Advocacy in Respiratory Medicine – getting our voice heard for change

Bronwen Thompson, UK Inhaler Group

It is important that patients optimise the benefit they receive from their inhalers for two reasons; to ensure that their respiratory condition is optimally controlled and to ensure that the healthcare system derives maximum benefit from the budget it commits to inhaled treatments. Ultimately we want to see respiratory patients having the best quality of life that they can.

Traditionally, efforts to maximise the benefit once an inhaler is on the market, have focused on educating patients to use their inhaler correctly, and ensuring prescribers and dispensers are familiar enough with the inhalers they are giving patients, to coach the patients in correct inhaler technique. Since the molecule and the device are integral components of the inhaled treatment, optimal usage of the device is required to deliver the molecule.

The UK inhaler group (UKIG) has been exploring other ways to drive optimal use of inhalers, and one of these is to look at how policy makers can influence professionals and patients to take the use of inhalers more seriously and derive maximum benefit from them.

We have identified organisations that shape relevant policy, and the mechanisms through those organisations which could be used as a channel to drive improved use of inhaler devices. These include the Department of Health and Chief Pharmaceutical Officer, Medicines and Healthcare products Regulatory Agency (MHRA) and National Institute for Health and Care Excellence (NICE).

The mechanisms we seek to influence include clinical guidelines, best practice guidance, incentive schemes for hospitals and GPs, and regulation over prescribing and dispensing practices.

Our work is organised around several themes:

• Colour coding of inhalers – how to maximise the benefit of colour coding so that patients understand the role of different inhalers and use them appropriately
• Prescribing by brand name, and dispensing the product intended by the prescriber – if the generic name is on a prescription, the patient may not always receive the same product each time
• Inhalers are medicines too – sometimes inhalers are treated less seriously than other medicines as they are not taken orally and swallowed
• Green/ environmental issues – selecting inhalers to minimise environmental harm by considering e.g. global warming potential of propellants, recycling of inhaler devices, refillable devices. The UK has set a target of reducing use of inhalers which have high global warming potential by 50% by 2022
• Use of inhalers in emergencies – advice given to patients when they dial 999 for emergency services, guidance for paramedics and ambulance staff, the role of spacers with MDIs.

In these themes – which have been prioritised after consultation with our members – we may undertake research to explore and understand an issue; we may educate healthcare professionals and/or patients; we may seek to raise awareness amongst the general public, and we may influence policy makers and seek to create levers at policy level to drive optimal use of inhalers.

The UK inhaler group is a coalition of not-for-profit organisations and professional societies with a common interest in promoting the correct use of inhaled therapies. There are currently 11 member organisations.