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.
