Appalachian College of Pharmacy Asthma Management Exposure Question Research

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PynverZnevr2294

Health Medical

Appalachian College of Pharmacy

Description

1) create a original response to the following question: I included classmate responses so you could see what others are saying

2)next, I need you to actually comment back to my classmates responses with some meaningful comment.


Question: GINA 2019 is going to create a significant uproar for the first line therapy for intermittent exacerbations. Based on your limited exposure to Asthma management- what do you think is/are the potential concerns about this new recommendation?

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Classmate response 1: My first concern regarding the new guideline is regarding patient adherence. Expecting to a patient to remember to use a new inhaler once daily might be difficult especially once the patient is feeling better and feels they no longer need it. Adding a second inhaler to the mix might cause more adherence problems because they may forget to take it or just feel that they do not need a second inhaler. This may still be the case if the steroid used is not an inhaler but an oral tablet. The new guidelines recommend 5-7 days of oral steroid use for each exacerbation. Another concern I see at my retail pharmacy is the cost of inhalers. Although some SABAs have become generic, they are still not affordable for a large population. I have seen generic albuterol sold at good prices with GoodRx, however I have not seen prices that the general population can afford for inhaled corticosteriods with GoodRx. While oral steroids are not as expensive, it it still an added cost for the patient. The last concern is regarding the actual prescription of the oral corticosteroid. Assuming the prescription is written with no refills, when the patient runs out and is in need how quickly is the doctor going to reply to their refill response? Would this hinder their treatment if they are not getting their prescription refilled promptly? Classmate response 2: As many people have already suggested, a major point of concern for patients will easily be the cost of changing to a combination product (ICS-formoterol) rather than their affordable rescue inhaler (SABA). Currently rescue inhalers have some very affordable options whereas a combination with ICS can cost hundreds of dollars. This will be a major change for a large population of people with asthma, and certain special populations have extra factors that need to be considered. The evidence is listed as being indirect and this may be a point of concern. This may be safe for the general population, but how well will this translate to special populations like the young, pregnant, or elderly. This is important when considering the wide range of side effects that can arise from taking corticosteroids (even inhaled). In general, low dose ICS do not have much in the way of systemic side effects but greatly increasing the population that is taking them will increase the frequency with which we encounter negative side effects. Other side effects from improper technique, such as thrush will likely become more common as well which may prompt additional office visits. Another major hurdle would be educating and updating prescribers on the new recommendations so that they update their prescribing habits. This also requires educating patients on the changes so they understand both how to change their care, but also why its being changed. Many patients get used to how they manage their symptoms and this new recommendation flips things from relying on SABA early on to using ICS, and SABA if needed or the two in combination from the start. Patient education already has it’s challenges so any major change in how we approach care will have its challenges. Classmate response 3: The new 2019 GINA guidelines have altered the treatment of mild persistent asthma to no longer just SABA therapy but with an addition of a corticosteroid. The new required medication will help treat chronic inflammation and decrease hypersensitivity events which was absent with the single use of a SABA. There are, however, a couple of concerns for this change in how it will affect patients. First, as a general rule, with the addition of more medications there tends to be more adverse effects in the body. This has a potential to decrease patient adherence who are fighting a lifelong disease that has the best results if treated in the beginning. Corticosteroids have many side effects if used for long term therapy such as, Cushing’s syndrome, thrush, hypertension, pancreatitis, impaired wound healing, osteoporosis, hyperkalemia, hyperglycemia, and more. Also, it is shown that people who need to take multiple medications are less adherent in taking their medications. In addition to the potential decrease in patient adherence, instead of purchasing one medication, a SABA, patients will now have the extra financial responsibility to purchase a corticosteroid. Another concern is if the market will be able to accommodate these new demands. If there were to be any medication shortages, this could be detrimental to patient treatment. Since there will be a higher demand of corticosteroids, price will increase for patients unless there are sanctions placed to prevent this. As a result, this change will further reduce patient adherence, and thus there will be a gap in healthcare treatment.
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Explanation & Answer

Attached.

GINA 2019 - Outline
Thesis Statement: Asthma remains a significant health problem around the world and the
Global Initiative for Asthma (GINA) has been working to address this issue.
I. Initial post
II. Response 1
III. Response 2
IV. Response 3


Running head: GINA 2019

1

GINA 2019
Name
Institution

GINA 2019

2
GINA 2019

Asthma remains a significant health problem around the world and the Global Initiative
for Asthma (GINA) has been working to address this issue. GINA (2019) introduces a paradigm
shift in the first-line therapy of intermittent exacerbations and presents an entirely new approach
to treatment. My main concern about the treatment approach is the issue of evidence leading to
this conclusion. According to Nolan (2019), GINA (2019) bases its recommendations on
emerging evidence of the potential adverse effects of short-acting beta agonist (SABA) overuse.
W...


Anonymous
Excellent! Definitely coming back for more study materials.

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