TELEMEDICINE in Asthma & Allergy patients in COVID days.

These are difficult days because of pandemic of COVID 19.

At the same time it is also important to safeguard health of patients who are suffering .

Day to day problems and acute problems are handled differently than the chronic problems. 

A known case of Allergic rhinitis , Asthma or  allergies must be already on treatment and needs continuity of care. The seasonal respiratory allergies are expected to have exacerbation of symptoms in April May & September October.  Those who are completely asymptomatic can become symptomatic or those who have perennial symptoms may have exacerbations.

The patients who are already on treatment must be having a written emergency protocol to deal with Asthma attack and they must have been repeatedly been explained how to use the salbutamol inhaler multiple puffs inhalation at the time of need. They must have already been imparted with the knowledge of how to identify Asthma attack.

If a doctor gets a phone call , it is important to assess the emergency on video call. 

Patients blue lips , working of alae nasi , chest retractions , rapid respiratory rate-the signs of respirator distress are easily visible on video. Such patients who have tendency to go into acute attack must be keeping home nebuliser and salbutamol and budecort respules.  They must start home nebulisation immediately & an oral dose of prednisolone as per body weight should be advised immediately. The doctor  should also alert emergency care because if cyanosis does not settle patient will require oxygen & hospitalisation . If this is needed nebulisation should continue in the car. Nebulisation is an aerosol generating procedure & is being done in hospitals under extreme care & protection but at home this is safe. However  even for emergency multiple puffs of MDI are preferred over nebulisation and are most of the times helpful in reversing the attack of asthma.

The most important aspect of chronic disease is routine regular follow up so that emergencies do not arise.

Every patient of NASOBRONCHIAL ALLERGY must adhere to follow ups . Allergic Rhinitis though it sounds simple has tendency to march to Asthma , therefore requires good control. If the rhinitis becomes worst it can be confused with Covid because both have flu like symptoms. Generally in Rhinitis there is no fever , cough and breathlessness which are hallmarks of Covid. Rhinitis has excessive sneezing , blocked nose , itchy ears , throat , nose , red itchy eyes , post nasal drip & a nasal twang in voice. But to give benefit of doubt Covid test should be done if evidences point towards that.

All this can be assessed by intelligent observations and questions on video call.  Sinuses are also involved in Allergic rhinitis resulting into typical headache. Patients will also have past history of exacerbations of allergic attacks.

Bronchial Asthma patients should also remain on regular follow up so that it can be ensured that they do not miss the preventive inhalers and do not get into emergency.

Inhalation techniques & PEFR can also be assessed on video calls.

Thus most of it is possible on telemedicine so patients must prefer this and should go for physical examination only if doctor finds it absolutely unavoidable.

COVID 19 FOR ASTHMATICS

Ever since  Corona pandemic is spreading its tentacles and engulfing many all over the globe the fear and anxiety of Asthma patients 

have increased manifolds

The main questions are "am I more susceptible because of weak lungs?""Can my steroids put me more at risk ?"Should I stop inhalers ?"

What can Ï take to boost immunity ?"How should I sanitise my inhaler and peak flow meter "

"But Ï took the flu vaccine so am I protected ?""Should I repeat the pneumonia vaccine , should I keep oxygen cylinder and nebuliser at

 home in case.I get into trouble?

To allay all the anxiety in one sentence I would urge to all Asthma patients that so far there is no scientific evidence that Asthmatics are 

more prone to infection due to Coronavirus or its complications. They need to follow the same rules of prevention like social distancing

,use of clean mask , hand washing and personal & environmental hygiene.

Taking specific questions it is recommended that they should continue to keep their Allergic rhinitis as well as Asthma under good control

with use of steroid nasal spray and inhalers so that rescue medicines are needed seldom. In fact seasonal allergies are at its peak therefore 

optimum control is desired. If you sway from this the emergency room visit might put you more susceptible to exposure to Corona though 

best practices are being followed in hospitals. In fact by proper control of Asthma with inhalers, nebulisation can be avoided which is the aerosol 

generating method and should be avoided during pandemic . Your inhaler and peak flow meter are your personal equipments , you should handle 

them after washing hands and clean them as you do on normal days. Sanitisers can be used if needed . If you keep good control of Asthma you will

 not need oral steroids or oxygen for emergencies. Asthma is a disease of airways , it is the reversible airway disease so don't think that your lungs are

 weak or your immunity is low. Keep eating normal healthy balanced food  , of course avoid your identified food allergens if any. Keep hydrated.

Don't use fumes or perfumes , dont smoke , don't take Aspirin , Brufen etc which are the usual precautions for all times.

The Influenza vaccine will protect you against those strains of viruses for which it is meant. No doubt Coronavirus affects lungs but taking  additional

pneumonia vaccine is not the answer . In any case Pneumonia vaccine is to prevent specific bacterial pneumonias.

Healthy food & no anxiety are the best for immunity. you don't need immunomodulators to prevent risk of Coronavirus infection.

Stay safe with discipline of avoiding Asthma triggers ,  Asthma control with proper medication &  positive attitude.

Follow all discipline to avoid corona virus as is applicable to general public.

  

IMPACT OF ALLERGY ON QUALITY OF LIFE.

He walked  swiftly in my clinic with newspaper in hand and uttered aggressively "'I bet you cant make me alright , no body could !'' I could gauze his angry mood , I thought he must be so upset because of his unbearable malady . I gave him a comforting look and requested him to sit down. He understood my unspoken words and my utmost desire to help him.
He said 'I read your article in Tribune and I thought I should try you also for my misfortune of nose allergy.But I have just one hour with me , my bus for Haridwar is after an hour , I am coming from Solan after submitting my resignation in the school."I said oh my God , why did you resign and what will you do now ? He said I have such severe running of nose all the time that it is impossible for me to even lift my head to take a class . Children make fun of me , I have to  use not a hanky but a towel to wipe my secretions." I said  "so what will you do in Haridwar , you have a new job "? He said , I am a PhD but I will simply run my fathers tiny shop as I am not suited for teaching or anything else due to my  severe allergy.
I thought to myself that what is the use of my super specialisations in Allergies if a young Ph D has to resign from job due to allergy and he has to  severely compromise with his aspiration .
I told my assistant , "Nadeem please go with him and help him take a room in nearby dharamshala "I insisted upon the man that please help me by staying here for two days. I promise I will do my best. He found me very convincing , he stayed back.
Meanwhile I called up his principal as luckily he used to come to me those days for his sons Asthma treatment. He said "yes doctor , how can I help you " I said so and so has submitted his resignation to you , please don't process it for next ten days."He said "Is he your relative , you never told me , well surely I can do it for you , first time in life you asked me for something "I said thanks and thought to my self that he had become my patient so he was indeed my relative!
 I tested him for two days and started treatment . He came back the fourth day and said "doctor I extended my stay as I have some hope in the treatment. I said treatment in Allergies is long so don't over expect. "He was firm on staying back . He came back after five days and he said 'Ok please prescribe for ten days I will keep coming to you from Haridwar."
I said come to me tomorrow. I spoke to the principal and reminded him of that resignation and told him how did he become my relative after reading my article in the bus and now he is ready to come back to the school for his job."The principal found it really strange and complimented me for thinking beyond my duty, he was happy to ignore his resignation. Next day when the gentleman came for his prescription my note also included "FIT to join duties in the school & request school to send him for review periodically as advised."
He was surprised and couldnt believe me . I told him the whole thing . Tears started rolling out of his eyes , he said I never knew doctors could think like this & tears wont stop. I told him stop your tears you are failing my treatment , your nose may also start crying . Me and my assistant treated him to samosa and Lassi and bid him bye. After so many years when I recall that day I am amazed at power of an article which has prevented  a teacher from failing in life due to ailment of allergy!