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Helen Reynolds has a prescription for her son Jack but seems unsure whether he has been diagnosed with hay fever or asthma...

“I took him to the surgery because he has had a cough for a few weeks now that just won’t go away. The GP has given him inhalers but said that he’ll probably only need them in the summer,” says Helen. When pharmacist Parveen asks a few questions she finds out that Jack’s cough is accompanied by sneezing and he seems to be rubbing his eyes more than normal, which is making them red and watery. He also seems more tired than usual.

Answer

From the symptoms Helen describes and the medication her son has been prescribed (a salbutamol inhaler, for use when required; a beclometasone 100mcg inhaler, to be used twice daily; and desloratadine oral solution, 2.5ml in the morning), it sounds as though Jack has hay fever that is triggering asthma symptoms. This explains the advice that Helen has been given about how long to use the inhalers for: the GP is assuming that as the pollen count falls, Jack’s symptoms will start to diminish.

The most sensible advice to give Helen is for Jack to use the ‘brown’ inhaler and antihistamine regularly as prescribed, and the ‘blue’ inhaler if he continues to suffer with a persistent cough.

If he needs to use the reliever frequently, Helen should take him back to the GP for a review as his steroid could be increased in dose or changed. Helen should also keep an eye on the pollen forecast and, as levels start to drop at the end of the season, consider stopping both the antihistamine and steroid inhaler to see if the asthma and hay fever symptoms recur, and booking another review appointment accordingly.

The bigger picture

Anything that irritates the airways can cause asthma symptoms, and sufferers may have one or several triggers. Avoiding them is an important aspect of asthma management, but is easier said than done as it can be difficult to identify triggers and, even then, some may be unavoidable such as viral infections, house dust mite, pollen and exercise. Anyone who notices that their symptoms have worsened should see their GP or asthma nurse as it may be a sign that their condition is not well controlled.

Extend your learning

• Are you aware of the differences in the stepwise management of asthma between children aged under five years and older children and adults? Compare the two using the information in the BNF.
• Find out more about asthma triggers.
• Patients with asthma on regular medication are eligible for an annual influenza vaccination. Are they also eligible for a pneumococcal injection? Find out here.