaking, and The cause of asthma is unknown; however, many common triggers have been
a persistent dry cough (usually at night or after exercise). Over time this cough may identified, including animal dander (especially cats), cigarette smoke, cold air,
become more productive. A cough may be the only symptom in young children. exercise, house dust mites, pollen, stress, strong perfume, viral infections (eg, a
These symptoms may occur suddenly as an asthma “attack”, or they can be cold) and some medicines (eg, aspirin and NSAIDs). Asthma cannot be cured but
TREATMENT OPTIONS
Category Examples Comments
Relievers
Beta2-agonists
(short-acting
[PRESCRIPTION MEDICINE]
bronchodilators) eg, salbutamol inhaler (Asthalin, SalAir,
Salamol, Respigen, Ventolin)
eg, terbutaline (Bricanyl)
eg, salbutamol liquid (Ventolin)
Preventers
Corticosteroids
[PRESCRIPTION MEDICINE]
eg, beclomethasone (Beclazone, Qvar),
budesonide (Pulmicort), fluticasone (Floair,
Flixotide)
Mast cell stabilisers and others
[PRESCRIPTION MEDICINE]
eg, nedocromil (Tilade), sodium
cromoglycate (Intal Spincaps/Forte),
montelukast (Singulair)
Anticholinergic [PRESCRIPTION MEDICINE]
bronchodilators or eg, ipratropium (Atrovent, Univent)
long-acting muscarinic tiotropium (Spiriva), glycopyrronium
antagonists
(Seebri), umeclidinium (Incruse Ellipta),
aclidinium (Bretaris)
Symptom controllers [PRESCRIPTION MEDICINE]
(long-acting beta2 eg, eformoterol (Foradil, Oxis), indacaterol
agonists)
(Onbrez), salmeterol (Meterol, Serevent)
Combination therapy [PRESCRIPTION MEDICINE]
eg, eformoterol + budesonide (Symbicort
Smart, Vannair), glycopyrronium
+ indacaterol (Ultibro Breezhaler),
ipratropium + salbutamol (Duolin
HFA), salmeterol + fluticasone (RexAir,
Seretide), tiatropium + olodaterol (Spiolto
Respimat), umeclidinium + vilanterol
(Anoro), vilanterol + fluticasone (Breo)
Spacers
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 corticosteroids. 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 inhaled
corticosteroids (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.
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).
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.
VENTOLIN
Asthma
Symptom Relief
doesn’t need to involve an
unpleasant aftertaste. 1
DISPENSE
ALCOHOL
FREE
VENTOLIN 2
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
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» Colds - Treatment
BONNINGTON’S IRISH MOSS
ASPEN PHARMACARE
Presentation: Cough Syrup, 200mL bottle
Active Ingredients: Each 10mL contains: 1.7 mg menthol, 9 mg camphor, 240 mg liquorice extract, 13 mg carrageenan,
3.8 uL ipecacuanha
Approved Indications: Soothes and relieves coughs and sore throats.
Contraindications: None known
Precautions: Use only as directed. If symptoms persist, see your doctor. Store below 30 degrees celsius.
Adverse Effects: None known
Directions: For adults and children over 12 years, take 10mls and repeat every 2 hours as needed.
Price Band: $14-16 per 200mL bottle
Medicine Classification: General Sale
Each common condition includes:
• General information
• Initial assessment
• Treatment options
• Customer advice
• When to refer to the pharmacist.
CODRAL ALL IN ONE
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Capsules, 24s
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg.
Night: Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy, do not drive or operate machinery. Avoid alcohol. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red and white night capsules at
bedtime. Allow 4-6 hours as necessary between doses. Maximum 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches, fever, body aches and pains, blocked and runny
nose, and sore throat.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems or are
pregnant or breastfeeding, are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected do not drive
a vehicle or operate machinery. Keep to the recommended dose.
Directions: For adults and children 12 years and over: take 2 day tablets every 4-6 hours as necessary. Maximum 8 tablets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL COLD & FLU + COUGH
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg.
Night: Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs, and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy do not drive or operate machinery. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red night capsules at bedtime.
Allow 4-6 hours as necessary between doses. Maximum: 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
Page 224 HEALTHCARE HANDBOOK 2017-2018 OTC Products
Using this handbook
The front section of this handbook gives an overview of 75 of the most common
conditions customers seek advice about from a pharmacy. These conditions are
presented in alphabetical order and are usually in a two-page format (see above).
Initial assessment
When talking to a customer about a condition, it is important to be observant
and not to bombard them with too many questions, especially if the answers
are obvious. The initial assessment paragraph for each condition offers guidance
about how to approach a customer or what specific symptoms to look for. Further
details about the initial assessment are given over the page.
When to refer to the pharmacist
These are prompts for questions to ask your customer. If the answer is obvious
or the answer already clarified during your initial assessment you do not need to
ask the question again. Listen for responses that indicate that it would be more
appropriate to refer the customer to the pharmacist.
Treatment options: OTC products
The Treatment Options Table in each chapter lists most currently available
products for that condition. Products with an asterisk have abridged, but more
detailed, product information in the OTC Products section (see left, for an example).
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