SMART therapy for Asthma

New guidelines suggest that for most asthma patients a single inhaler strategy with both an ICS and a quick onset LABA can be used for maintenance and rescue therapy. This has been shown to improve symptoms and decrease need for health care visits. But what is the latest data on SMART therapy and what are the barriers to its use?

The GameChanger: SMART therapy should be the standard of care for most asthma patients.
 
Host
Geoff Wall, PharmD, BCPS, FCCP, BCGP
Professor of Pharmacy Practice, Drake University
Internal Medicine/Critical Care, UnityPoint Health

Jake Galdo, PharmD, MBA, BCPS, BCGP
CEO
Seguridad

Reference
Meta-analysis
https://pubmed.ncbi.nlm.nih.gov/35230437/

Asthma Action Plan
Do You Have an Asthma Action Plan?

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CPE Information
 
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the latest information concerning SMART therapy in asthma.
2. Discuss how healthcare workers can decrease barriers and increase acces to SMART therapy.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-165-H01-P
Initial release date: 05/06/2024
Expiration date: 05/06/2025
Additional CPE details can be found here.

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Transcript

Speaker 1: 0:08

Hey CE Plan members From CE Impact. This is Game Changers. I'm Jen Moulton and today I have with me Jeff Wall and Jake Galdo to talk about smart asthma therapy. Welcome, friends.

Speaker 2: 0:18

Hello.

Speaker 1: 0:19

Jake, selfishly, I love when I have you both on the podcast, so this is a special treat, um, not only because I get to sit back and listen, which is nice. Um but mostly because I get to learn from you, since you are both way smarter than me on this topic.

Speaker 3: 0:36

Kind of you to say yeah.

Speaker 1: 0:37

Yeah, you got what I did.

Speaker 2: 0:38

Just on this topic, nothing else. That's not true at all.

Speaker 1: 0:44

Um, well, I am excited. I've been excited about this. We've been talking about doing this topic for a few weeks here and I'm excited to finally get it going, because, even though the smart therapy has been in the Gina recommendations for a few years I think, like 2020 or 2022, I'll let you all clarify that but there's there's been such low uptake, so I'm sure that we will, partly today, get into how we, as pharmacists, can change that, as well as all the recommendations and how we can talk to physicians about why this is a smarter therapy. So I will let the two of you take it away today.

Speaker 3: 1:24

I'll get started and yeah, I'm appreciative my frequent co-pilot, jake, is with me because I mean I think Jake has, you know, knows a lot about some of the background stuff and logistic stuff, as well as the quality metrics. So you know, asthma is an interesting disease in that it's one of the few diseases that mortality has either stayed stable or actually gone up in the last 20 years. I mean, we've managed to, you know, for a lot of other chronic diseases managed to level things off or get a little better, but especially in low socioeconomic patients or patients who live in urban areas, asthma mortality has actually increased. And so you know, this is obviously an area where I think you know, as pharmacists and providers, we need to do a better job. And it isn't like there isn't good data out there, you know. I think you know there are well done clinical trials that help us guide therapy and there are well done clinical guidelines and there are several guidelines out there. You always get nervous when there's two big or three big organizations doing kind of dual. You know dueling guidelines, but I think almost everybody out there you always get nervous when there's two big or three big organizations doing kind of dual. You know dueling guidelines, but I think almost everybody uses the GINA guidelines nowadays and you know it's a nice stepwise progression, you know. I mean it's pretty easy to follow, I think, when you start getting into the higher, you know, intensity of asthma symptoms and more severe asthma, and you start getting into the world of biologics, which we could do an entire podcast on itself because, you know, biologics have revolutionized the treatment of severe asthma.

Speaker 3: 2:53

But you know, but even at the areas where I think most primary care physicians and other providers deal with this, there's been some big changes. And the thing we're going to focus on today, of course, is what's called SMART therapy, you know, which basically, in a nutshell, means that patients have one inhaler, okay, and they only have one inhaler and that's the inhaler they use for everything. It's the inhaler they use for maintenance therapy as well as acute symptoms. And this is hard, I mean, you know, paradigm shifts like this are always difficult to, you know, get into routine clinical practice. I'm old enough to remember back when, you know, beta blockers were completely contraindicated when it came to heart failure, and now, of course, there's standard therapy. It would be, would be almost malpractice not to use beta blockers, but in those first, you know, six or seven years after the studies came out that that beta blockers actually were incredibly beneficial in heart failure, there was very low uptake because, you know, clinical inertia, especially for well-entrenched ideas like that, are difficult to overcome.

Speaker 3: 3:55

And I think that's the same thing with asthma and SMART therapy. It was beat into my head, you know, you know many, many years ago that you know you use inhaled corticosteroids for maintenance therapy and you use short-acting beta agonists for acute symptoms. And you know I think we all have seen the commercials you know with you know the inhaled corticosteroid inhalers that they you know they, they warm during the commercials you know don't use this for acute symptoms. You know sort of thing and and and and so again, it's well entrenched in, I think, medical thinking that that we, we don't do this. And so you know. Now of course we have data to suggest that in fact you can and probably should use inhaled corticosteroids during acute symptoms, and that's kind of the whole basis of SMART therapy. Now the thought, of course, was that you know now that the standard is inhaled corticosteroid and labotherapy combination for most asthma patients, in fact for all asthma patients.

Speaker 3: 4:55

Now which is the other thing too you know and I think Jake will probably talk a little about this as well is that you know the GINA guidelines. You know mention that. The other thing to keep in mind is that even in stage one asthma.

Speaker 3: 5:07

So you know patients who you know have occasional symptoms, you know stuff like that that they should still again receive smart therapy. So you know, albuterol has largely faded from the scene and again that's going to be difficult for many providers to wrap their head around. I think, again, that's going to be difficult for many providers to wrap their head around. I think so. The theory is that inhaled corticosteroids, of course, is one of the few therapies we have. We know that stabilizes lung function and has solid data showing that it decreases symptoms. It improves FEV1. It decreases health care costs because people don't go to the emergency room or urgent care. It hospitalizes as much. So basically it's just beneficial across the board linchpin of therapy. But there is evidence now that suggests that many of the doses we use for inhaled corticosteroids are not enough and that patients will probably benefit from extra doses of inhaled corticosteroids. And so the thought was well, when somebody has acute symptoms, why couldn't they take a hit off their inhaled corticosteroids, knowing that it's not going to necessarily help with with its, with the new, with the acute symptoms, but that its extra dose will help with the inflammation that comes along with bronchospasm? And until about 10 years ago we didn't have any labas out there that had a quick enough onset that you would force you to use inhaled corticosteroids and a short acting beta agonist together when someone had acute symptoms, which is just not going to work right. Fortunately, now we have several LABA-ICS combinations out there that have shown pretty conclusively that they do have an onset within two minutes or so, or three minutes, and so they can be used. Even though they're a long acting beta agonist, their onset of action is short enough that they can be used for acute symptoms. And that's where the combination has come up. If we can pick a LABA that has a very quick onset of action and inhaled with steroid, we no longer need to, no longer need two inhalers to be used during acute symptoms, and that's again one inhaler for everybody, one inhaler to rule them all, if you will, for the Lord of the Rings people out there, you know, you know, basically one inhaler that will work. And so that's where smart therapies come in.

Speaker 3: 7:37

Now, has this been studied? Yes, it has, and the studies haven't been terrific studies because of course you know it's going to be difficult to do randomized control trials. Who's going to pay for these studies, et cetera, et cetera. But the data that does exist shows that patients who routinely use SMART therapy, especially if they have moderate, persistent or persistent asthma, it has been shown to improve symptoms beyond just short-acting beta agonists and maintenance LABA ICS therapy. It's also been shown to decrease healthcare utilization. So it is beneficial to use SMART therapy. It's easier for patients, I would say, dare say, it's probably cheaper for patients because they're not having to juggle four or five inhalers around sometimes. And it's going to make education easier for patients because they only have to learn one inhaler technique. Right, you know, they don't have to learn the. You know a rapid acting, you know metered dose inhaler for their albuterol as well as their dry powder inhaler or the slow mist inhaler or whatever.

Speaker 3: 8:38

So you know there's just multiple reasons why smart therapy would be beneficial and again we have evidence showing that it works. So why haven't people used it? And, as Jen points out that I haven't read a lot of hard studies on this, but I know there's been a couple of posters that have come out there that uptake has been very poor. That uptake of smart therapy has been less than 20% in most cases and I think again, it just comes down to, especially for primary care providers, who have, you know, 87,000 things thrown at them every single day and they have to kind of be on top of, you know, 150 guidelines and 300 new studies and all that other stuff that this is just not really entered their routine of practice and they just don't think about smart therapy. So I mean, I think that's kind of where we're at with the therapy itself, is that there are multiple reasons why it's beneficial, and but I think it is such a paradigm change from the short acting beta agonist for symptoms inhaled corticosteroid long acting beta agonist for maintenance therapy that it's just that the uptake has really been poor. And so, you know, that's that's kind of where I think the clinical space lies.

Speaker 3: 9:44

And my pulmonologists are really good about this, but they're pulmonologists, right, they usually see the worst of the worst asthma patients. Primary care physicians commonly see asthma that's not that severe, and so I think, pharmacists, we can do a lot of things here. I think obviously we can advocate for our patients to make sure that they're getting that. You know, again, sometimes talking to providers and saying, hey, you know, I just sold this albuterol inhaler for, you know, this patient. You know, I'm not sure you're aware about smart therapy. You know, if you just basically allow them to use a dose of their lab ICS during acute symptoms, we don't even need to fill this, this albuterol, you know, I think that will help. I think, training patients about it and educating them, because, you know, especially older asthma patients have been it's been beat into their head probably since they were very first diagnosed you never use your maintenance therapy for acute symptoms. Well, now you do, and, and so I think that's that's something that we can do.

Speaker 3: 10:42

There's also been some progress in what are called digital inhalers, so basically inhalers that are designed electronically to deliver more drug, to lower airways. And there are smart inhalers, so again, they alert you when it's time for a dose. And I mean, again, there's all sorts of neato technological stuff you can do here, but I'm sure there's a price tag to that. So I think pharmacists can just play a huge role for advocacy and education in this. So that's kind of where I'm at. Jake, I know that in your world, especially in community pharmacy, there's a lot of angles here logistics, quality measures, et cetera, et cetera. So what you know, what have you found with smart therapy personally, and what can pharmacists do really?

Speaker 2: 11:25

If you were to see me right now. Jeff, you know that I'm readjusting my glasses because I'm about to be a little pedantic on you.

Speaker 1: 11:32

Please pedantic away. You're welcome in advance.

Speaker 2: 11:34

Yes, Thank you. So I see your Lord of the Rings reference. I will raise you Spider-Man across the universe or multiverse, excuse me. And in Spider-Man we learned that chai tea is redundant and it's actually tea tea, right? So chai is tea, and so we never want to say chai tea, because that's saying tea tea. Smart therapy is also redundant.

Speaker 2: 11:57

And I think it's really important because this is how we frame it and how we talk to people. Smart actually stands for same maintenance and reliever therapy, okay, and so we don't necessarily need to say smart therapy, because that's saying same maintenance, reliever and reliever therapy, therapy, right. But I think that this is a crucial aspect, because I'm not going to write a recommendation and fax it over to Dr Moulton. I'm using Jen as our example here. I'm going to fax it over to Dr Moulton and I'm going to say hey, you know, you should use Budesonide for motorol for smart, because that's not how you make friends in healthcare.

Speaker 3: 12:33

Right.

Speaker 2: 12:35

She's not going to like me saying do this because it's smart. But that's what this represents is the same maintenance and reliever therapy, and I think, if we hound in on that just for a moment, I think it reemphasizes what we're actually talking about here. We're talking about, to your point, chronic therapy with an inhaled corticosteroid and long-acting beta agonist that is also used for the reliever therapy, and what this does is it creates kind of a bifurcation of recommendations in a pharmacy or a way to identify our patients. First and foremost is are the patients on the right ICS-LABA combination? And so you kind of alluded to this and you talked about it a little bit. But the data shows that the long-acting beta agonist that is indicated for SMART is for motorol. So, first and foremost, we need to switch everybody that is on an ICS-LABA over to an ICS-LABA combination that is with motorol, and that's actually what the GINA guidelines are stipulating. Use SMART, and when you use SMART, make sure it's promoterol. So that's item one, item two and that's a little kind of like identify patients, and you've talked about this. It's not just that we don't use albuterol. Albuterol is no longer recommended, right? It's like what's the purpose of albuterol? It's reliever therapy. Well, now we know that the treatment of symptoms, so acute symptomatic management, is not with albuterol. That's a contraindication. It's actually to be treated with this ICS-LATL combination and I think that this is what we need to start thinking about in a community pharmacy setting. We need to think about how we're interventionist and to do that, we need to identify the thing that we need to intervene on and that's appropriateness of therapy.

Speaker 2: 14:18

I am a patient with asthma. I don't say that I'm asthmatic because I don't define myself by my medical conditions. Jeff, I am a person with asthma and I had to advocate and argue with my physician, with my primary care, to get on the right therapy, because they just said no, right, and it's like well, here's the guidelines. At this point they just kind of like do whatever I say because I think they're tired of me like printing out articles and giving it to them. But that's me advocating for myself. So we need to think about how we can do that in the pharmacy setting for our patients. And I think that this drives towards quality in the community pharmacy setting, because how do we denote pharmacy A is better quality than pharmacy B and we can use some of these metrics as a way to say I'm better because I care for persons with asthma differently and I optimize. I make an intervention and I optimize their care, which is, to your point, a paradigm shift in how we view pharmacy, how we can do value expression, but also how we can optimize the care for our patients.

Speaker 2: 15:20

Right, because it goes back to think about Medicaid. Medicaid is oftentimes a big payer in our state and that tends to be children. Children have a bunch of asthma and they're often going to having exacerbations, but how do we optimize their care to prevent that from happening? And ultimately, you're right, Inhalers are expensive I am not going to discount that and that drives a lot of the challenges that we have. But I think that that's also where we can play into emphasizing this, because you know when you look at who dictates what the copay is right Cause I'm not going to talk about the total cost, I'm going to talk about the patient's experience of cost, which is the copay Well plan formulary you know each contract dictates what the the cost is right. My pharmacy has a copay of $30. Jeff, your pharmacy has a copay of $10.

Speaker 2: 16:08

But, who dictated mine was 30 and yours was 10? That was the PBM, ultimately the health insurance company, ultimately HR, because they might be trying to direct patients to specific stores for preferred networks. Well, again, this gets back to the idea that if my pharmacies can optimize asthma management better, then we should have lower copay, which then increases access and addresses that social determinants of health. So it is all kind of intertwined in this idea of how do we start to raise awareness, to start to mitigate it.

Speaker 2: 16:38

And the other thing that is kind of interesting, you know, outside of this whole idea of smart, is just good management of a person with asthma, which is having an asthma action plan. Right, because that drives into this when should I take additional doses of my ICS lab inhaler? Well, when I'm having breathing problems. Well, when do I know that I'm having problems? My asthma action plan tells me when I should start to take more doses, starts to tell me when I need to take a steroid dose pack, and so the other question is do our patients have asthma action plans? And I can tell you, when I dispense drugs, particularly when I dispense nebulizers, and I ask that question, the answer is always no, right, and that's a huge intervention that we can do to equip patients to know when to use SMART effectively.

Speaker 3: 17:25

That was, you know, an asthma action plan, and I don't know if they still do the green, yellow, red zone thing.

Speaker 3: 17:30

Oh, they do, yeah, yeah, and I mean, I was again, you know when the when dinosaurs roam the earth and pharmacists compounded only three medications when I was in pharmacy school, you know that that was still. You know I mean that that was beaten to our heads and again it just hasn't had a lot of uptake and that's always really surprised me. You know that most patients with asthma I mean I think very motivated patients do, but I think the majority of patients with asthma you're right, they don't have an action plan. So yeah, that's engage our school systems.

Speaker 2: 18:00

I have a friend and he was talking to the nurse at their school system and they were talking about how they could collaborate together. Does the pharmacy need to come out and do vaccinations?

Speaker 2: 18:17

are there other services the pharmacy could offer. And they said, well, what about asthma? Asthma is really a burden of disease on our community. And they're like, oh, that's a good idea. And then the question was okay, so what's the incidence of asthma in our schools? And let's just act like it's 30%. It was pretty high because of the burden in the community. And then the question was okay, well, how many kids in the school system have an asthma action plan? And it was one. It was the pharmacist's daughter.

Speaker 3: 18:44

Of course, of course.

Speaker 2: 18:46

Right, yeah, and that was just like again, intervention for how we can get into our communities to start to optimize care and make intervention is just. Are the school systems equipped to manage asthma?

Speaker 3: 18:58

exacerbations. And I remember, you know, when my girls were in school, you know, and you know, I know, that like if you had a disease or you know you had a condition that had to have, that might have an emergency or an acute exacerbation, not just asthma, but you know, you know diabetes, whatever that. You know the nurses, the school nurses, had to receive the medication from you, the family, and had to and hopefully knew how to use it but often needed to be trained. And so, yeah, I have. I have no doubt that that you know the vast majority of of of kids in schools you know don't have an action plan. And then you know they're like, well, where's the albuterol You're, you're having an, you know you're having extra symptoms, like, yeah, we don't use those anymore. So I mean the idea of education really goes out, you know.

Speaker 2: 19:49

And what's really even scary. I'm now like, really, you know, thinking about this and considering it is I have one inhaler, so you're telling me that I need to go to school and give it to them. Well because we always would dispense two albuterols one for home, one for school. I'm not going to dispense two $400 inhalers.

Speaker 3: 20:09

Right yeah, no one's going to let me do that Right. Well, which is the other piece too. I mean, in your world, in, in, in, you know, in community pharmacy, has there been any uptake from PBMs about? Okay, we're going to, we're going to give, we're going to allow, instead of the 28 day or 31 day fill, we're going to allow. You know there's a, you know, a 10 day leeway on both sides because someone had to use their inhaler six or seven more times than they normally would. So they're going to go out. You know they're going to run out of their inhaler three or four days before the fill date. Have you, have you seen any uptake there? Or have they basically had to say you know too bad, you know, sort of thing?

Speaker 2: 20:53

There's a lot of too bad, but I also think that this is where we, as pharmacists, could do some unique services. When we think about med sync programs, we often, you know, for, for patients that have packaged medication, we'll do it on a 28 day cycle, right, cause we just want to give them four blister packs, seven days each, right, right? Uh, very, sometimes, if they're just pill bottles, it's a 30-day sink. You know, what would be interesting is if we sink out the, the inhalers, off of like 26 days and build out that cushion right, that's a great idea, right, but?

Speaker 2: 21:21

proactively, just go ahead and start to create a cushion. I know that I have probably a 14-day window that I've built on my own for my inhalers because I have a two year old little bioterrorist that makes us sick at all times and so, like at two in the morning, when I am up I am, I am sucking on that inhaler, trying to breathe to get some sleep, and I feel okay about it because I know I'm not going to run out, because I've built up that buffer Right. Right, that's that you know that's a.

Speaker 3: 21:49

That's a pretty unique situation and again, I put my researcher's hat on and go. You know it would be really interesting to to to look at at that, you know, at a, at a, you know you know a system level right, so not even because you probably wouldn't be able to look at it, just one pharmacy, but if you could look at, like you know, a city's grocery store chain or you know, you know an independent who had three or four pharmacies or something like that, where you can pull the data basically and take a look at MedSync and then building that cushion and seeing you know the financial impact to patients, that would actually be a very interesting study. So that's, that's, that's that's, I think, good advice for our providers and our patients. That you know, you know that that helps build up that. So you know you're, you know it's the end of the month and you reach for your inhaler because you have symptoms at two o'clock in the morning and you don't get anything. So that that that that's a good thought.

Speaker 3: 22:35

So I would like to think that, that that insurance companies are going to be better about about covering this sort of thing. But of course I think we're, you know it's got. Pdms don't necessarily follow evidence-based medicine, to our detriment in many cases. So any other things you want to talk about asthma-wise or smart-wise, I know there's. There's going to be competition for Femiderol, where I think it's Budesonide and Albuterol, I think is coming out, or it's something like that. I think there's a new inhaler that's Budesonide based that I think is supposed to come out. That is going to be a competition for the only agent in town really. So it'll be interesting to see what happens with that.

Speaker 2: 23:20

Yeah, I think the other thing to think about is a lot of our inhalers are becoming generic now, and so I am on a Budesonide promoter. All combination, combination and it's generic and there's multi-source generics. So there is an ability to kind of shop around to get the ones that are best cost for your, your family needs.

Speaker 3: 23:39

That's good to hear again, because I think that this is, I think cost is one of the big impediments to implementation. But again, I've, I've really been surprised. You know again, when, when, when, when a big paradigm shift in medicine happens, clinical inertia always means there's some time before things change. And you know, I think the last big example of that was the DOACs. You know, I mean, you know, you know we had, you know, pradaxa come out and everyone's like finally, well, you know, praise the Lord, we have a drug that can take over from warfarin. It doesn't have all the side effects and doesn't have all the interactions. And you know we don't have to monitor INRs. And then you know we couldn't get anybody to be on them because like, well, I don't know, I'm kind of scared. You know what if they have a bleed or what? 30 years to get something to replace warfarin. And then we got something to replace warfarin and nobody wanted to do it, you know.

Speaker 3: 24:33

And now, of course, everybody's on DOACs, and I think this is the same thing here. I think you know it's just been so ingrained in the treatment of asthma that you know albuterol is the drug for acute symptoms that it is going to take a while, but I mean, I think we've passed the while stage. You know, as, as Jen pointed out, you know, it was the GINA 2020 guidelines that basically started the idea of, of of smart therapy. And here we are, four years later and I, you're right, you know the uptake has been very low. So I, you know, pharmacists need to make noise about. This is just the bottom line. You know, again, knowing how busy community pharmacists and I don't want to, you know, you know blower the boom with more things for them to do, but this is an area where I think we can make a real impact with a phone call or with, with, you know, with with one conversation, with, with a patient.

Speaker 2: 25:22

I think, in some cases, I completely agree, and I think the other thing that I'll end on for everybody to think about is I'm a patient with asthma and there might be like this mindset of patients talk about they take an albuterol or I've heard them take albuterol and I hear the breathing get better, so I know albuterol works. I don't know if this long acting antagonist, the inhaled corticosteroid, right. I'll tell you 2am. It does work. I do go back to bed.

Speaker 3: 25:50

Right, and yeah, I mean, you know, yeah, that's, that's the other piece too.

Speaker 3: 25:52

I mean, if you've been a person with asthma for 20 years, you know, yeah, you know you know, that feeling you get when you, when you use the albuterol, right, you know, you're like, wow, okay, I could absolutely feel the symptoms of bait, probably feel my heart rate go up and all that other stuff. You know, yeah. But I mean, you know, yeah, you know it's working, whereas, yeah, I would be a little bit nervous, especially if I have really bad asthma. It's like okay, if this doesn't work, what's plan B? Because plan B for me is going to be falling on the floor because I'm hypoxic, yeah, yeah. And again I get pointing out the, the, the education that really needs to happen, I think, for this to be done. So well, jake, that's, I appreciate it. You know, jen, that's kind of where we're at.

Speaker 1: 26:32

I mean, you, do you have questions from the moderator perspective, or yeah, no, I just you know a couple of things that I took away. I mean, you know, jeff, going back to what you said, that this is one of the areas where there's actually decreased mortality or increased mortality. Sorry, increased mortality, yeah, never. That is always like a weird statement. Increased mortality, and I feel like, you know, even from an education standpoint, like from my education standpoint asthma sort of flies under the radar, like whenever this comes up we're like wow, you know, wah, wah, like you know it's not a super flashy or exciting topic, but but the fact that it's we're four years into this and I mean it, nothing has happened, is really interesting to me.

Speaker 3: 27:17

Yeah.

Speaker 3: 27:17

I mean I, I agree, and I mean in my world, you know, again, I think if you talk to my pediatric colleagues, I think they they're like, well, yeah, no, we definitely see little like you know, little ones, you know, or you know kids admitted to the hospital with asthma exacerbations. In my world it's pretty rare. I mean, I'll have the very occasional asthmatic on on my medicine service and then, yeah, when someone comes in with status asthmaticus and they're like in extremis and you know, yeah, they, then they have been in the ICU on the vent and my pulmonologist will tell you there is very few things more scary than a patient with asthma, severe asthma, on the ventilator and they really try to do everything they can to keep that from happening.

Speaker 3: 27:57

So yeah, I think it does fly under the radar, especially for people who treat primarily adults, because fortunately, most people with asthma are able to treat their symptoms and at most, hopefully just get a burst and taper of steroids that gets them under control, you know. But that doesn't mean that people don't die from asthma. In fact they do. And again, you know, teenagers and adolescents, you know, you know, do die from asthma. So yeah, yeah.

Speaker 1: 28:24

So I think you know I mean our role as pharmacists, I think is is huge here and that we can do some of that education. And you know, jake, to your point, you know nervous to try something different. You know when the word gets out that it works. You know, hopefully we can have a little bit of a movement there. But I also.

Speaker 1: 28:41

The other thing is I will add a link to the asthma, to an asthma action plan in the show notes because I think that's a really good point, that again, you know, we just sort of think, oh asthma, like you know, there's just it's, it's not, there's nothing new per se or flashy in this area. So we just, I think we don't think about it often and I think having that asthma action plan is a super easy thing to do expose patients to it so that they know, and so I'll put a link to that so that if you don't do that in your practice, that's something kind of low lift, that that you can implement. So so yeah, so those are the two things, unless either one of you have anything else to wrap up Any last words.

Speaker 2: 29:23

No, but thank you for letting us talk about this Absolutely.

Speaker 1: 29:25

No, it's a great. It's a great topic, so hopefully we get a lot of listeners this week because I think this is really important. So that is it for this week. If you're a CE plan member, be sure to claim your CE credit for this episode by logging in at CE impactcom. Thank you, jeff, and thank you, jake, and, as always, have a great week and keep learning. We'll talk to you next week.