Educating the patient, controlling the disease: a point prevalence evaluation of structured pharmaceutical asthma care in real world settings

Asthma control remains suboptimal worldwide, often due to modifiable factors such as incorrect inhaler technique and reliever overuse. Community pharmacists (CPs) are well-positioned to address these gaps through structured patient education. A point prevalence evaluation was conducted in 1247 patients across 127 community pharmacies (11.1% of all pharmacies) in North Macedonia (Dec 2023-Sep 2024). Asthma control was assessed using the Asthma Control Test (ACT), while Asthma Slide Rule (ASR) was used to evaluate short-acting beta-agonists (SABAs) use. Inhaler technique was assessed using device-specific checklists. CPs provided comprehensive care, including adherence support, lifestyle counselling, and monitoring. Poor inhaler technique strongly predicted poor asthma control (ACT: OR = 5.98; ASR: OR = 6.43). Among 127 patients followed, correct technique improved from 71.7% at baseline to 88.8% at the second visit, and among patients who attended all three visits, accuracy increased from ∼63% at the first visit to∼89% at the second and 98.2% at the third (56 patients). By the third visit, the association between technique and control diminished, reflecting the success of comprehensive pharmaceutical care. These results highlight the critical, multifaceted role of CPs in improving asthma outcomes and support the integration of CP-led comprehensive pharmaceutical care for asthma into national management strategies.