Rules of Two®:
The Rules of Two® were created as a way to identify uncontrolled asthma and the need for controller therapy.1 The EPR-3 guidelines state that assessment of asthma symptoms should include daytime asthma symptoms, nocturnal awakenings, frequency of SABA (rescue) use, and difficulty performing normal activities due to symptoms. On top of these, they state that pulmonary function should also be used to assess asthma control.2
The following categories may indicate poor asthma control according to the Rules of Two®:3
- Using rescue inhaler more than twice per week
- Refilling rescue inhaler more than twice per year
- Nighttime awakenings due to asthma symptoms more than twice per month
- Peak flow at less than 20% from baseline with symptoms
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If a patient falls within any of these categories, they may need a step up in therapy, after assessing for technique and adherence to their current regimen. |
Application for pharmacists
- When filling new prescriptions for rescue inhalers, educate patients on overuse of their rescue inhaler. Share the Rules of Two® with them, and let them know how this relates to control of their asthma.
- When refilling rescue inhalers, check when the last one was filled. If a rescue inhaler is being filled too frequently, it could be that the patient is using it too much, or it could be that the patient doesn’t need a refill yet and could save money by waiting.
William Rook, Pharm D Candidate with reviewed by Rachael Zins, PharmD, AE-C
Going The Extra Mile in 2022
The Problem
According to statistics, about 10% of a pharmacist’s client base has diabetes. Of those with diagnosed diabetes, many if not most, will have accompanying hypertension and dyslipidemia. Some will already have signs of macrovascular, and/or microvascular damage (retinopathy, neuropathy, or nephropathy). Type 2 diabetes is progressive and unrelenting in nature if not properly managed. Pharmacists in any setting should be a part of the team that helps guide people with diabetes in living a healthy life.
Being Part of the Solution
Pharmacists who want to make a difference in the lives of people with diabetes must find a way to consistently deliver important information. This is especially critical early in the diagnosis and when goals are not being met. Potential subjects can include medications, self monitoring, lifestyle changes, available community resources such as Diabetes Self-Management and Education Services (DSMES) and Diabetes Prevention Programs (DPP).
Be Fluent in the Language of Diabetes
When having a conversation with a person with diabetes it is important to know that words do make a difference. The terminology we use can be the difference between a successful and engaging bilateral conversation, and one that leaves both parties feeling that nothing was accomplished. The American Diabetes Association and the Association of Diabetes Care and Education Specialists convened to produce a brief list of guiding principles for having successful conversations with people with diabetes.
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Subjects for Conversations
Our monthly pharmacy newsletters cover important diabetes-related topics. Each of the subject areas is purposely addressed because most patients with diabetes need to know something about them, and pharmacists need to be ready to answer questions and offer guidance. Our newsletters are always current at the time of publication, and offer pharmacist’s talking points and resources
The 3-Minute extra Mile
Try taking three minutes to go the extra mile for your patient with diabetes. Pick a subject, based on a new or refill prescription and have your 3-minute extra mile consult. Be familiar with the subject matter and the talking points, have a patient education handout if available, and offer the information. Not everybody is grateful or interested, but the information you are attempting to give is valuable. Think of the Starfish Story: you can’t help everybody, but you might help that one person.
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James Bennett BsPharm, CDCES, BCGP Bozeman MT 59715
References
- Millard M, Hart M, Barnes S. Validation of Rules of Two™ as a paradigm for assessing asthma control. Proc (Bayl Univ Med Cent) 2014;27(2):79–82.
- National Heart, Lung, and Blood Institute. National Asthma Education Program. Expert Panel on the Mangement of Asthma. (2007). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. U.S. Dept. of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute.
- Rules of Two® 2021. Baylor Scott & White Health Website. Accessed August 17, 2021. https://www.bswhealth.com/specialties/asthma-care/
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