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In this scenario, the student is expected to ask relevant questions to gauge how the patient is coping with their new medication - Beclometasone dipropionate (Clenil Modulite) inhaler.
Please ensure that this scenario and mark scheme aligns with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.
You will need a student pharmacist and an actor for this OSCE station.
Asthma
You are the pharmacist at a general practice. Your role is to conduct a new medication review for this patient who has been newly started on a Beclometasone dipropionate (Clenil Modulite) inhaler for their asthma two weeks ago. You need to ask relevant questions and answer any queries that the patient may have.
You do not need to contact the prescriber.
To do:
Collect accurate patient details and a brief medication history, emphasising any newly prescribed medications.
You are expected to provide counselling information to this patient and to answer any questions appropriately. You must provide relevant advice.
You have 8 minutes.
You have access to the BNF.
You may use the following resources during this station: Medicines, 2024.Clenil Modulite 200microgram Inhaler https://www.medicines.org.uk/emc/files/pil.6976.pdf
You are Suvarna Ramji (Soo-var-nah, Ram-jee).
Opening Statement: “Hello, I started this inhaler two weeks ago, I’m here to discuss how it is going and more information about it.”
Patient information:
Provide this information when prompted.
Name: Suvarna Ramji
Age: 20
Prescription:
Beclometasone dipropionate (Clenil Modulite) 200 micrograms inhaler - inhale ONE puff TWICE daily
Indication:
“Asthma.”
“I was told they would be stepping up my treatment after recently had a few asthma attacks. So, this new one is meant to help”
Past Medical History
“I was diagnosed with asthma in childhood when I was 7 or 8 years old”
Medication History:
“Salbutamol 100mcg/dose inhaler - inhale TWO puffs when needed, my reliever inhaler, and this new one.”
Allergies:
“Hay fever.”
Symptoms:
“Short of breath, tight chest and a wheeze that was worse at night.”
If the pharmacist asks:
“I started using the Clenil inhaler two weeks ago”
“I have gotten on with it fine, as I have been using inhalers for years.”
“I take the inhaler every day. I do not want to have another asthma attack.”
“It is working. I am out of breath much less and my chest does not feel tight anymore. I haven't had to use my reliever inhaler.”
“I have a sore throat; I believe is a side effect to that new inhaler – Is this possible? How would I prevent it?”
Query to ask the pharmacist:
“I have been getting a sore throat like the inhaler is irritating it – is this possible How would I prevent a sore throat?”
“Why am I getting a sore throat after using the inhaler?”
Any criteria marked in red must be met to pass this station.
Red Flags missed: 0
Referral Criteria for Asthma
Refer to A&E if:
Severe Asthma Attack: Symptoms include severe breathlessness, inability to speak in full sentences, significant worsening of symptoms despite using a reliever inhaler, or signs of cyanosis. This can be life-threatening.
Respiratory Distress: Severe difficulty breathing, rapid breathing, use of accessory muscles, and signs of hypoxia. This can be life-threatening.
Failure to Respond to Treatment: No improvement after using a high-dose reliever inhaler (E.g. Salbutamol), or if the patient has rapidly worsening symptoms. This needs immediate medical intervention.
Urgent GP Referral:
Frequent nighttime symptoms of coughing, frequent use of reliever inhaler, or breathlessness significantly impacting daily activities: This may be a sign of uncontrolled asthma.
Medication Review: Concerns about the efficacy or side effects of current asthma medications, or if there is a need for a review of the treatment regimen.
Frequent Exacerbations: Multiple asthma attacks or exacerbations within a short period that require medical attention. This may be a sign of uncontrolled asthma.
Routine GP Referral:
Ongoing Management: Regular review of asthma control and adjustment of long-term management plans. This includes assessing the need for additional medications, changes in dosage, or lifestyle adjustments.
Referral for Specialist Assessment: If the patient's condition is not improving with standard treatments or if there is a need for a specialist assessment for complex asthma.
NHS (2024) Beclometasone inhalers: Side effects of Beclometasone inhalers. Available at:https://www.nhs.uk/medicines/beclometasone-inhalers/side-effects-of-beclometasone-inhalers/(Accessed: 23 August 2024).
British National Formulary (BNF) (2024) Beclometasone dipropionate. Available at:https://bnf.nice.org.uk/drugs/beclometasone-dipropionate/#indications-and-dose(Accessed: 23 August 2024).
Asthma.net (2024) Avoiding inhaler-induced sore throat. Available at:https://asthma.net/living/avoiding-inhaler-induced-sore-throat(Accessed: 23 August 2024).
NHS (2024) Asthma. Available at:https://www.nhs.uk/conditions/asthma/(Accessed: 23 August 2024).
NHS (2024) Salbutamol inhaler. Available at:https://www.nhs.uk/medicines/salbutamol-inhaler/#:~:text=Salbutamol%20is%20used%20to%20relieve,in%20an%20inhaler%20(puffer). (Accessed: 23 August 2024).
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