As part of the Innovation for Health Inequalities Programme (InHIP), pharmacy teams, at Tameside and Glossop Integrated Care NHS Foundation Trust, are playing an increasingly important role in improving outcomes for children and young people with asthma across Greater Manchester. Nicole Turner, a Specialist Pharmacy Technician working across pharmacy and paediatrics, sits at a crucial point in the pathway – supporting families with education, optimising medicines, and helping ensure children are using the right inhalers and devices for their needs.

In this interview, Nicole reflects on her role within the paediatric asthma pathway, the challenges families face, and how pharmacy is helping to create safer, more consistent care.

Can you tell us a bit about your role and how it fits into the paediatric asthma pathway?

I work across both the pharmacy department and the children’s unit, which gives me a really helpful and quite unique perspective on how the asthma pathway works in practice. Being involved at different points means I can see where things don’t always join up for families, particularly when children move between hospital, community and home settings. A large part of my role is reviewing asthma medicines and inhaler technique, but it’s also about spending time with families to make sure they genuinely understand why treatments are important. That education and reassurance element is a big part of helping children stay well and avoid unnecessary hospital visits.

When children first come into the asthma pathway, what medication-related issues do you most commonly see?

Non-adherence is probably the biggest issue I see, and it’s rarely because families don’t care or don’t want to engage. More often it comes down to lack of understanding, forgetfulness, or the realities of very busy family lives. Some children move between different households, which can make routines harder to maintain. Asthma is also a variable condition, so when symptoms aren’t present families sometimes feel that preventer medication isn’t needed. That misunderstanding can increase the risk of flare-ups later on.

What approaches have you found help improve adherence and understanding for families?

Clear, structured education makes a huge difference, especially when the whole family is involved. I always try to explain not just how to use the medication, but why it’s important and what it’s doing inside the body. Involving children and young people in decisions – such as choosing an inhaler device they feel comfortable with – can really boost confidence and engagement. Small changes can have a big impact, particularly when children feel listened to and included in their own care.

How often do you find children are using an inhaler or spacer that isn’t quite right for them?

It happens fairly often. A common example is children over the age of five still using a spacer with a face mask, when guidance recommends moving to a mouthpiece. These details can easily be missed as children grow. I regularly review inhalers and spacers and work closely with clinicians and GPs to make sure each child is using the most appropriate device for their age, ability and circumstances. Getting this right can improve technique, confidence and overall asthma control.

Another challenge we sometimes see is when inhalers are prescribed correctly in hospital or clinic, but a different inhaler is then issued in the community. Even small changes can make a big difference, as different inhalers often require a different technique. If that change isn’t explained or demonstrated, children and families may not realise they’re using it incorrectly. This can lead to poor medicine delivery, symptoms not improving, and what appears to be non‑adherence when actually the medication just isn’t being used effectively. Ensuring inhalers are issued as prescribed, or that technique is rechecked and explained if a switch is unavoidable, can make a real difference to outcomes for children.

What role does pharmacy play in making the asthma pathway safer and more consistent?

Pharmacy has an important role at key transition points, such as when a child is discharged from hospital, when medicines are changed, or when repeat prescriptions are issued. These are points where misunderstandings can easily happen. By checking medicines, reinforcing education and ensuring information is clearly handed over, pharmacy teams help reduce variation and improve safety across the pathway.

Do conversations about medicines help open up discussions about triggers such as smoking in the home?

Yes, they often do. Talking about asthma medicines naturally leads into wider conversations about triggers and the home environment. These discussions need to be handled sensitively, but they can be really valuable. When families feel supported rather than judged, it becomes easier to talk about things like smoke exposure and to signpost them to appropriate support services.

What advice would you give to other pharmacy teams looking to strengthen their role in paediatric asthma care?

I would suggest starting by focusing on children who frequently attend A&E, as they’re often the ones most in need of additional support. Structured asthma reviews, clear education and good communication with the wider multidisciplinary team can make a real difference. Building strong relationships with nursing and medical colleagues also helps ensure care feels joined up for families.