The Victorian tragedy that occurred in November last year pushed emergency services to the limit… here’s how to prepare as pollen season begins across south-east Australia
Nine people died in Victoria late last year and more than 8500 required emergency hospital care when a freak weather event combining high pollen count with hot winds and sudden downpour led to the release of thousands of tiny allergen particles triggering sudden and severe asthma attacks.
Some Melbourne pharmacies were inundated with people seeking reliever puffers; a significant proportion of these people were experiencing their first asthma attack.
As many as one-third had not been diagnosed with asthma previously.
Based on latest research, here’s how you can prepare:
1. Identify asthma in people with seasonal hayfever and allergies. Patients with seasonal allergic rhinoconjuctivitis or allergies to grass pollen appear to at higher risk of thunderstorm asthma. Studies have shown that more than 95% of thunderstorm asthmatics are allergic to pollen and rye grass pollen.
2. Stock up on asthma reliever medication. Hospitals, medical centres and pharmacies were caught unawares during the crisis last year. Pharmacies are advised to consider maintaining higher stocks of asthma reliever medication and spacers during spring.
3. Educate patients to raise awareness of the risk of thunderstorm asthma in those with a history of asthma or seasonal rhinitis, and of asthma first aid in the general public. Print out the flowchart for pharmacists on thunderstorm asthma and place it near your workspace, to help guide staff conversations with patients.
4. Advise people with hayfever to carry a Ventolin puffer. Consider inhaled corticosteroids for patients with asthma and hayfever, particularly for anyone who “sneezes or wheezes” in spring. People who suffer from hayfever are advised to carry a Ventolin puffer at all times – especially if thunderstorms are expected.
5. Even just low doses of corticosteroids could save a life. Current asthma treatment guidelines recommend use of inhaled corticosteroid treatment for patients who have all but intermittent asthma symptoms. Even low doses of inhaled corticosteroids are strongly associated with protection from severe exacerbations and asthma-related death.
6. Review patients asthma action plans, discuss medication use. In patients with established asthma, especially those with co-existent seasonal rhinitis, the leadup to grass pollen season should prompt review of allergic triggers, asthma preventer adherence, asthma action plans, and consideration of prescription for preventer therapy in those not already using one.
7. Use warning system when available. Be aware that the Victorian Department of Health and Human Services, along with the Australian Bureau of Meterology, are developing a thunderstorm asthma prediction and warning system.
8. Tell at-risk patients to stay indoors. Just before and during thunderstorms, at-risk individuals are advised to stay indoors with windows and doors closed, to take their asthma and rhinitis preventer medication, activate action plans and have reliever drugs at hand.
9. Keep abreast of weather conditions, especially when thunderstorms are predicted. Melbourne pharmacists are encouraged to learn more about the AIRwatch system, which reveals when there is a high risk of thunderstorm asthma, based on the weather conditions. AIRwatch is a network of two air sampling stations – one at the Waurn Ponds campus and the other at the Burwood campus. Samples are taken daily during September to March – hay fever season in Melbourne – with daily forecasts of the amount of pollen in the air and the likelihood of thunderstorm asthma both listed on the website.
10. Don’t suggest immunotherapy. Be aware there is scant evidence supporting the use of immunotherapy for grass pollen-induced asthma, and no evidence for the use of allergen immunotherapy in thunderstorm asthma.
National Asthma Council flowchart for pharmacists (downloadable)