The storm that hit Melbourne on 21 November 2016 remains the largest epidemic thunderstorm asthma event on record.
Ten people died, and several thousand more struggled to breathe, including people with asthma, people who didn’t know they had it, and people with allergic rhinitis who had never had an asthma attack.
As grass pollen season begins, the National Asthma Council Australia (NAC) is asking pharmacists to raise the topic with patients now.
The season typically runs from early October to the end of December, and “brings with it a seasonal increase in asthma and allergic rhinitis” as well as the chance of thunderstorm asthma.
Control is the first line of defence
Professor Peter Wark, a respiratory physician and NAC spokesperson, says the best defence people with allergies and asthma can have as they head into pollen and thunderstorm asthma season is good day-to-day control of their asthma.
“Asthma management guidelines have changed in the latest update of the National Asthma Council’s Australian Asthma Handbook, and it is essential that adults and adolescents with asthma receive a correct diagnosis and receive treatment with an anti-inflammatory inhaled corticosteroid-containing regimen,” he says.
“The recommendation is now for anti-inflammatory reliever therapy (with budesonide/formoterol) as needed in those with mild asthma. Or maintenance and reliever therapy (inhaled corticosteroid/formoterol), regularly and as needed. This provides the best protection for most people with asthma against acute attacks.
“The aim of treatment should be for patients to maintain good control of asthma symptoms and prevent flare-ups, and using an anti-inflammatory reliever is the best way to achieve this.
“It is important to remind patients that relying only on a blue puffer, or needing it often, means they are at risk of severe asthma attacks, emergency department visits and hospital stays.
“Now is the time to ensure patients are on the best treatment to control their asthma and to update their written asthma action plan so they know what to do during a spring thunderstorm or asthma emergency.”
The allergic rhinitis connection
Professor Wark says people with allergic rhinitis and allergy to ryegrass pollen may be at risk of thunderstorm asthma, even if they have never had asthma symptoms before.
“People who are allergic to ryegrass pollen and have asthma could have a severe asthma attack if outside in gusty winds just before or during a thunderstorm in spring or early summer in a place where there is ryegrass pollen in the air. This includes most of south-eastern Australia,” he says.
Professor Wark says first-line treatment options for allergic rhinitis include intranasal corticosteroid sprays, used alone or in combination with intranasal antihistamines.
“Combination intranasal antihistamine-corticosteroid sprays are more effective than either treatment used alone,” he says.
“Intranasal corticosteroid sprays reach full therapeutic effect after one-two weeks, while intranasal antihistamine sprays have a rapid onset of action, providing symptom relief within 15–30 minutes.
“If patients have allergic rhinitis and asthma, treating their allergic rhinitis can also improve their asthma.
“Allergic rhinitis can cause upper and lower airway inflammation, but even more concerning, allergic rhinitis can lead to an increased risk of serious asthma flare-ups.”
A poster for your pharmacy
The NAC has released an updated Allergic Rhinitis Treatments chart in time for the pollen season outlining the main intranasal treatment options for allergic rhinitis currently available in Australia.
Designed as a poster for your pharmacy wall, the Allergic Rhinitis Treatments chart is an invaluable tool to help pharmacists explain to patients the range and types of treatments available.
Free hardcopies can be ordered at [email protected].
For more information, visit: nationalasthma.org.au.
