Ten top tips for a Respiratory MUR
1. Check the patient’s PMR for frequency of ordering of medication before starting the
review.
For patients with asthma
 Ordering more than thirteen short-acting reliever inhalers over the last year may
indicate poor control and that preventative treatments need to be stepped up.
 Generally patients with asthma should require twelve inhaled corticosteroid (ICS)
preventer inhalers per year (might be less for 200 dose metered dose inhalers).
 Is the patient prescribed a long-acting beta 2 agonist (LABA) without an ICS?
This requires a review of the regimen.
2. What does the patient know about their condition and its treatment?
3. Has the patient had a review before? Who did the review? Does the patient see
anyone else for their condition? Explain that the reviews are being done with the
knowledge of GP practices in the area and that the aim is to improve medicines use
for respiratory conditions.
4. Check adherence with the information from the PMR and document any reasons for
non-adherence e.g. difficulty in using device, side-effects, perception of
ineffectiveness, lack of knowledge of indications for different inhalers. Does the
patient experience any problems taking / using their medicines?
5. Assess inhaler technique - use In-check device. Would the patient benefit from a
device switch, adding a spacer? Does the patient have the same devices i.e. MDI or
Turbohaler?
6. Does the patient know how to take other medicines prescribed for their respiratory
condition e.g. rescue packs of corticosteroids / antibiotics, mucolytics or theophylline
for COPD.
7. Give smoking cessation advice if appropriate.
8. Does the patient need flu or Pneumococcal vaccination?
9. Does the patient have any questions / need more information about their medicines?
10. Refer patients if they report:

An increase in exacerbations

Their symptoms are not controlled

Side-effects of medicines

Severe or life-threatening asthma exacerbation

Haemoptysis- spitting or coughing up blood