‘Burning throats, difficulty breathing and burning eyes.’

View of Sydney Harbour on Tuesday 10 December 2019.

Sydney pharmacists have been working overtime after the city was hit with an air quality index ten times the ‘hazardous’ level on Tuesday

After weeks of haze covering Sydney due to the bushfires burning across NSW, the city was blanketed on Tuesday with the worst magnitude of smoke yet.

Parts of the city saw levels of PM2.5 reach over ten times the “hazardous” level of 200, with Sydney’s east reaching over 2500 and Sydney’s north-west over 2200.

Presentations to emergency departments and calls for NSW Ambulance assistance for asthma or breathing problems have been higher than normal across the state in the past month, according to NSW Health.

Meanwhile smoke alerts have also been issued across Canberra, Brisbane, Adelaide and Victoria in the past few weeks and months.

Community pharmacists on the frontline have seen the effects firsthand.

“It’s degenerated into a continuous blanket of smoke and it’s really obvious at the coalface in community pharmacy,” Nick Logan, a pharmacist proprietor from Sydney’s lower north shore, told AJP.

“We’re selling bucketloads of P2 masks and we’re selling much more salbutamol – which is a concern that people are relying on that, because that’s not the best course of action to manage bronchoconstriction,” says Mr Logan.

“The amount of spacers we’re selling – we’re telling people they’re getting 50% more medicine through spacers. And reminding people that there’s better ways to manage bronchoconstriction by salbutamol, which is really a band-aid treatment. We recommend they go to the doctor, get an action plan, be diagnosed and prescribed with corticosteroids.”

The bushfires have seen the levels of harmful particles in the air skyrocket across major cities on Australia’s east coast with Sydney seeing levels ten times the ‘hazardous’ level of 200. Source: dpie.nsw.gov.au/air-quality/current-air-quality

Community pharmacy proprietor Caroline Diamantis, from Sydney’s inner west suburb of Balmain, said the situation has been “really bad” in her area.

“We’ve got a massive issue of people with burning throats, difficult breathing and burning eyes,” she says.

“We’ve been selling masks, getting people to use eye drops every hour, to use their preventers if they’re on them or, if they’re not, to talk to their doctor for emergency use of corticosteroid treatment.

“And using their SABA (short-acting beta-agonists) to use in an emergency situation. If someone’s really struggling you can have up to six puffs.”

Ms Diamantis says that while most people can be “quite blasé” about not using their preventer or adhering to their asthma action plan, the severe levels of smoke have seen people “quite concerned or frightened”.

“We’re seeing it across all ages,” she says. “This is much worse because it can trigger a reaction when you’re not ready and you’ve got very little time to treat it.

“We’re seeing people who come in, and they’ll say, ‘oh no, I’ve been feeling so well I haven’t needed [my preventer]’.

“Then it’s obviously an education session – we don’t let a single opportunity pass where we don’t say, you’re relying on your Ventolin two to three times a week, that is not controlled asthma – these attacks can be sudden and you could end up in hospital.

“Pharmacists are very well-trained to advise that patients should not just be using Ventolin all the time, only emergency use as a top up if something in the atmosphere has triggered [their symptoms], whilst they’re using their preventer,” says Ms Diamantis.

Mr Logan agrees this is a crucial time for pharmacists to share their expertise.

“It’s a really good opportunity to encourage people to have an action plan with really clear directions about what they’re going to do, and how they manage their asthma,” he says.

“It’s a fabulous opportunity for pharmacists to recommend spacers and for people to update their action plans and have a clear algorithm for managing their breathing difficulties.”

With the outlook for a drought-breaking rain looking poor, bushfires continue to rage across NSW showing no signs of abating.

The NSW Rural Fire Service has confirmed more than 700 homes have been destroyed by the fires and six lives lost.

There are bushfires currently blazing in areas of Victoria, and there have also been serious fires occurring in Queensland, the Northern Territory and Western Australia.

Bushfires are currently tearing through NSW. Image courtesy QUT.

Further days of poor air quality are on the cards for those across the nation.

On these days, NSW Health is particularly reminding the elderly and parents and carers of young children to stay inside with doors and windows shut, where possible, and postpone outdoor activities.

NSW Health Director of Environmental Health, Dr Richard Broome said the fire emergency engulfing many parts of the state means the smoke affecting so many communities shows no sign of lifting in the near future.

For most people, smoke causes mild symptoms like sore eyes, nose and throat. However, people with conditions like asthma, emphysema and angina are at greater risk because the smoke can trigger their symptoms.

“NSW Health continues to recommend that people with these conditions should avoid outdoor physical activity when there’s smoke around,” Dr Broome said.

Dr Broome said, with more and more people starting to wear a variety of face-masks, it is important to consider the evidence.

“The main concern with smoke is the very fine PM2.5 particles, which are so small they pass through most types of mask. A P2 mask does filter out these particles, but is only effective if there is a good fit and an air-tight seal around the mouth and nose. Evidence shows that this is difficult to achieve in practice, so they may not provide the benefit people are hoping for.”

ACT Health said people can take the following precautions to help minimise the effects of smoke and air pollution: 

  • Stay indoors, with windows and doors closed;
  • Stay in air-conditioned premises and switch the air-conditioner to ‘recycle’ or ‘recirculate’ to reduce the amount of smoke entering the building;
  • Visit a local air-conditioned building such as a library, community centre or shopping centre; and
  • Check on elderly neighbours or other people who you think might need extra help.

You may be interested in reading:

State of emergency
Pharmacists caught in the midst of devastating NSW bushfires, but still serving their communities

Emergency supply
Department of Health advises that emergency medicine provisions are in place for bushfire affected parts of NSW, Queensland

Bushfires spark breathing concerns and asthma warning
The National Asthma Council Australia is cautioning Australians that bushfires raging throughout the country are putting lives at risk from asthma

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