Prepare for particular problems

We’re told the average person can survive up to four weeks without food, or four days without water, but when it comes to surviving without air, we’re in trouble after two minutes.

In the game of staying alive, it seems air is the most valuable resource, yet it’s free.

We can manage without air for brief periods, like those who enjoy diving underwater, holding their breath until their lungs scream for oxygen.

They’re in full control, confident in the knowledge they can surface and draw a long, deep and satisfying breath when it’s needed.

However, those with asthma or other respiratory conditions, despite not being underwater, will at times experience that same, desperate need for oxygen.

For them, there’s no control, and drawing in a long, deep and satisfying breath is nothing more than a dream.

It’s these people who’ll recall the terrible impact of the smoke from last summer’s catastrophic bushfires and, as the first of those fires started back in late July, they’ll be conscious this year’s fire season has arrived.

They’re among the vulnerable, and pharmacies can be a source of support and improved protection.

To help pharmacies support those with respiratory health issues during the coming summer months, this article explores the latest health recommendations to emerge as a result of the black summer bushfires.

The pharmacist’s role

An Asthma Australia bushfire survey showed people will go to pharmacies in the first instance because these are the most accessible outlets for seeking advice and relief, not only confirming pharmacy’s place on the frontline but also underscoring the importance of pharmacies being able to advise and counsel patients towards achieving better health outcomes.

“Those visits are usually to buy reliever medication because the patient is experiencing symptoms,” says Asthma Australia CEO Michele Goldman.

asthma management

“Either they’ve had really mild asthma and don’t normally carry reliever medication but are now having some trouble, or their regular medications are running short and they know they need to be diligent at this time.

“I think pharmacists can anticipate ahead of the summer season and make sure their stock levels are above normal, given the experience of last season when one of the big issues was that stock just ran out so quickly. With life-saving medication like reliever medication, that just can’t happen.

“Pharmacists can also play a valuable role by questioning the person coming in to buy a reliever, to try and understand a number of things:

  • Has the patient seen a GP recently?
  • Do they have a diagnosis?
  • Have they been prescribed a preventer?
  • If so, are they using it regularly?

“The worst thing that can happen is for a patient to continue to come into a pharmacy and buy multiple reliever medications over a long period of time.

“The pharmacy can disrupt that process and, through questioning, identify whether they really should be going back to their doctor.”

Asthma Council Asthma and Respiratory Educator Marg Gordon agrees, adding that pharmacists should check on how much over-the-counter reliever medication people are buying.

“The clear message now is that patients should be on preventer therapy,” she says. “Those who are using lots of reliever should flag a warning to pharmacists who then open that conversation.

“Everyone needs to have short-acting reliever for acute flare-ups of symptoms, but the most recent research certainly shows that because asthma is an inflammatory condition of the small airways of the lungs, the long term effect of being on low dose preventive therapy, which is usually inhaled corticosteroids in Australia, is very beneficial to good asthma control. It reduces the risk of severe flare-ups and improving quality of life for people.

“While this isn’t really a change, we need to focus on getting the consumer message out that, while it may be cheap and easy to buy a reliever over the counter, it may not be the best treatment.”

It’s not what but how

Skill is a funny thing. We can develop a high degree of excellence in something but, over time, as we continue to do it regularly, that excellence loses its shine and slips back into the mediocrity zone.

Driving a vehicle is a good example, with most experienced drivers admitting they can be somewhat blasé about certain road rules, particularly when no one is watching.

Ms Goldman says this is also true of patient technique in the use of asthma devices, and suggests pharmacists are perhaps the best placed among health professionals to help maximise the benefits of those devices for their patients.

“A key role pharmacists can play is looking at the way patients are using their medications, because so often people aren’t using their devices correctly,” she said. “This of course means they’re not going to be getting the full benefit of the medication, so they’ll be symptomatic.

Red lungs

“The importance of technique is one of our core messages, and not just in bushfire season, because up to nine out of 10 people aren’t using their devices correctly. The research shows device technique should be reviewed regularly, at least every few months.

“Asthma devices are really complex, and with so many different types, the chances of knowing how to use a device intuitively are very low.

“Even if your health professional, or your doctor or your pharmacist has shown you how to use it first time around, you’re not going to get it perfect first time and you’re going to forget.

“In day-to-day use, only half concentrating when you’re using your meditation, you’ll quickly slip back into other habits.”

For a pharmacist to be effective when advising patients on device technique, it’s important not to simply ask if they’re using their device correctly, because they’re going to reply, ‘yes, I think I am’.

Instead, Ms Goldman suggest pharmacists should be asking, ‘Would you mind showing me how you use this device?’

A wealth of resources is available for pharmacists wanting to learn and keep current on asthma issues, with device technique videos available at: asthma.org.au/about-asthma/medicines-and-devices/techniques/.

Asthma Australia also recommends the ThinkGP online asthma modules available at: thinkgp.com.au/content-partner/asthmaaustralia.

Asthma Australia says pharmacists have found module four, ‘Preventative care to stop asthma flares’, particularly beneficial and suggests modules one and two would be very helpful as well, while all modules also earn pharmacists CPD credits.

To read the full feature as it appears in the August issue of Retail Pharmacy magazine, visit: retailpharmacymagazine.com.au/magazine.