Better Asthma Control Starts at the Pharmacy: Evidence, Interventions, and Outcomes

Asthma is problematic for multiple populations of patients worldwide, and when uncontrolled, it has serious implications for health-related quality of life.^1-³ According to the 2023 Global Initiative for Asthma guidelines, asthma is characterized by respiratory symptoms such as wheezing, shortness of breath, chest tightness, and coughing that vary over time in frequency and intensity. These symptoms are associated with bronchoconstriction, airflow limitation, airway wall thickening, increased mucus secretion, and episodic exacerbations that can range from mild to life-threatening.²

The Challenge of Adherence and Disease Control

One of the most persistent challenges in asthma management is poor adherence to prescribed treatment regimens, including pharmacologic and nonpharmacologic therapy. To that end, poor asthma control can lead to worsening symptoms and disease progression, negatively affecting patients’ and their families’ quality of life, limiting their ability to attend work or school, and often resulting in hospitalization.^3,4 In clinical practice, poor adherence is often reflected in excessive use of short-acting β-agonists and underuse of inhaled corticosteroids, patterns that are strongly associated with increased exacerbation risk and poorer long-term disease control. Pharmacists play an important role in identifying these medication-use patterns and intervening to improve therapy management through counseling, adherence monitoring, and inhaler technique assessment.

Pharmacist-led counseling and inhaler-use training have been shown to improve medication adherence and correct inhaler technique, leading to better asthma control compared with usual care.^3,5 Poorly controlled asthma may lead to persistent airway inflammation and remodeling, which, over time, can result in progressive, sometimes irreversible airflow limitation. Patients with frequent exacerbations often require systemic corticosteroid therapy, which may cause adverse effects such as osteoporosis, hypertension, and metabolic complications. Repeated exacerbations are also associated with increased health care utilization, including emergency department (ED) visits, hospital admissions, and unscheduled outpatient care. Uncontrolled asthma may worsen comorbid conditions, including allergic rhinitis, obesity-related respiratory dysfunction, anxiety, and sleep disturbances. Patients with uncontrolled asthma frequently report reduced exercise tolerance, sleep disruption due to nocturnal symptoms, and increased absenteeism from work or school, all of which significantly impact daily functioning and overall quality of life. Evidence continues to mount that pharmacists’ involvement and interventions can help mitigate disease progression, improve breathing function, reduce morbidity, and even curtail ED visits for both adult and pediatric patients.⁶

Pharmacists’ Role in Community-Based Asthma Care

In the community, care encompasses clinical topics as well as social and financial assistance, because many ED visits stem from inappropriate inhaler use and/or lack of insurance or underinsurance, resulting in diminished access to optimal therapies.⁷ Pharmacists contribute to asthma management through several different interventions in clinical practice. These practices include assessing inhaler technique during medical dispensing, identifying excessive reliance on short-acting β-agonists, and performing adherence assessments during refill encounters. Additionally, pharmacists assist patients in navigating insurance barriers, identify cost-effective alternatives, and improve access to patients’ asthma therapies.

Over the past decade, meaningful declines in asthma-related ED visits and inpatient hospitalization rates have been observed, coinciding with therapeutic guideline shifts aimed at curbing acute exacerbations.¹^,² This reflects shifts in treatment paradigms from reactionary to proactive, thus articulating a clear message that asthma management is no longer just about “rescue vs controller” but about adopting a more prevention-focused approach with medication optimization and monitoring playing a central role.²^,4,5 Pharmacy practice has become increasingly important in supporting this transition.^4,5 A recent meta-analysis of 4 randomized controlled trials and 4 quasi-experimental studies in 1812 participants found a significant decrease in the rates of asthma/chronic obstructive pulmonary disease (COPD) exacerbation after involvement of pharmacist-led interventions of demonstration and training of proper inhaler techniques in the community pharmacy setting.⁵

Evidence Supporting Pharmacy-Based Interventions

Clinical evidence has shown that pharmacy-based interventions contribute to these improvements, with studies demonstrating better symptom control, improved pulmonary function, and reductions in hospital admissions.^3,5,6 A 6-month randomized trial conducted in community pharmacies in Belgium, a 12-month controlled intervention study in Germany, a 6-month community pharmacist-led intervention in Australia, and many more worldwide studies all established the significant impact of pharmacist-led interventions on asthma and COPD management and control.⁵ Increases in patient engagement see an increased likelihood that they monitor peak flow reading as well as increased improvements in quality of life and notable decreases in frequency of symptoms and improvements in the utilization of maintenance medications.⁵

Pharmacists have an increasingly important role in expanding asthma care. Their responsibilities may include screening patients for symptoms of uncontrolled asthma, identifying individuals at risk of exacerbations, and collaborating with prescribers to develop individualized asthma action plans in line with current treatment guidelines.^4,5,8,9 Pharmacists also play an important role in improving medication adherence by addressing barriers to therapy, providing patient education, and reinforcing correct medication use during routine pharmacy visits.

Looking Ahead: Pharmacists as Partners in Prevention

As asthma management shifts toward prevention-focused care, pharmacists are well positioned to support improved outcomes for patients with asthma. Through targeted patient education, medication optimization, inhaler technique training, and collaboration with other health care professionals, pharmacists can help reduce exacerbations, improve disease control, and enhance quality of life for individuals living with asthma.

REFERENCES

1. Most recent national asthma data. CDC. Updated May 10, 2023. Accessed March 20, 2026. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

2. Pocket guide for asthma management and prevention for adults, adolescents and children 6-11 years. Global Initiative for Asthma. Updated 2023. Accessed March 20, 2026. https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Pocket-Guide-WMS.pdf

3. Adisa R, Ufuah UF, Ige OM. Impact of pharmacist-led intervention in medication adherence and inhaler usage on asthma and chronic obstructive pulmonary disease control: a quasi-experimental study. BMC Health Serv Res. 2024;24(1):1199. doi:10.1186/s12913-024-11683-9

4. Benavides S, Rodriguez JC, Maniscalco-Feichtl M. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. Ann Pharmacother. 2009;43(1):85-97. doi:10.1345/aph.1K612

5. Bridgeman MB, Wilken LA. Essential role of pharmacists in asthma care and management. J Pharm Pract. 2021;34(1):149-162. doi:10.1177/0897190020927274

6. Macedo LA, de Oliveira Santos Silva R, Silvestre CC, Alcântara TDS, de Magalhães Simões S, Lyra DP Jr. Effect of pharmacists’ interventions on health outcomes of children with asthma: a systematic review. J Am Pharm Assoc (2003). 2021;61(3):e28-e43. doi:10.1016/j.japh.2021.01.002

7. Parrott TD, Wallace MD, Niehoff KM, et al. Pharmacist review of chronic inhaler therapy appropriateness for hospitalized patients with COPD or asthma. J Am Coll Clin Pharm. 2023;6(12):1304-1312. doi:10.1002/jac5.1862

8. Kritikos VS, Reddel HK, Bosnic-Anticevich SZ. Pharmacists’ perceptions of their role in asthma management and barriers to the provision of asthma services. Int J Pharm Pract. 2010;18(4):209-216. doi:10.1111/j.2042-7174.2010.00040.x

9. Watkins K, Bourdin A, Trevenen M, et al. Opportunities to develop the professional role of community pharmacists in the care of patients with asthma: a cross-sectional study. NPJ Prim Care Respir Med. 2016;26:16082. doi:10.1038/npjpcrm.2016.82