Roles of Pharmacists in Asthma Management
- Asthma is a heterogeneous condition that affects both children and adults.
- In addition to its direct burden on patients, asthma also represents a meaningful economic burden in the United States.
- Collaborative health care efforts are needed to effectively manage asthma in both inpatient and outpatient settings, and pharmacists play a key role in optimizing treatment plans in patients...
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Asthma is a heterogeneous condition that affects both children and adults. While the clinical presentation of asthma may vary between patients, it typically manifests as chronic airway inflammation with fluctuating respiratory symptoms and expiratory flow over time. Symptoms include wheezing, coughing, shortness of breath, and chest tightness, which might potentially be triggered by environmental allergens, weather changes, exercise, and viral infections, among other causes.1-4
In addition to its direct burden on patients, asthma also represents a meaningful economic burden in the United States. Approximately 10.9 million missed workdays were attributed to asthma in 2018, and approximately 898,000 emergency department visits and 94,000 hospitalizations listed asthma as the primary cause in 2020, with the estimated annual health care cost due to asthma listed at $50.3 billion.5
Collaborative health care efforts are needed to effectively manage asthma in both inpatient and outpatient settings, and pharmacists play a key role in optimizing treatment plans in patients with asthma. Although treatment options for asthma have increased in recent years, inhaler devices remain the cornerstone of asthma management. Pharmacists have the unique possibility to provide patients with detailed education on inhalers by explaining the different types of devices, demonstrating and correcting inhaler
adverse effects and drug interactions. For example, higher doses and longer durations of inhaled corticosteroids (ICS) are associated with a higher risk of side effects including bruising, pneumonia, and osteoporosis. Incorrect technique with ICS-containing inhalers (eg, not rinsing the mouth with water after each dose) can also cause medication to stay in the mouth and throat rather than entering the lungs, which increases the risk of developing thrush and dysphonia.12 For these reasons, pharmacists play an important role in encouraging use of the minimum effective ICS dose once asthma control is achieved and addressing concerns related to technique, adherence, and triggers before recommending higher ICS doses.
Medication management can be improved further by checking whether patients are taking any other medications that can have potential drug-drug interactions. Such as, cytochrome P450 3A4 inhibitors such as ketoconazole, ritonavir, and clarithromycin can increase serum concentrations of ICS medications, increasing the risk of ICS adverse events. Patients with cardiovascular comorbidities may also be taking non-selective ß blockers, which block ß-2 receptors in addition to ß-1 receptors and interfere with bronchodilation.13,14
Conclusion
Asthma represents a major disease state in which pharmacists can make significant interventions to improve patient care. Pharmacists make valuable contributions to asthma management by educating patients on inhaler devices, techniques, and adherence, as well as making recommendations to the health care team to address medication costs, adverse events, and drug interactions.
Pharmacists remain key players in asthma management, and their role will continue to grow as more medical therapies are developed for the treatment of this widespread and heterogeneous disease state.
REFERENCES
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Dharmage SC, Perret JL, Custovic A. Epidemiology of asthma in children and adults. Front Pediatr. 2019;7:246. doi:10.3389/fped.2019.00246
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Asthma. World Health association. May 6, 2024. Accessed January 8, 2026.
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