We invite comments from primary care on a proposal made in an article in Lancet Respiratory Medicine1 that patients with asthma and COPD who have had, or are at risk of having, an exacerbation should be given standardised emergency inhaled treatment packs containing the appropriate pMDI or pMDIs (salbutamol for COPD, salbutamol and beclomethasone 250 mcg for asthma) and a spacer. These packs, with simple instructions for their use, should be kept sealed and separate from the patient’s routine inhaled treatment and used if the person was experiencing an attack that was not responding, with advice to call the GP practice or 111 if the pack was opened. Other oral treatments for exacerbations could also be given at the clinician’s discretion.
We think this would lead to better outcomes of exacerbation self-management and fewer emergency department attendances and admissions. It might contribute to a reduction in avoidable deaths.
Advantages: first, patients would have immediate access in an emergency to the most effective possible method for the self-administration of high-dose inhaled treatments. Second, every patient would have been taught how to use these treatments correctly. Third, the task of teaching self-management of exacerbations would be greatly simplified for health professionals since there would be one standardised set of advice for the inhaled treatments for asthma and one for COPD. Fourth, this consistency of message would increase patient confidence and would facilitate widespread public and professional awareness of the key elements of safe and effective inhaled self-management. Fifth, with a move towards more use of dry-powder inhalers for routine treatment on environmental grounds, this would ensure that patients using DPIs for routine treatment retained access to pMDI/ spacer for the treatment of exacerbations not responding to usual therapy.
All changes in practice take work, but we think this would end up saving time in primary care by simplifying the task of self-management education and by helping achieve better treatment outcomes.
The article can be accessed without charge provided you register with the journal online. Let us know what you think — either by letter to the BJGP, by email to duncan.keeley{at}nhs.net, or by writing to Lancet Respiratory Medicine.
- © British Journal of General Practice 2019
