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Helping your patients manage asthma in hay fever season

As hay fever season approaches, many patients find that their asthma symptoms worsen.1 Although these two conditions aren’t the same, epidemiological studies have consistently shown that asthma and allergic rhinitis often coexist in the same patients.2,3 We have compiled some tips to help both you and your patients manage their asthma during this period.

Hay fever season typically runs from March to September and is a result of the increase in pollen, causing allergic rhinitis in sufferers.1,4 One of the most common hay fever triggers is grass pollen, which mainly affects sufferers between May and July.4,5 Allergic rhinitis affects between 17% to 28.5% of the adult population in Europe.6 Many people find that their asthma symptoms worsen or can be triggered by allergies, with more frequent emergency hospital admissions noted.2 Studies have shown that the prevalence of asthma is more than six times higher in those suffering with allergic rhinitis who are exposed to pollen than those without.7

Typical symptoms of allergic rhinitis include sneezing, itchy nose and throat, blocked nose and itching eyes, which occur on contact with an allergen (pollen, dander, dust mites).1,8 Asthma symptoms include wheezing, chest tightness, and difficulty breathing.9 Successful control of allergies, alongside effective asthma management, could help improve symptoms and reduce asthma flare ups, according to UK charity Asthma+Lung.10

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Urge patients to take antihistamines and intranasal steroid sprays

Antihistamines are a common treatment for allergy symptoms and can be taken two to four weeks before the patient usually gets symptoms during allergy season.11,12 This can help protect against pollen allergies.12

Intranasal corticosteroid sprays have been shown to relieve allergic rhinitis symptoms.13 Interestingly, they have also been shown to be moderately effective with asthma, which may lead to reducing asthma exacerbations and hospitalisations.2

Encourage patients to take their preventer inhaler as prescribed, and carry their reliever inhaler with them

Educating patients on taking their asthma medication as prescribed is crucial.10,15 This is significant year-round to control asthma, however, if patients suffer with allergy-induced asthma, it can be especially important to make sure that they are taking their preventer inhalers as prescribed.10 It is also vital in this period that patients keep their reliever inhalers on them in case of a flare up of symptoms.10

Consider performing a FeNO test on patients to help manage their asthma.16 In the clinic, FeNO testing can help ensure that patients are taking medications correctly, as a study showed that approximately 50% of adult patients on long-term therapy are non-adherent to their medication.16,17 FeNO testing can help guide treatment options through dose titration, checking inhaler technique, and monitoring asthma management at point-of-care.18,19

Manage the sneezing and the wheezing

Overall, it is important to manage both allergy and asthma symptoms to improve outcomes.22,23 As suggested by the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, patients with persistent allergic rhinitis should be evaluated for asthma, and patients with asthma should be evaluated for rhinitis.24 Costs for asthma are significantly increased in patients with allergic rhinitis, so effective treatment of both may help to reduce these alongside improving patient outcomes.25,26 We hope that you can use the information in this article to help your patients manage their symptoms better during this season.

Want to learn more about how FeNO testing can help manage your patient’s asthma? Check out our FeNO learn app for handy educational content or book a demo to see how NIOX® can help you help your patients.



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Helping your patients manage asthma in hay fever season

References

1. Asthma & Lung UK. What is hay fever? Available at; https://www.asthmaandlung.org.uk/conditions/hay-fever/symptoms. Accessed; Apr 2024.
2. Bousquet J et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008. Allergy. 2008;63(s86):8–160.
3. Khan D. Allergic rhinitis and asthma: epidemiology and common pathophysiology. Allergy Asthma Proceedings 2014;35(5).
4. American College of Allergy, Asthma & Immunology (ACAAI). Hay Fever. Available at; https://acaai.org/allergies/allergic-conditions/hay-fever/. Accessed; Apr 2024.
5. Met Office. When is hay fever season in the UK? Available at; https://www.metoffice.gov.uk/weather/warnings-and-advice/seasonal-advice/health-wellbeing/pollen/when-is-hayfever-season. Accessed; Apr 2024.
6. Brożek J et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines—2016 revision. Journal of Allergy and Clinical Immunology. 2017;140(4):950–8.
7. Leynaert B et al. Association between asthma and rhinitis according to atopic sensitization in a population-based study. Journal of Allergy and Clinical Immunology. 2004;113(1):86–93.
8. Siddiqui Z, et al. Allergic rhinitis: diagnosis and management. British Journal of Hospital Medicine. 2022;83(2):1–9.
9. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2023. Available at; https://ginasthma.org/2023-gina-main-report/
10. Asthma & Lung UK. Pollen, hay fever, and lung conditions. Available at; https://www.asthmaandlung.org.uk/conditions/asthma/asthma-triggers/pollen. Accessed; Apr 2024.
11. National Health Service (NHS). Antihistamines. Available at; https://www.nhs.uk/conditions/antihistamines/. Accessed; Apr 2024.
12. Asthma and Allergy Network. Ask The Allergist: Timing Your Allergy Meds. Available at; https://allergyasthmanetwork.org/news/ask-the-allergist-timing-your-allergy-meds/. Accessed: Apr 2024.
13. Dahl R et al. Intranasal and inhaled fluticasone propionate for pollen‐induced rhinitis and asthma. Allergy. 2005;60(7):875-81.
14. National Health Service (NHS). Hay fever. Available at; https://www.nhs.uk/conditions/hay-fever/. Accessed; Apr 2024.
15. Asthma & Lung UK. Using your inhalers. Available at; https://www.asthmaandlung.org.uk/conditions/asthma/using-your-inhalers. Accessed; Apr 2024.
16. Asthma and Allergy Foundation of America (AAFA). FeNO tests to monitor FeNO levels. Available at; https://aafa.org/asthma/asthma-diagnosis/lung-function-tests-diagnose-asthma/feno-tests-to-monitor-feno-levels/. Accessed; Apr 2024.
17. Barry LE et al. Cost-Effectiveness of Fractional Exhaled Nitric Oxide Suppression Testing as an Adherence Screening Tool Among Patients With Difficult-to-Control Asthma. The Journal of Allergy and Clinical Immunology: In Practice. 2023.
18. Porsbjerg C et al. Asthma. The Lancet. 2023.
19. Sabatelli L et al. Cost-effectiveness and budget impact of routine use of fractional exhaled nitric oxide monitoring for the management of adult asthma patients in Spain. J Investig Allergol Clin Immunol. 2017;27(2):89-97.
20. Alving K et al. Validation of a new portable exhaled nitric oxide analyzer, NIOX VERO®: randomized studies in asthma. Pulm Ther. 2017;3:207-218.
21. NIOX®. Product Labelling Summary NIOX VERO®. 2023.
22. Asthma & Lung UK. Managing asthma in adults. Available at; https://www.asthmaandlung.org.uk/conditions/asthma/managing-asthma-adults. Accessed; Apr 2024.
23. American Academy of Allergy, Asthma & Immunology (AAAAI). Hay fever / rhinitis. Available at; https://www.aaaai.org/conditions-treatments/allergies/hay-fever-rhinitis. Accessed; Apr 2024.
24. Bousquet J, van Cauwenberge P, Khaltaev N. Allergic Rhinitis and Its Impact on Asthma. Journal of Allergy and Clinical Immunology. 2001;108(5):S147–334.
25. Yawn B et al. Allergic rhinitis in Rochester, Minnesota residents with asthma: Frequency and impact on health care charges. J Allergy Clin Immunol. 1999;103(1):54–9.
26. Titulaer J et al. Cost-effectiveness of allergic rhinitis treatment: An exploratory study. SAGE open medicine. 2018;6:2050312118794588.