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The other side of spring

Nerine Zoio 04 September 2017, 8:00AM
The other side of spring

Most people welcome spring as the season that heralds the end of winter and the start of warmer weather.  

For pharmacists, it brings a flare-up of customers with spring-related ailments, with many pointing to a noticeable increase in allergies and asthma. 

Allergies and asthma often occur together and the same substances that trigger hay fever symptoms, such as pollen, dust mites and pet dander, can also cause asthma symptoms. 

Pharmacist Ban Quillinchi from Unichem Fred Thomas Pharmacy in Takapuna, Auckland told Pharmacy Today there has been a noticeable increase in the number of customers seeking relief for allergies and asthma this year. 

"We have had more customers coming in of late who are battling hay fever and allergy symptoms, especially rhinorrhoea, sneezing and ongoing congestion," Mrs Quillinchi says. 

"Doctors' rooms are not the first port of call for people suffering from these conditions but rather pharmacies as people self-medicate - and as the first port of call I can say that the situation has deteriorated compared to last year." 

She points out it takes time to ask customers questions to determine what products are best for them, and she often differentiates allergies and asthma from colds and flu because of their duration beyond a few days to a fortnight. 

Allergies, on the other hand, can last for months. 

"I also find out whether customers have symptoms that appear all the time or whether they appear seasonally as colds are often winter bound, whereas allergies appear all year round," she says. 

"Cold symptoms also take a few days to appear after infection with the virus, whereas allergy symptoms can appear immediately after contact with allergy triggers." 

Also, the most common symptoms of colds include coughing, a sore throat and a runny, stuffy nose, says Mrs Quillinchi. They sometimes include aches, fatigue and rarely include a fever. Sneezing and itchy eyes are less common symptoms.  

Allergies, on the other hand, often include itchy and watery eyes, and a runny or stuffy nose, sometimes a cough, fatigue and a sore throat, but never fever or aches.  

"Allergies affect all age groups and my pharmacy, in line with most community pharmacies, recommends antihistamines (syrup for children) or steroid nasal sprays as starting measures. 

"We've had a few cases where it's clear someone has to see the doctor for something extra - maybe an antibiotic," she says. 

Mrs Quillinchi has also noticed that, generally, people's asthma has become exacerbated and more people are struggling with it. 

She says it works well to start with the symptoms that are not caused by asthma.  

Asthma does not cause fever, chills, achy muscles, or a sore throat, so any one of these is cause for concern as they could indicate a respiratory infection and are a good sign a doctor should be consulted.  

On the other hand, typical asthma symptoms are frequent or chronic coughing, shortness of breath, wheezing and a tight feeling in the chest, which could necessitate a doctor visit to rule out chronic asthma, she says.  

These symptoms may feel like the start of a cold, or even the flu, but it is important that asthma sufferers understand and recognise the difference, to get proper treatment.  

"It's also important to be able to differentiate between something like seasonal allergies and the common cold, as allergens can greatly increase the risk of an asthma attack." 

She says she has noticed one of the reasons why people are struggling with asthma is because they do not take their preventer every day but, with the onset of winter and sickness, they use their relievers more.  

Allergy -Stat Box

"So it's very important to educate customers as to the importance of using their preventers as prescribed," she says. 

According to David Fu, a pharmacist at Auckland's Unichem Panmure Pharmacy, allergies are "a big one" in spring, especially hay fever. 

Mr Fu says patients often self-treat mild to moderate allergies, asking pharmacists for guidance about which over-the-counter antihistamines, decongestants, combination products, or nasal sprays work best.  

"If an antihistamine as a first line of treatment is not working as seen from persistent or recurring symptoms, a nasal inhaler can help," he says. 

"A big thing is making sure customers know how to use their nasal spray because if they don't use it properly, their condition does not improve and their medication is wasted. 

"Allergy eye drops also work by reducing histamine in the eye tissues." 

Mr Fu says at times he determines if a customer has an allergy or a viral infection.  

"Both conditions can affect the upper airways, especially secondary bacterial infection. Viral infections can also lead to lower respiratory tract conditions, such as bronchitis, bronchiolitis, pneumonia and, especially, asthma," he says. 

As to asthma, he says the primary difference between an allergy attack and an asthma attack is the location in the body of the ­reaction.  

"Allergens often trigger this response in the upper respiratory system. The reaction happens because the body produces IgE [immunoglobulin E] antibodies, which in turn cause the body to produce chemicals like leukotrienes and histamines. These chemicals trigger the allergic reaction itself, which is commonly experienced as sneezing, congestion, itching, watery eyes, hives, headaches or irritated skin. 

"Asthma, on the other hand, is a more serious condition that can be triggered by the same IgE antibodies, but the reaction is located in the lungs and upper bronchial passages. They may become inflamed and close, causing coughing or wheezing." 

According to the Asthma and Respiratory Foundation NZ website, over 521,000 people take medication for asthma in New Zealand, which includes an estimated one in seven children and one in nine adults.  

For children, asthma is one of the most common causes of hospital admissions. 

The foundation also points out that most New Zealanders suffer or know someone who suffers from allergies. It says that one in six New Zealanders are affected by allergies at one time or another, and more than 10 per cent of New Zealand children battle with the symptoms every day. 

The general manager for education and research for the Asthma and Respiratory Foundation NZ, Teresa Demetriou, says pharmacists can play a role in providing patients with valuable resources to educate them about pharmacological agents for treating and managing asthma. 

"People with mild asthma may only need a reliever inhaler to be used as necessary, but people with moderate to severe asthma should be on a preventer every day as prescribed by their doctor. Pharmacists are able to monitor whether patients are picking up their preventer along with their reliever, and the number of reliever inhalers being issued," Ms Demetriou says. 

"Pharmacists can use their position and expertise to educate patients about the proper use of inhalation devices, especially patients who have been recently diagnosed and are struggling with their diagnosis and treatment plan. 

"As more treatment options and patient resources become available for controlling asthma, a collaborative effort between healthcare professionals and patients, coupled with patient education and stressing the importance of patient adherence, is fundamental for effectively controlling asthma." 

She says for successful management of asthma, it is important patients be thoroughly educated about their condition, know the warning signs of asthma attacks, know the factors that may trigger an attack, know how to manage attacks, adhere to their asthma plan and know how to properly use the prescribed treatment. 

"There is no question that increasing awareness and promoting education about asthma can reduce the numbers of asthma-related hospitalisations, emergency department visits, missed days at school and work, and deaths." 

Janet Hutchison from Asthma Auckland emphasises the importance of educating people about asthma, especially what triggers their asthma and how to manage it.  

"There are many different triggers, which commonly include respiratory infections, exercise, cold air and allergies to pollens, dust mite and animals to name a few. Treatment for underlying allergies is important and a skin prick test or RAST [radioallergosorbent test] can identify possible allergens," Ms Hutchison says. 

"Asthma treatment is prescribed according to each individual's asthma control, following national guidelines. Education around how the medications work and how to take them correctly is crucial for people with asthma, and inhaler technique should be checked at each review. 

"Pharmacists also play an important role in checking that people are able to use their inhalers correctly when they are collected from the pharmacy." NZ

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