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is University of Technology Sydney’s Professor Philip Hansbro, whose grant of almost $1.1 million will be used to run a project with the mission of ‘Defining and treating the physiological effects of bushfire smoke exposure’. Retail Pharmacy spoke to Professor Hansbro to learn more about those effects. “What we know is any exposure to the respiratory tract, whether it’s bushfire smoke, cigarette smoke, or air pollution causes an inflammatory response in the airways and lungs because the immune system thinks you’re getting an infection,” he said. “That causes the immune system to introduce immune cells that release factors to kill what they perceive to be pathogens. While they’re effective at killing pathogens, they damage healthy host cells, too. “If that happens once, your body is designed to deal with it, but the problem comes with longer or more intense periods of exposure. “When you have continued rounds of exposure to the respiratory tract, attracting an inflammatory response from your immune system, the constant cycle of wound and repair eventually leads to your system not being able to cope, resulting in the development of scar tissue.” Scar tissue is a major contributor during an asthma attack as it builds up inside the airways, making it hard for asthmatics to get enough air into their lungs. It is this reduced lung capacity that means asthmatics are among those at greater risk when air quality is poor. Planning ahead To understand how people were affected during the emergency caused by poor air quality, Asthma Australia developed and disseminated a survey to give people with asthma and the wider community an opportunity to share what they experienced during the prolonged periods of exposure to bushfire smoke. The results of the survey1 were released to the public in June, accompanied by 10 key recommendations from Asthma Australia for reducing the impact of any future air quality emergency. We asked one of the report’s authors, Asthma Australia CEO Michele Goldman, what pharmacists can learn from the report. “We know that any exposure to smoke University of Technology Sydney’s Professor Philip Hansbro and his team are currently working on a project to define the physiological effects of bushfire smoke exposure. and small particulate matter is harmful to health, and the larger the concentrations and the longer the period of exposure, the more harmful it can be,” she said. “It has also become clear the harm isn’t just in the short term, but there are longer term impacts as well. Essentially, this means if our population is going to be exposed to periods of bushfire smoke more often and with greater intensity, we’re setting ourselves up for more respiratory disease in the future. “The work being done by Professor Hansbro will lead to a clearer understanding of the point at which we can confidently say permanent damage is being done. “In the meantime, we can become better at being able to differentiate when air quality is OK, when it’s poor and when it’s hazardous. Asthma Australia is advocating for education campaigns to try and improve what we’re calling environmental health literacy, so people understand what air quality data means for them in terms of their daily living and behaviour. “Hopefully, people will know to stay indoors when conditions are really hazardous, and to only go about the life activities which involve being outdoors and exposed when conditions are less harmful.” The pharmacist’s role The Asthma Australia bushfire survey showed people will go to pharmacies in the first instance because these are the most accessible outlets for seeking advice and relief, not only confirming pharmacy’s place on the frontline but also underscoring the importance of pharmacies being able to advise and counsel patients towards achieving better health outcomes. “Those visits are usually to buy reliever medication because the patient is experiencing symptoms,” Ms Goldman said. “Either they’ve had really mild asthma and don’t normally carry reliever medication but are now having some trouble, or their regular medications are running short and they know they need to be diligent at this time. “I think pharmacists can anticipate ahead of the summer season and make sure their stock levels are above normal, given the experience of last season when one of the big issues was that stock just ran out so quickly. With life-saving medication like reliever medication, that just can’t happen. “Pharmacists can also play a valuable role by questioning the person coming in to buy a reliever, to try and understand a number of things: • • • Has the patient seen a GP recently? Do they have a diagnosis? Have they been prescribed a preventer? If so, are they using it regularly? “The worst thing that can happen is for a patient to continue to come into a pharmacy and buy multiple reliever medications over a long period of time. “The pharmacy can disrupt that process and, through questioning, identify whether they really should be going back to their doctor.” Asthma Council Asthma and Respiratory Educator Marg Gordon totally agrees, adding that pharmacists should check on how much over-the-counter reliever medication people are buying. “The clear message now is that patients should be on preventer therapy,” she said. “Those who are using lots of reliever should flag a warning to pharmacists who TO PAGE 56 • RETAIL PHARMACY • AUG 2020 RESPIRATORY HEALTH 55