Advanced Services are designed to support patients in their adherence to treatment in order to optimise the benefits of treatment. There are a number of adherence issues that may be relevant for respiratory patients and should be considered when counselling.

Patient's knowledge

• Many patients will be prescribed drugs for other conditions.
• Does the patient know what each medicine is prescribed for?
• Does the patient understand the difference between preventer and reliever inhalers?
• Do they understand what may trigger their symptoms?
• Does the patient understand which inhaler they should use first?

Dosage regime

• Is the patient taking the medication as prescribed?
• Are they under or over using any treatment?
• Are there any concerns over the pattern of prescription orders? For example excessive use of a reliever and/or not ordering a preventer.
• Does the patient have any problems with the medicine and does this stop them taking any doses?

Compliance

• Does the patient take all their medication?
• If not why not?
• Is there a problem co-ordinating breathing in when using their inhaler.
• Has any change in therapy been explained fully?
• Has the patient stopped using their inhaler because they feel well?
• Has the patient failed to take or complete a course of steroids?
• Does the patient know how to use their peak flow meter correctly?
• Does the patient understand the risks of complications if they do not take their medicine as prescribed?

Formulation

• Does the patient have problems with the type of inhaler prescribed?
• Can they demonstrate correct technique?
• Does the patient have problems with blister packs?

Side effects

• Does the patient experience any side effects?

Efficacy

• How often do they need to use their reliever inhaler?
• Do they amend their treatment depending upon their symptoms or peak flow results?
• Do they monitor their peak flow results?

Other considerations

• When was their last annual review at their clinic or with GP?
• Do they have any other medicine related problems?