Pharmacist-led SABA overuse case-finding combined with multidisciplinary FeNO guided management of asthma

Introduction: Inhaled corticosteroids (ICS) are the cornerstone of asthma management. However, many patients solely rely on short-acting beta agonists (SABA), thereby not being able to control their underlying pulmonary inflammation and being at increased risk for complications. Direct symptom relief by SABA is not a motivation to use ICS as continuous medication for asthma treatment. Moreover, even when ICS are prescribed, underuse, nonadherence and/or poor inhaler technique are common. While these are recognized issues, a direct marker of the seriousness for the need of ICS by patients with asthma is not available in primary care. We aimed to evaluate the use of fractional exhaled nitric oxide (FeNO) measurement for tailoring ICS usage and dose. Service description: In 2023, two Dutch community pharmacies started conducting a program in which the electronic medication dispense system was used to find high-risk asthma patients based on high SABA use. At their pharmacy visit, FeNO, asthma control (ACQ) and medication adherence (TAI) were measured and tailored interventions were offered in close collaboration with the regional multidisciplinary primary care team (GP, nurse). Interventions included: feedback on inhaler technique, feedback on adherence, starting or increasing ICS dose, provding an asthma self-management plan, very brief advice to quit smoking and/or referral to the GP. Service evaluation & lessons learned: With this service, 34 high-risk asthma patients, typically under the radar of the GP, could be identified. Prerequisites for succesful implementation of the service are good regional agreements within primary care. In this project, pharmacists and GPs discussed criteria for referral, when ICS start and/or dose adjustment were indicated and who would perform which intervention. To perform and interpret FeNO measurement, a training is required as is good training on how to teach inhaler technique. Overall, both healthcare professionals and patients highly valued the service provided.