JAMES BOND VILLAINS AND ASTHMA
For those of you who are James Bond fans out here, you must have seen the Casino Royale showing in the usual Christmas TV line up this year
Eagle eyed pharmacy colleagues will have noticed the constant use of the ‘silver’ inhaler by Le Chiffre at numerous times during the movie and during the extensive poker game that was integral to the movie.
It seems the triggers for Le Chiffre’s asthma symptoms were caused mainly by pressure and in circumstances where things were not going to plan. Stress related asthma symptoms are common, with Asthma UK reporting up to 69% of patients find worsening of asthma symptoms with stress and anxiety.
Participating in a $115 million poker game, whilst being a fully-fledged Bond villain, would certainly be classed as a stressful situation!
Le Chiffre is seen to be using his MDI inhaler device too fast for good lung deposition and does not often shake the inhaler before use. This will only result in deterioration of his symptoms and poor asthma control during stressful situations.
Given Le Chiffre’s preference for using a single inhaler only and frequent use of what can be presumed to be short acting beta agonist therapy (SABA), he would benefits from stepping up to a maintenance and reliever therapy regimen and provided the options of using an MDI or a DPI device with full counselling on inhaler technique and with the possible addition of a spacer to use when he is next playing poker!
It is safe to assume Le Chiffre needs to see his local community pharmacy for identification of his inhaler, the actual use of his inhaler, explore his beliefs around inhaler use, determine whether he would be suitable for step up or even a regimen that involves maintenance and reliever therapy and recommended for the use of a spacer given his poor technique, all of which detailed in his personalised asthma action plan!
After all, we wouldn’t want a James Bond villain dying prematurely!