CEimpact Podcast

Optimizing Asthma Care: Guideline Updates and Practical Pearls

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Asthma management continues to evolve, with updated guidelines emphasizing personalized care, smart inhaler use, and early intervention. This episode reviews key pharmacotherapy updates, stepwise treatment strategies, and practical counseling tips to support adherence and inhaler technique. Tune in to strengthen your role in improving outcomes for patients living with asthma.

BONUS: With this episode, you also get exclusive, free access to beautifully designed clinical charts and practice resources from our friends at Pyrls, that you can use in your everyday practice. Click here to access these practical tools!

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Rachel Maynard, PharmD
Lead Editor
Pyrls

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe current guideline-recommended pharmacologic treatments for asthma, including stepwise therapy approaches.
2. Identify key counseling points for improving inhaler technique, adherence, and asthma control in patients.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-214-H01-P
Initial release date: 6/16/2025
Expiration date: 6/16/2026
Additional CPE details can be found here.

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Josh Kinsey:

Hey, ce Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and as always, I'm excited about our conversation today. Asthma remains a common yet often mismanaged condition, with poor control leading to preventable symptoms, hospitalizations and reduced quality of life. In today's episode, we'll cover recent treatment updates, counseling strategies and the pivotal role pharmacists play in helping patients breathe easier and live better. Before I introduce today's guest, I wanted to share that we've launched a special pilot series in collaboration with our friends at Pearls, a modern drug information resource and app. These crossover episodes, called Game Changing PEARLS see what we did there combine PEARLS' trusted, evidence-based clinical tools with CE Impact's expertise in pharmacy education and accreditation, bringing you timely, actionable content that supports both your practice and your professional development. It's a privilege to work alongside the Pearls team and we are excited to kick off this pilot series with today's episode focused on the management of asthma, and representing Pearls today is Rachel Maynard. It's so great to have you as our guest today, rachel, welcome.

Rachel Maynard:

Thanks so much, josh, so excited to be here.

Josh Kinsey:

Yeah, and I know that you have a busy schedule, so we are so grateful that you took time out of your schedule to sit with us today and talk about asthma. And for our listeners, since it's probably the first time they've met you or heard from you, if you want to take a couple minutes to tell us a little bit about yourself and how you started in pharmacy and some of your passions, and just tell us all about yourself.

Rachel Maynard:

Yeah, sure. So, yes, my background originally was in community pharmacy. I started working as a technician while getting my undergrad degree and that's what drove me to go to pharmacy school. After pharmacy school, I did a community pharmacy residency and practiced as a staff pharmacist for a few years and also providing clinical services for a grocery store chain and also managing those services for a regional group of chains.

Rachel Maynard:

So after that I then sort of moved into the drug information and education space writing, creating content for healthcare professionals and I have done that for now over a decade, and most recently I've been with Pearls in again a very similar role, sort of helping to manage the editorial process, our content development process, and to really ensure that we're providing resources and education and tools for clinicians to help them optimize patient care. And that's really what I'm passionate about is knowing what it's like in a community pharmacy and how challenging that can be, making sure they have the tools they need to practice to the best of their ability. And for our topic today, like asthma, is one of those topics that I think we see so many patients with and we can make such an impact on their lives, and so I'm super excited to be here to chat about that.

Josh Kinsey:

Yeah, that's great, and a lot of our discussion for today is going to focus around some of those things that you can do with the patient at the counter and like making sure to improve adherence and whatever. But in general, you know, asthma is one of those disease states that every pharmacist, regardless of what role they're in, it's probably has encountered a patient with it, and so even you know some of these nuggets that we're going to share today.

Josh Kinsey:

You know they can be implemented anywhere in your practice setting. So just I'm really excited. I feel like asthma is one of those things that is super important and really detrimental to a patient's quality of life, and I just I feel like sometimes we don't talk about it enough because you know it's. I just feel like we need to elevate it more and really focus on how can we make the quality of life for these patients better. So super excited about our talk today. So thanks again for joining us. We really appreciate it and just really excited about this partnership with Pearls.

Josh Kinsey:

So all right, so let's go and jump in, just as I always like to do lay the groundwork and the foundation, make sure everybody's on the same page. So let's just have a brief review of asthma in general and maybe just a reminder of you know how is that different than you know a chronic perspective of that like COPD and whatever, like you know, because sometimes those kind of get blurred because inhalers are used for both sometimes. So let's just kind of have a quick review of asthma and just kind of talk a little bit about that and lay the groundwork there.

Rachel Maynard:

Sure. So in a nutshell, it's, as you said, chronic inflammatory condition of the airways. And so if you think about how asthma is diagnosed, there's really sort of two components of that. It's these respiratory symptoms, which are sort of those classic symptoms you think of, like wheezing, cough, shortness of breath, and then there's this variable expiratory airflow, so you know, assessing whether there's reduced ability to exhale because of that inflammation, and so that's why it makes sense that inhaled corticosteroids are a foundational treatment for asthma, because of that inflammation and that variable airflow.

Josh Kinsey:

Sure.

Rachel Maynard:

In terms of differentiating from COPD. That can be tricky because there are, you know, there's overlap in symptoms with the cough, the shortness of breath. I think some of the differentiators are things like if you're waking up at night with symptoms, that's more indicative of asthma. If you have a patient who also has allergies, for example like allergic rhinitis or eczema, those can also be sort of cues that it might be more related to asthma, whereas if you have an older patient, that can be challenging because you know there's sometimes some overlap there. But also thinking about a history of smoking, and if you know, copd is almost always associated with a history of smoking and so that's another cue to think about. But I will say, you know, smoking is also a trigger for asthma symptoms too, and so even though there's overlap, there can also be this people can have both, they can have features of both and even though there's variable expiratory airflow with asthma, if you've had asthma for a long time, some adults may have more persistent airflow problems and that can also be more similar to COPD, where there's this more persistent airflow problems, and that can also be more similar to COPD, where there's this more persistent airflow limitations. So that's why it's tricky, I will say.

Rachel Maynard:

In the most recent updated asthma guidelines that we'll chat about a little bit more, they actually called out what term to use. So you may have heard this term asthma, copd, overlap, and that was sort of the term that we used to use because it was, you know, just a way to think about these two conditions overlapping and the fact that they have similar symptoms and diagnostic process and that sort of thing. They are now encouraging people to use the term asthma plus COPD so that it's not seen as like a separate condition. It's more so that people have features of both, and so I thought that was just sort of an interesting nuance that they're calling out asthma plus COPD versus overlap, because that's inherent, but really these patients have features of both asthma and COPD.

Josh Kinsey:

Yeah, and I think, rachel, one of the things that I don't know that I thought this, but I feel like it was. I feel like the general population thinks that sometimes is that asthma is for kids and COPD is for adults, and that is we need to like make sure that we're not on that wavelength, because that is not true, correct. I mean, there are adults that have asthma, and only asthma, and maybe, like you said, overlap as well, but but that is not the case, like you can't just look at it as children have asthma and adults have COPD when they get older.

Rachel Maynard:

So I mean I'll say that I think that you can use that as a differentiator to help again sort of figure out what the patient has. Sure, because asthma is COPD.

Josh Kinsey:

Is their age Right right?

Rachel Maynard:

But yeah, for I looked up some stats when thinking about this topic, and 9% of adults in the adults in the US have asthma, versus 7% of kids, and so you know it's very common in adults and so, yes, I think that's a good distinction to make.

Josh Kinsey:

Yeah, yeah, very good, okay. So, and as you mentioned, this kind of a great kind of lead in here, it does affect millions of patients across different age groups. You gave some great stats there 9%, 7%. I mean, that's that's quite significant when you think of that, and I think, just reiterating the fact that why we're here today is to talk about how proper management can significantly increase the quality of life, decrease hospitalizations, reduce healthcare utilization in general, funding cost whatever, and just an overall reason for us as pharmacists to jump in, because we have great access to the patients, they have great access to us and these slight little tweaks can really make a difference. So I think that's really what I'm excited to dig into today is how just these a few little things that you can do and can really change the patient's quality of life. So, with that, what are some of the roles of the pharmacist? So I know we're going to dig into them deeper, but what do you feel like? Where do you feel like pharmacists can interject themselves here with asthma and with asthma patients?

Rachel Maynard:

Yeah, so I think there's so many opportunities again, regardless of your practice setting. But one of the keys with asthma is that it's not just a set it and forget it sort of condition. It's something that you know. Patients need to be assessed and their medications reviewed and adjusted as needed, sort of on this you know, cyclical basis.

Rachel Maynard:

And so the idea that, like you say, patients are coming in for refills or even, you know, for whatever reason, into the pharmacy and just having that opportunity to have these frequent touch points with them, it's just such a prime opportunity to reassess how their asthma is being managed, how they're using their inhalers, if they're using it properly. I would say that's one of the biggest opportunities is just thinking about those frequent touch points and the fact that we can really make an impact on adherence to medications, but also how to use those medications properly and also, you know, keeping an eye on things like vaccinations and preventing triggers and, you know, other comorbid conditions that can worsen asthma, like obesity or GERD. You know, all of these things sort of are just a prime opportunity for us, I think.

Josh Kinsey:

Yeah, I'm glad you mentioned vaccines, because that's a big one. You know, the guidelines call out specifically that section of the population and there are, you know, certain things that are recommended for them, and so I think that's really important too and I love the idea. I mean, we should be doing cyclical type interventions with our patients in every disease state. But this one, you know, certainly, and also thinking about too again, especially if it's a child who has asthma, as they grow, as their body changes, as their hormones change and the way that they metabolize, I mean we may have to adjust doses as they grow older. So you know just things. Thinking about that too, like you can't just be like, okay, they're on a maintenance inhaler and they're on a rescue inhaler and they're good till they're 25 or whatever, like that's just not going to be the case.

Rachel Maynard:

So well and honestly sorry, josh. I mean, I think one of the things is, even like a decade ago, the way we thought about managing asthma is very different than I think what guidelines are recommending now? Whether or not all of those changes to the guidelines can be implemented in practice is another story, but yeah, there's. There's been quite a change in thinking over the last few years and so, even if a patient's been on therapy for a while, if they're not well managed, it could be an opportunity to relook at that and see if there's an opportunity to improve.

Josh Kinsey:

Yeah, that's great and you bring us. Let's talk about guidelines. So one of the opportunities for pharmacists is to make sure that we are up to date on the guidelines for the treatment and management of asthma. So let's talk a little bit about what that looks like, and I know that we're going to utilize a wonderful resource from Pearl, so I'll let you kind of guide me on when to share that screen. But, yeah, let's talk a little bit about the importance of the guidelines and making sure that we're up to date on those.

Rachel Maynard:

Sure. So the guidelines are the ones that I think many clinicians are following these days are from the Global Initiative for Asthma, or GINA guidelines, and those are nice because they come out every year, and so they just came out in May, a couple of weeks ago and it allows us to sort of keep on top of what's changing, what evidence is coming out, how can we improve, you know, standard of care and even little things, like I mentioned, that asthma plus COPD versus asthma, copd overlap and some preferred terminology, that sort of thing. They address that too. So I think that's typically where people are following. Are these GINA guidelines?

Rachel Maynard:

There were guidelines, and GINA is international, so it's not country specific, whereas there are US-based guidelines that you might remember from the National Health, lung and Blood Institute from like 2007, so almost 20 years ago, and those are still in place. They did come out with a more focused update in 2020, looking at just a few key things, and so that was sort of where the concept of smart therapy, which I'm sure we'll talk about, came out on the US side of things, and then again, gina has sort of been iterating on that over the past few years as well. So I just say that because there's a couple different sets of guidelines, but I think, just from a frequency of updates perspective, the Gina guidelines are where a lot of us tend to rely on, and so, yeah, to that end, what we've been working on at Pearls just recently is updating our pharmacotherapy review, which is like a quick note sort of how you approach a patient with asthma, and updating that to reflect these most recent guidelines that just came out.

Josh Kinsey:

Yeah, that's great, that's great. Do you want to jump into some of those? Yeah, let's go for it.

Rachel Maynard:

And so, yeah, you can share the chart that we have, which is, as you said, sort of a stepwise approach, and we have it outlined for both adolescents and adults, so 12 and older, and then also for younger children. But in terms of just thinking generally, especially about this broad population of our adolescents and adults, you can see there's sort of this preferred approach and then also an alternative approach, and the preferred approach is really where Agena recommends that most patients start and the focus is on making sure that patients at diagnosis or soon thereafter are incorporating an inhaled steroid into their therapy in some way, and that's to again help reduce that inflammation and help manage and also prevent symptoms and exacerbations going forward. So, with either the preferred or the alternative approach, the idea is that the patient will have both a controller medication and a reliever medication, and so the controller, as the name implies, it, helps to manage those symptoms and prevent future symptoms. That reliever is to help with, as needed, you know, when wheezing, coughing, those asthma symptoms crop up, to help provide that quick relief. But I will say this is another thing that I sort of learned as we were doing this most recent update the idea of controller versus maintenance is that I was thinking of them as sort of synonymous, and again, I think that's because we've had this idea that you know you have your quick relief inhaler and then you also have your maintenance inhaler that you take every day to prevent symptoms along with your reliever, and whether that's a short-acting beta agonist or a long-acting beta agonist, like for motorol specifically, the idea is helping the patient get that inhaled steroid at the same time they're getting their quick relief medication.

Rachel Maynard:

So the idea of a controller could actually be something that a patient is using only as needed. If they have their inhaled steroid for motorol combo and they're only using it as needed. If they have their inhaled steroid promoter or combo and they're only using it as needed for more mild asthma, it's still helping to control their symptoms, right? It's not something they need to use every day, and so I thought that was a really interesting distinction just this idea of controller versus maintenance not being interchangeable and sort of this new paradigm about incorporating inhaled steroids and more of that, you know, even as needed therapy.

Josh Kinsey:

Yeah Well, I was going to ask because I used the term rescue inhaler earlier. I was going to ask if that's been replaced with reliever. So is that? Is that the case Like is that pretty much.

Rachel Maynard:

You know that's a good question. They I didn't see anything in the guidelines about that specifically. They do say that people often do you refer to it as a rescue inhaler. It's really just for that quick relief of symptoms. I think the what I've heard in the past about the concern with the term rescue is that, like, it's not meant to be. Yes, it relieves your symptoms quickly, but it's not meant to be used Like if you're having an acute exacerbation you might need you know to go to the hospital or something.

Rachel Maynard:

So but with, with the, the, the growth of sort of these combo inhalers with a formotorol with inhaled steroid, or even the more recent product that's come out in the last couple of years, which has albuterol with an inhaled steroid, the idea is that hopefully it will be less. You know, rescue, because you're getting that, that steroid, along with your quick relief, sure yeah sure, no, I, I, I.

Josh Kinsey:

I appreciate that approach in the sense of rescue kind of indicates, you know, like, oh, this takes care of an emergency situation, as opposed to it really shouldn't Like if there's's, if it's a really dire situation, you should be seeking emergent care. Um, and so reliever is yeah, okay, I can see that that makes sense. Uh, okay, well, also, these charts are so good, I mean, they're just, they're so. I mean, I am your typical type a pharmacist who just loves you. You know colors and flow and I always my family and friends whenever they visit or whenever we go on a trip, I have a color-coded itinerary for our trip.

Rachel Maynard:

And so I always.

Josh Kinsey:

I always get poked fun at for all of my color coding and I even like work in like this is when we're relaxed in the room.

Rachel Maynard:

Oh, wow.

Josh Kinsey:

So I love these charts Like this just this speaks my language right here and they're just, they're so good and they're so easy to have on hand just to help with your patients as you're managing asthma, and this is just one disease state where we're looking at something that Pearls has. So these are just so great. And for the listeners, I didn't really mention it, but all the charts that we're showing, all the handouts and resources that we're showing, are going to be available in your profile. So be sure to grab these, you'll be able to have access to them. Be sure to grab these, you'll be able to have access to them, so okay.

Josh Kinsey:

So with that, let me get back to my notes here. So let's talk a little bit about we've kind of gone over the importance of the guideline making sure that understanding. Why is that important for the pharmacist to stay up to date on it? Because, like you've said, they change every year and sometimes those nuances are, you know. It's important to note them. So let's talk about the role of pharmacists in counseling, specifically with inhaler technique, to ensure that patients are getting the right delivery of the medication, and you know I've seen so many patients over the years just do it so wrong over the years just do it so wrong and it's so sad because you know it's just a simple, a simple discussion that can be had and showing of techniques.

Josh Kinsey:

So let's, I'd like for you to talk a little bit about the importance of that.

Rachel Maynard:

Yeah, I mean, I think you're spot on. It seems like something that it's. It seems like something that it it's simple but not necessarily easy. Right, like so the idea that like it's something that we should be able to tackle and patients should be able to tackle. But you know, every inhaler is different. They all have their little nuances in terms of preparation and cleaning, and you know and it's not super intuitive, like you know.

Josh Kinsey:

sometimes I've even looked at a new one and been like what know? And it's not super intuitive, like you know. Sometimes I've even looked at a new one and been like what do I do? You know.

Rachel Maynard:

Right, right, yeah, and thinking about like limited time too. We all have limited time and so to like have to open up a package and open up the label and like help a patient walk through that, that can be a big barrier. And so, yeah, I think in the guidelines I think they said like up to 70 or 80% of patients have trouble using their inhaler, don't use it properly. So it's like a huge, huge number. But also that many healthcare professionals, as you said, don't always know how to properly instruct if they're not intimately familiar with the product either. So, yeah, actually, so within the Pearl's Drug Summary pages, in our counseling points, you know we have these key counseling points to just drill in on that you're going to focus on with the patient.

Rachel Maynard:

And right in there is the administration guide for these inhalers, so you can just pop that up with that again, having to like open up their package and sort through the label. So just open that up and then walk through it with the patient. But I would say, like you know, it's sort of that classic teach back method, so walking them through the steps as you would normally counsel a patient and then having them teach you back how they would do it and then pointing out any errors or opportunities for correction. But I mean, it's, each inhaler is different, as we said. And then there's the meter dose inhalers, which are a little different from the dry powder inhalers and require different techniques.

Josh Kinsey:

And so, yeah, it's definitely a challenge, but something that is just right within our wheelhouse and such a good opportunity to impact Absolutely. And you know I'd be remiss if we didn't talk about, during counseling, reiterating the importance of adherence, you know.

Rachel Maynard:

Oh, absolutely, yeah, yeah.

Josh Kinsey:

Yeah, that is going to be something that is super important for specifically this disease state, because if they're adherent on, you know the regular, what is it?

Rachel Maynard:

now their controller controller.

Josh Kinsey:

If you're adherent with their controller medications now, then you know they're going to be able to use less and less of those reliever products and have less and less exacerbations that require, you know, some sort of emergent care, hospitalization whatever, which is our goal, like we're trying to improve the quality of life and reduce the burden on healthcare, you know so yeah, so adherence is also super important to talk about with patients, along with the technique.

Rachel Maynard:

And so just to like expand on that a little bit, because again, this concept of how asthma is managed has changed in the last decade or so a little bit, and so, like the idea of your inhaled steroid is your controller, you do that every day and then you have your albuterol, which is your quick reliever, and you're doing those together.

Rachel Maynard:

But really the guidelines in the past few years have encouraged this smart therapy, so single inhaler, maintenance and reliever therapy all in one inhaler, and so that makes it so much easier for patients because it's just one inhaler. They don't have to think about, well, I use this for this and this for this. It's one inhaler and they can use that combo inhaler for their quick relief of symptoms and for their daily maintenance, and so that hopefully helps to simplify things. But also, you know, if you have a patient with more mild asthma and maybe they're not on an inhaler every day, but they are using it when they have symptoms and they're getting that inhaled steroid dose because they're taking that combo product Adherence means a little differently there, but it's like making sure that they are using it when they have symptoms and they know they can. You know, they know that they're using that instead of maybe they had albuterol in the past and you know understanding why they're maybe now using that combo inhaler.

Rachel Maynard:

So, yeah, it's. I will say, also thinking about adherence, though, even though the smart therapy has been sort of, you know, the preferred treatment, now I think cost and insurance issues can be a barrier. So, you know, if you're using smart therapy and you're using your maintenance dose, but you're also supposed to be using it as a reliever, then sometimes insurance will pay for that additional dosing and so, yeah, we have right, because you would, you would run out, it run out of it sooner than what, yeah, like how do you monitor that day's supply?

Josh Kinsey:

yeah, exactly, and again that goes back to your point earlier where you were talking about. This is a cyclical management for these patients, because you know what. If you see like, oh, they're coming in every 18 days for this, then clearly maybe maybe the dose is not right, maybe they're not as controlled as we thought. You know, because they're using it so much more often and you know that's what we as pharmacists can see. We can see when they're requesting the refill too soon. Or you know if we're on the provider side of it. We can see when you know the refills are coming in as requests to send and things like that. So, yeah, like in an AmCare setting or whatnot, where we're working to actually, you know, manage the care. So yeah, that's great.

Josh Kinsey:

The other thing to talk about I think that's important in adherence is also talk about in counseling. Along with adherence is also the importance of trigger avoidance. Can you speak a little bit to that? Is there anything you want to talk about in counseling? Along with adherence is also the importance of trigger avoidance. Can you speak a little bit to that? Is there anything you want to talk about there?

Rachel Maynard:

Yeah. So again, that's a great opportunity for us to be listening to what patients are talking about, just even in conversation, as you're just chatting with them about other things. Right now, allergy season is sort of in full swing and that can be a trigger for many patients with asthma. So, being aware of that, again, smoking can be a trigger. So if a patient does smoke or vapes, you know, pointing out that this could be contributing to the worsening of your symptoms and helping them on that journey to quit if possible.

Rachel Maynard:

There's also, you know, a viral infection that could be a trigger. So helping patients stay healthy again through vaccination. And so, yeah, I mean, again, there's seeing patients and they're getting, you know, an over the counter histamine or something, or you see them sneezing and you know these sorts of things can be a cue to be like hey, did you also know that this could be? This could impact your, your asthma management too. And maybe we need to think about, you know, monitoring closely if you're having some sort of viral infection or allergies or whatever the case may be Absolutely, absolutely.

Josh Kinsey:

Yeah, those are all great points. So let's, I think we've kind of hit on our major points that I wanted to be sure we talked about today. I want to also show your other couple of resources that are going to be available to listeners. So let's, I'll just kind of share and you can kind of just quickly let us know what we're looking at here.

Rachel Maynard:

Yeah, so so we pearls at pearls we have this really fabulous inhaler chart that compares the dose categorizations for inhaled steroid combo products, so various inhalers that have inhaled steroids.

Rachel Maynard:

You can sort them into low, medium or high dose and that's based on the GINA guidelines. And it can be challenging to sort of quickly compare what dose a patient might be on and what they might need to switch to. And again, this goes back to the idea of like adherence and making sure we're overcoming cost barriers for patients, because insurance plans change, insurance formulas change and patients may all of a sudden be not able to get the inhaler that they've taken for years, and so this part allows you to very quickly compare. Okay, if a patient's on mometasone and they're going to switch to fluticasone at a medium dose, here's how you would do it with the number of puffs per day and it's again sorted by ages 12 and older and pediatrics. So a very quick and easy way to help those patients switch if formulary issues come up. And I will just say, with both the step therapy chart and this corticosteroid comparison chart, it is meant and is used as a way to keep it very simple, but also being aware that, like after any switch.

Rachel Maynard:

We also still want to encourage patients to be monitoring their symptoms, being aware of any worsening of asthma, because everyone's going to respond differently to their particular product. So it's just a good reminder to, after any switch or when starting, circling back with that patient again to see how they're doing.

Josh Kinsey:

Yep. So it's a great guidance document. It is not the gospel truth, you know exactly. And then this one, which I also love again, love the color coding, love the flow of everything, and just the summary of it's just so good. So I'll let you kind of speak to this one really quick too, yeah.

Rachel Maynard:

So this is an inhaler comparison chart and, like you say, it's just, it's very nice to look at. You know, there's not a lot of the things that you're looking at on paper that you're like, oh, this looks nice to look at. But this, I would say, is it's very, like you say, color coded. It's sorted by class, so inhaled steroids versus labas versus Lama labas and combos, so very easy to quickly find what you might be looking for in terms of which drugs are in a specific class. It also notes which ones are approved for asthma versus COPD. So helping with that indication and also with the approved age ranges. And then there's dose categorizations in there too. So helping again if you need to switch between doses of particular steroids, helps with that conversion as well. And it also, by the way, notes which products are available as generics or authorized generics.

Josh Kinsey:

So, again, if you're running into insurance issues, that could be another clue to help with those, those barriers absolutely yeah, and one thing you mentioned earlier and I'll just this is kind of just to summarize and reinforce the importance of counseling and adherence and, you know, talking about the triggers and that kind of thing. One thing you mentioned was vaping and I heard recently the, the percentage of patients that and it's staggering and just, and you know, like, just I feel like we're back in that cycle of you know the whole, like what was it? Probably the sixties and seventies when, when smoking, you know the whole, like what was it? Probably the 60s and 70s, when smoking, you know the issues really came to light, really started, you know downplaying it and whatever. But I just felt like we're back there again in a similar situation. So I love that you pointed that out because that, you know, that's a trigger for those patients and that's something that we need to be sure that we're talking about, because I don't feel like we're always talking about. You know, we always mention smoking right, people, people who vape don't think they smoke right, so it's so making sure to point out the vaping, I think, is just really important. So, yeah, yeah, okay.

Josh Kinsey:

Well, this has been so much great information, rachel, like just so good, uh, and uh, just so excited to have you on today and to discuss this and to show how these great resources from Pearls just can really help our pharmacists out. That's our whole goal is to make it easier for our pharmacists, because we know that they're overworked, we know that their workflow is difficult, we know that they have limited time, and so if there's anything that we can do to make that time more special and more dedicated to that patient, and if we can train them in certain ways to be able to be more effortless with that counseling, then that's our goal. So these are just such great supplements to the education that we already provide. So this is great. Such great supplements to the education that we already provide. So this is great. So what?

Josh Kinsey:

I always ask everyone, all my guests, at the end? We've given lots of nuggets today that I hope our listeners walk away with. But what would you say? Rachel is our game changer here. So what is our, what's our real big take home as pharmacists in, you know, in the space of asthma management?

Rachel Maynard:

Well, I think you know we can't say it enough that those touch points that are sort of built in naturally to some of our interactions with patients are just the prime opportunity to be able to reassess inhaler technique, reassess adherence, help correct any issues that might be coming up, identifying triggers, all of those things. We didn't specifically say this, I don't think. But another thing that ties into that is, before recommending any change in therapy or encouraging a patient to change their dosing or something like that, always assessing inhaler technique and adherence before recommending any change to a colleague or prescriber, because it could just be a little correction can help them get the most benefit from the medication and really improve their symptoms. So, and prevent those exacerbations and ED visits.

Josh Kinsey:

So that's a great point in that. You know, don't always jump to the fact that you need to up the drug, because it could, if they're not getting it Exactly and on the flip side.

Rachel Maynard:

I'll just throw in one more point here. So we talk about often stepping up therapy, but also, if you have a patient who's well managed and after a few months is stable, think about stepping down too. You know it's a step. Steps go both ways. So that's also something that the guidelines were, you know consider when you may be able to step down if a patient's doing well, especially if they changed therapy recently.

Josh Kinsey:

Great point, and that's not something that is super common with a lot of the disease states that we manage is like, okay, well, let's just take them off the stock. So that's really a great point to highlight. So thank you Well again, Rachel. So good, it's been great to have you on this week. Thank you so much for joining us. We really appreciate the partnership and we appreciate your time today.

Rachel Maynard:

Thank you so much. This was fun, glad to be here and glad to support girls here with CE Impact.

Josh Kinsey:

Great, thank you. If you're a CE Plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at ce impactcom and, as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you again.