Pharmacists

My mum went to the pharmacy today and asked the pharmacist which one of my inhalers I should increase and by how much due to my asthma being bad at the moment, and the pharmacist told my mum I should go and see my doctor as she couldn't give me any advice, so I was wondering if pharmacists are actually allowed to give advice regarding medial conditions or not? I always thought that they were and this is very frustrating as I feel a doctors appointment is unessesary.

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Hi Lejaya,

You are right that community pharmacists can give advice on many different medical conditions, and as far as I am aware (although I am prepared to be corrected) there is not a specific list of conditions that they can or cannot advise on. It is very much up to the individual discretion and experience of the pharmacist. Common things they will advise on are short term treatments for things like colds and flu, hayfever, indigestion and short term diarrhoea or constipation. They will usually be quite happy to advise on the correct use of any medication that can be bought over the counter, and there are also certain drugs that are designated 'prescription only' that can be 'prescribed' in certain situations at certain doses by a pharmacist. In some hospitals, they have even more prescribing power.

One thing they will not tend to be happy about, though, is recommending doses of prescription medication that are different from that which the doctor has prescribed. Apart from anything else, although pharmacists are very knowledgable about drugs, their mechanisms of action, doses, indications and side effects, they do not have so much knowledge of the clinical assessment and diagnosis of conditions, and are not trained to examine patients in detail, for example. If you are having an exacerbation of your asthma, you need to be seen by a doctor or at least your asthma nurse, so that you can be properly assessed to make sure there is nothing else going on, such as a chest infection or allergic reaction, that might require different treatment.

If you do feel that a doctors appointment is not always necessary in this situation, it is still worth seeing your doctor on this occasion so that you can discuss management and come up with a clear plan for occasions when your asthma deteriorates in the future. That might simplify things for future occasions.

Increasing inhalers may not be appropriate at all - although it used to be recommended, it is now thought that increasing your steroid inhaler when you have a short term worsening of symptoms (such as when you have a cold or cough) does not actually achieve anything, and it is no longer recommended. Increasing the dose may be appropriate for more long term worsening in symptoms, as part of 'stepping up' your treatment according to the BTS/SIGN guidelines for the management of asthma. Again, this is something which your doctor would have to decide on, though.

Hope this makes things a little clearer and explains why your pharmacist reacted the way they did - they were not just being awkward!

Take care

Em H

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Thanks for the reply Em,H it was really helpful! but you know how you said that increasing steroid inhalers short term is no longer recommended, do you know what is recommended now? cause most of the time when I go and see my doc she tells me to increase my seretide inhaler and then go back to my normal dose when my asthma is better, but then it tends to flare up again soon after reducing the dose!

so it would be really helpful if there was anything I could suggest to her or that I could try doing myself that might help my asthma

Lejaya

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Hi,

If you are having symptoms chronically and using a lot of your reliever inhaler every time you go back to the lower dose, then it may be that you need to be on the higher dose long term, or consider adding in another agent. That is really your GP's call, though, so I would discuss your concerns with him/her.

The only thing that has been shown to work in short term exacerbations, eg due to viral infections, is a short course of steroid tablets, if your symptoms are severe enough to warrant that. If you are getting frequent colds, though, and having prolonged exacerbations with each one, again that might be a sign that your asthma is generally not as well controlled as it could be and it might be useful to consider a more longterm increase in preventer medication.

Hope this helps

Em H