Although pharmacists are in an excellent position to recognize patients whose asthma may be poorly controlled due to poor inhaler technique, 19, 20 it was clear from our telephone survey that community pharmacists rarely counsel patients on the steps involved in using a Turbuhaler, or check the patient's Turbuhaler technique at any stage. These results are consistent with published data for other asthma medications, which have shown counseling rates in the community pharmacy to be low.21 For example, it has been shown that patients need careful instruction in use of pressurized MDIs, including step-by-step demonstration at the time of dispensing, and observation of their technique.18 Because MDI technique tends to decline without routine review, 22 it has been recommended that pharmacists should reassess a patient's MDI technique when prescriptions are refilled or renewed. More generally, international asthma guidelines recommend that pharmacists should form part of a team approach to patient education about use of inhalers, 23 while the pharmacy practice guidelines from the American Society of Health-System Pharmacists specifically recommend that pharmacists should demonstrate the use of inhalers and should observe patients' medication-use capability.24 The results of the present telephone survey in Australia confirm the findings of Mickle et al that few pharmacists give patient education when dispensing inhaled devices.25 Potential barriers to such a role for community pharmacists include business pressures, lack of clinical knowledge, and time constraints.26 31 However, dispensing asthma devices presents a unique opportunity to counsel patients about how to use them, a need not necessarily met by other health care providers. Pharmacists need to embrace an opportunity that has the potential for real impact on patient care. Baseline data from the counseling study are consistent with previous studies, which have shown that poor inhaler technique is common among respiratory patients9, 10, 31 and that there is evidently a need for improving inhaler technique with some type of patient education.16, 3235 The steps that were completed correctly by only few patients during initial assessment were holding the Turbuhaler vertically during loading, exhaling to residual volume before inhalation, and holding the breath after inhalation. Turbuhaler technique was assessed using a published inhaler-specific checklist, 8 which was said to have been developed from guidelines issued by the Dutch Asthma Foundation. The individual steps in this checklist largely correspond to the steps described in the patient information statement issued by the manufacturer. However, it should be noted that the manufacturer's instructions do not incorporate a breath-hold following inhalation step 8 of the checklist ; .8 A study of 14 children given 2 agonist by Turbuhaler showed no significant benefit from a 10-second breath-hold.35 It might be considered inappropriate to and salmeterol. Benazepril LOTENSIN EQUIV ; benazepril hctz LOTENSIN HCTZ EQUIV ; captopril CAPOTEN EQUIV ; captopril hctz CAPOTEN HCT EQUIV ; enalapril VASOTEC equiv ; enalapril hctz VASERETIC EQUIV ; fosinopril MONOPRIL EQUIV ; fosinopril hctz MONOPRIL EQUIV ; lisinopril PRINIVIL, ZESTRIL equiv ; lisinopril hctz ZESTORETIC EQUIV ; quonapril ACCUPRIL EQUIV ; quinaprkl hctz ACCURETIC EQUIV ; ACCUPRIL ACCURETIC MONOPRIL MONOPRIL HCT ACEON ALTACE MAVIK UNIRETIC UNIVASC GS GS 20mg 20 25 ATACAND * ATACAND HCT * AVALIDE * AVAPRO * DIOVAN * DIOVAN HCT BENICAR BENICAR HCT COZAAR HYZAAR MICARDIS MICARDIS HCT TEVETEN TS TS TS 16mg 16 12.5mg Not Covered Prior Authorization Quantity Limit Restricted to Specialist Avail. through Specialty Pharmacy Program. Ca n t NHS l o go The NHS logo may only be used without the descriptor line on fascias where space restrictions mean it is not possible to incorporate it. On all other materials, the descriptor line must be used. W h e assistan ce ? The NHS identity website contains a copy of the pharmacy guidance and the pharmacy artwork nhsidentity.nhs pharmacy. If you require further assistance you can contact the NHS Identity Helpline: 0207 972 5250 or nhs.identity dh.gsi.gov and fluticasone. Tors are advised to allow a little more than one square yard of floor space for each animal. 31 The crowding is not just to save space--crowding also reduces feed costs. What most people would consider healthy and natural movement is, to today's pig farmer, expensive and undesirable. A modern pig farmer wants his pigs to stay as motionless as possible--when a pig walks, the farmer sees costly feed wasted to provide the energy for movement instead of being stored as flesh. Keeping pigs under crowded conditions decreases activity and increases profits. When researchers cut floor space given to piglets from .22 to .14 square meters, feed ex, for example, quinqpril 20 mg.

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