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Allergic asthma and COVID-19: the implications “Flu, COVID-19, and indeed, any illness, can make asthma worse,” Dr Claxton said. “Prevention where possible is best, which includes regular review of asthma to ensure the condition is controlled.” In the event of an exacerbation, which can occur due to illness and viral infection, Dr Claxton adds that an asthma action plan can be “very helpful for patients to allow them to start therapy on their own” in this instance. “This can limit any delay in seeking help and avoid patients having to leave home with the potential for exposure to other illnesses or indeed the risk of spreading their own,” he said. “If the action plan doesn’t settle the exacerbation, then an escalation plan, which may mean presenting to hospital, is needed.” Most health professionals will agree that the flu can be a “common and predictable exacerbator of asthma”, making flu vaccination particularly important for asthma sufferers. “Flu vaccination is an effective way of reducing the risk of an asthma exacerbation, so it’s very important that people with asthma have an annual flu vaccination, unless there’s a specific contra-indication,” Dr Claxton said. Dr Blower added: “Any viral infection can make asthma worse, so one of the good things to do is to get an influenza vaccine. So, even if it doesn’t completely protect you, it will mitigate the infection substantially and reduce the chances that you’ll get influenza exacerbation of your asthma.” Role of a pharmacist Pharmacists and pharmacy assistants have an important role to play within the asthma management team. “In allergic asthma, as with every other asthma, the pharmacist and pharmacy assistant have a role in ensuring control and compliance with treatment (e.g. someone who’s buying Ventolin: are they on a preventer?) \[and in\] helping with patient education about asthma, the asthma treatment plan and the inhaler device,” Dr Claxton said. He adds that one of the reasons for poor asthma management and control is incorrect use of the inhaler device, which works best if used properly. “Ensuring that the patient understands what asthma is, what the treatments are for and how to use the inhaler they’ve been prescribed goes a long way to controlling asthma effectively,” he said. Pharmacists and pharmacy assistants also have a role to play in helping patients or customers to “identify and avoid triggers”. “In periods of high infection risk – flu season, COVID pandemics – ensuring asthma is well controlled and action plans are up to date is important to prevent asthma exacerbations,” Dr Claxton said. ALLERGIES 41 Gerald Quigley, Community Pharmacist, suggests isotonic saline (“without a preservative”) as a way to reduce the risk of allergic asthma exacerbations. “If you go to the National Asthma Council website, they have a chart, which is their allergic rhinitis treatment chart,” he said. “This shows regular irrigation with isotonic saline without a preservative is one of the most important ways of interfering with the development and the ongoing issues we have with asthma. That allergic cascade is interrupted if you use isotonic saline without a preservative.” RETAIL PHARMACY ASSISTANTS • JUN 2020