Know how pollen affects your asthmatic patients
Seasons can arrive loaded with problems
How have your patients fared so far this pollen season? Clinicians say last year’s rain, combined with a mild winter in many regions, helped trees shower their patients with plenty of trouble this spring. And with grass pollen ready to take over this summer, physicians say they expect to stay busy.
"It’s just been wild," says Ira Finegold, MD, an allergist in private practice and chief of allergy at St. Luke’s-Roosevelt Hospital Center in New York City. "I can tell from the number of patients coming to the office that the pollen is high, and they’re having troubles."
And if your area has experienced a nice, moist spring, expect grass season to be just as troublesome. Typically, a heavy tree pollen season ushers in high grass pollen counts.
"The worst is yet to come," he says.
What can you do about all this pollen?
Finegold says, by all means, start patients with antihistamines to get symptoms under control. But if the traditional first-line medications don’t do the job, he suggests hitting symptoms hard and then backing off when you get the responses you are looking for, rather than gradually increasing treatments.
"If patients are really having trouble, I recommend step-down therapy rather than step-up therapy," Finegold says. "Gauge the level of asthma, and if it’s severe, come in with steroids if you have to." He adds that steroids have no lasting side effects if taken for a short time.
Pollen can also reveal which patients haven’t been taking their regular maintenance medication. They may have been feeling well and slacked off on their drug routines. But their status can quickly change if they are allergic to particular pollen that suddenly goes airborne. "Now they’re in trouble," Finegold says.
It also helps clinicians to know how individual patients have reacted to pollen in previous years; it can give you a head start on knowing what to expect now.
"Base what you’re doing on past experience," says Henry Milgrom, MD, an asthma and allergy specialist at National Jewish Medical and Research Center and professor of pediatrics at the University of Colorado, both in Denver.
If you know a tough season is coming for a particular patient, try starting medications before symptoms develop, he says. And practitioners should remember that just because an asthmatic is suffering attacks this time of year doesn’t mean pollen is causing the problem.
There’s a threshold where most patients will begin to show symptoms. Generally, if pollen counts reach that threshold, those patients will be affected regardless of how high the counts get. "For most people, there’s not a leap," Milgrom says. "It’s just more of the same. It’s a rare individual who goes from nothing to something."
But when pollen counts escalate, there’s a better chance more patients will reach that threshold. In Kentucky, for example, counts are 10 to 100 times higher than last year, says Bann C. Kang, MD, professor of internal medicine at the University of Kentucky’s Division of Allergy and Immunology in Lexington. That’s thanks to a short, mild winter that left "all those trees growing so naturally, so abundantly," she says. "Lots of trees are very happy." Kang estimates that 13% to 15% of asthmatics in Lexington have a high sensitivity to tree pollen.
Explaining pollen counts to patients
Pollen counts are measured by the amount of airborne allergens present in the air. The concentration is reported as grains per cubic meter of air.
For tree pollen, a count of more than 1,500 is considered very high, which is the most severe category. This means most people with any sensitivity to these pollens will experience symptoms. Very sensitive people may have severe symptoms.
The National Allergy Bureau in Milwaukee is the pollen- and mold-counting network certified by the American Academy of Allergy, Asthma, and Immunology. It’s funded through a grant to the AAAAI from Pfizer Inc. and UCB Pharma Inc.
[To learn about pollen levels in your area, call (800) 9-POLLEN. Or visit the National Allergy Bureau’s Internet site at www.aaaai.org/NAB.]
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