What PCPs need to know about allergy and asthma winter flare-ups
LANDOVER, MD — Allergy and asthma challenges get plenty of billing in the spring and fall, but there’s usually very little mention of the hypersensitivity disorder of the immune system or the chronic inflammatory disease of the airways during the winter. However, December is when asthma flare-ups frequently occur, primarily because of triggers related to the flu, resulting in a higher number of hospitalizations.
“Allergies are an all-year problem that can make life miserable,” said Mike Tringale, vice president of external affairs for the Asthma and Allergy Foundation of America (AAFA). “In the past, it’s been considered a springtime phenomenon. Those of us who live with allergies and/or asthma know it’s a year-round problem. The spring and fall are the two biggest seasons because outdoor allergens get in the way, a little less-so in summer and winter.”
Roughly 22 million Americans have asthma. Some 40 to 45 million Americans have nasal allergies, with some crossover of the two maladies.
“With crossover in these two chronic diseases, it can make it difficult to manage,” said Tringale. “Part of it is recognizing indoor versus outdoor allergens, and outdoor allergens that are brought inside, such as wood burning in the fireplace during the holidays. To get ready for the winter, it’s important to have allergies and asthma under control.”
Primary care providers (PCPs) see the vast majority of patients with asthma, and have a critical role to play if patients aren’t also seeing an allergist, said Tringale.
“It’s really important for them to be familiar with latest information about treating and preventing asthma,” he said. “Many PCPs may not recognize the link between allergy and asthma. For example, a patient may come in during the fall for an allergy checkup, wheezing and coughing due to a respiratory problem, and/or constriction of air passages in the head and throat. They should also be screened for asthma, which has a different kind of diagnostic, workup, and questions.”
Asthma emergency room visits and hospitalizations spike during flu season, noted Tringale.
“The flu affects lungs and airways,” he explained. “People with asthma already have compromised airways leading to the lungs, and the flu adds another layer of complexity and problems of chronic disease. In fact, patients with food allergies and asthma are at a higher risk of death. Even during the time of flu shot shortages, asthma patients were among the higher-risk population to receive flu shots, along with the elderly and pregnant women. It’s very important for a physician to talk to a patient with moderate to severe allergies, and history of chronic bronchitis, to serve as a clue that they’re at a higher risk for asthma.”
PCPs, who are becoming the critical gatekeeper for the healthcare system, do a great job managing allergy and asthma patients, Tringale said.
“They’re trained and are expected to be a much more comprehensive provider, with more comprehensive training in all disciplines,” he said. “They’re incentivized from keeping patients to go to specialists. On the flip side of the coin, many health plans don’t want patients to go to specialists unless it’s absolutely necessary – with rather severe symptoms.”
In allergy care, many health plans have turned their philosophy into policy: the fail first approach, Tringale said.
“Many health plans now require a PCP to instruct allergy patients to seek over-the-counter solutions before providing a prescription for medication,” he explained. “That means patients must visit the doctor twice, and try a medication that might not work for them. Trial and error isn’t a very safe approach. Nonetheless, patients are driven to their healthcare providers, and if PCPs had a full array of asthma and allergy medications, they could manage the mild to moderate allergy and asthma patient well. Allergists often see the more severe form of disease, and have a few more tricks in their bag to help the severe allergic patient.”