Rethinking pharmacy conversations on asthma care

Pharmacy interventions in asthma management can be difficult because patients often don’t fully understand the underlying nature of the condition. These experts explain how to cut through.

Most people don’t understand what inflammation means, said Lead at the National Asthma Council Australia, Debbie Rigby FPS. 

 ‘I explain that your lungs have a long-term sensitivity or irritability which we need to treat so they’re less reactive to stimuli, whether it’s a viral respiratory infection or exposure to tobacco smoke,’ she said. 

‘That underlying tendency in  lungs is not treated by SABA alone. So, we need to use something that will maximise your lung function and reduce the irritability of your lungs.’ 

Helping patients make the behaviour switch

Making sure patients understand the new recommendations on how asthma medicines should be used for optimal health benefits is a critical part of the conversation with patients who come into the pharmacy for an inhaler, Ms Rigby said. 

‘I think it’s just going to be a different conversation we have with patients in a community pharmacy setting, because we do have salbutamol available over the counter without a prescription,’ she said. 

Switching from over-the-counter medicines to prescription medicines requires a big behaviour shift for patients who have been living with asthma.  

Ms Rigby has produced many education webinars on the subject and written widely about how patients can be encouraged to make the switch. 

‘It’s using all the behaviour change theories trying to motivate that person to change their behaviour, and that’s partly through education as well as support and just better understanding of the condition they’re living with,’ she said. 

It’s important that patients understand asthma as an ongoing chronic inflammatory condition that can be bubbling away and then triggered, Ms Rigby said, and that they understand they can reduce the risk of flare-ups with the appropriate medicine. 

‘They can have better control of their asthma so it doesn’t have an impact on their day-to-day activities – whether it’s going to school or work or doing exercise.’

While non-prescription SABA will continue to be sold in pharmacies, pharmacists will now need to initiate conversations with patients living with asthma to ask whether they think SABA is the best treatment for them, and whether there’s a better option, said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee. 

‘The answer to that question might often be “yes”, if adolescents and adults are just using SABA,’ he said. ‘There might still be a role for SABA alone in some children.’

It is important for pharmacists to consider how to start a conversation to help people living with asthma understand there is another approach they should consider and to encourage them to see their doctors to discuss the treatment alternatives, he said. 

‘These are people who might have been using SABA for some time, and don’t see it as an issue,’ he added. 

Prescribing pharmacists step in

In Queensland, prescribing pharmacists are assisting patients living with asthma to manage their conditions, said pharmacist prescriber Demi Pressley MPS, who practises in Cairns.  

‘Patients have responded really positively to pharmacist care and management of respiratory conditions,’ she said. ‘Patients have returned to say I changed their life through the treatment provided and the time, care and education I had provided.’ 

The ability to initiate or change to preventer therapy when a patient comes to the pharmacy to buy salbutamol, or when they report increased salbutamol usage, has shifted the focus and goals of patient interactions, she added. 

‘Rather than emphasising the importance of review and seeing their GP, I am able to conduct a comprehensive assessment with the patient and get them onto the most appropriate treatment at the time of their presentation, arrange appropriate follow-up and investigations – all while keeping their regular prescriber updated,’ Ms Pressley said.  

When a patient recently arrived at Ms Pressley’s pharmacy requesting a salbutamol inhaler, she recommended they change their treatment for more effective management. 

‘Through initial discussion, I was able to find out that they had been using their inhaler 3–4 times daily for the last few weeks, when their usual usage was 1–2 times a month,’ she added.

‘With this information I was able to discuss the chronic conditions management pilot, and the patient was happy to have a comprehensive consultation. During this consultation, I learned the patient suffers seasonal flares during cane season. 

‘They usually use Symbicort during this time but couldn’t see their GP for another 3 weeks. I was able to initiate the patient on Symbicort therapy immediately and notify their GP of this.’

Read more about the Australian Asthma Handbook’s updated guidelines in the October 2025 cover story of the Australian Pharmacist journal.