In the April issue of Retail Pharmacy magazine, Tracey Cheung explored asthma management in the colder months and the important role of pharmacists in this space.
For those with asthma, autumn and winter can be a particularly vulnerable time, with the cold and dry air of these seasons triggering asthma symptoms and flare-ups, according to Asthma Australia.
The organisation’s Senior Manager, Research, Information and Evaluation, Anthony Flynn, gives the example of exercising during winter, when we tend to breathe in more through the mouth than the nose. Breathing through the nose, the air gets filtered, warmed and humidified, he says, and when breathing is through the mouth, the air goes straight to the lungs unfiltered, cold and dry.
Asthma Australia says this can increase irritation and sensitivity, tightening of the muscle around the airway, and development of asthma symptoms.
Coping during cold weather
Mr Flynn says management in the colder months starts with hygiene.
“During winter, we spend more time indoors, with other people, so are more vulnerable to the viruses circulating in the air, and on surfaces that we share,” he said. “Viruses are among the most common cause of asthma symptoms, and people with asthma should try to avoid them. Stay home when unwell, avoid others who are unwell, and wash hands frequently.”
People with asthma are encouraged to consider annual vaccinations.
“Seasonal influenza can cause severe exacerbations in asthma, and having asthma may increase the risk of severe flu,” Mr Flynn said. “Asthma Australia recommends all people with asthma access the [flu] vaccine.
“People with asthma should discuss immunisation options with their doctor to make tailored decisions about these.
”Pneumococcal disease can result in severe exacerbations, and asthma is a risk factor for invasive disease from pneumococcal infection. Pertussis, or whooping cough, can also be problematic for people with asthma.”
Mr Flynn adds that COVID-19 can also be “a real hazard for people with asthma in winter”.
“During this high-risk season, patients should discuss their specific condition with their doctor, update their asthma action plan, ensure they’re using their preventer, and that associated conditions or lifestyle factors are being addressed,” he said.
Professor Brian Oliver, Head of Respiratory Research Group at Woolcock Institute, advises against complacency.
“The measures we took during COVID, such as mask-wearing, can help to prevent viral infections, which is important,” he said.
“Asthma in some people can cause very episodic symptoms, and this can lead to complacency in how they take their medication. However, if an event such as thunderstorm asthma comes along and they have no plan in place, the health consequences can be dire.”
Pharmacist input
Community pharmacists can be effective at identifying gaps in consumers’ treatment plans and supporting consumers to have constructive conversations with their treating GP, according to Asthma Australia.
“When meeting a person with asthma, checking on whether they’re using a regular preventer, adhering to it according to the prescription, and using the device correctly, can be incisive actions that can have profound results in getting people on track with their condition,” Mr Flynn said.
“Equally fundamental is the opportunity to reinforce education about information a person with asthma has to be proficient in, from accessing and understanding their asthma action plan, to knowledge of asthma first aid, identifying and addressing escalating symptoms.”
Correct inhaler use
Pharmacy Guild National President Professor Trent Twomey says asthma management usually includes the use of medicines, some delivered using an inhaler.
He adds, though, that recent research has shown more than 90 per cent of people with asthma don’t use their inhaler correctly, so aren’t getting the full benefit of their medicines and may be suffering unnecessarily.
“Various studies show that regardless of the type of inhaler device prescribed, patients are unlikely to use inhalers correctly unless they receive clear instruction, including a physical demonstration,” Professor Twomey said. “The risk of misusing inhalers is particularly high in older and more debilitated patients.”
Pharmacists can guide
This is where a community pharmacist can be helpful: to assist patients, as well as provide good, objective, evidence-based information about the condition, Professor Twomey adds.
“For some people, equipment like ‘spacers’ and ‘face masks’ can make inhalers easier to use,” he said. “Research has found that a brief verbal instruction on correct technique, with a physical demonstration, is effective when repeated over time, and can improve clinical outcomes.
“Another reason for patients to speak to their pharmacist about their asthma management is that some medicines have been shown to trigger an asthma attack, or to worsen the condition.”
Mr Flynn agrees that some medicines can make asthma worse.
“They range from those used as complementary therapies, like echinacea, and more conventional treatments, like beta-blockers, used to treat hypertension,” he said. “Not all people face difficulties with the same medicines, so all medicines and complementary therapies should be discussed when a community pharmacist has a conversation with a person with asthma.”
Pharmaceutical Society of Australia General Manager Education and Training, Kerri Barwick says pharmacists need to be more attentive to patients during the cooler season.
“If this is a particular area of interest for you, reach out to [PSA members’] respiratory care Communities of Specialty Interest group,” she said.
