Thunderstorm asthma events are triggered by high grass pollen and certain types of thunderstorms, during which tiny pollen grains from grasses can be swept up in the wind and carried long distances. Pollen is then breathed in and can trigger asthma and asthma attacks.¹

People with the highest risk of developing thunderstorm asthma are those sensitive to grass pollen and who have seasonal hay fever. Those affected by both hay fever and asthma can suffer severe asthma attacks during the grass pollen season. Also, those who experience wheezing or cough with their hay fever can be especially affected during this season.

People should watch out for symptoms and get tested for rye grass pollen allergy if they’re concerned, according to a media release from Asthma Australia CEO Michele Goldman.

“If in doubt, you should see a doctor and ask about thunderstorm asthma and how to get tested for rye grass allergy,” she said.²

Management 

Ensuring that patients have an asthma action plan or hay fever treatment plan in place is essential to ensure preparedness for treating their asthma and recognising when it’s getting worse.

Ms Goldman says that, additionally, being aware of asthma first aid is important in recognising when an asthma attack may be taking place.

“This season could bring many storms, so please learn asthma first aid and how to recognise an asthma attack,” she said

“Tight chest, difficulty breathing, gasping, wheezing, puffing when speaking, and persistent coughing are all signs someone can’t breathe well.”²

Treatment 

Having access to preventer and reliever medication during thunderstorm asthma season is vital to help control asthma symptoms and asthma attacks. Preventer medication works by averting asthma symptoms, while reliever medications are fast-acting medicines that work to relieve asthma symptoms caused by asthma triggers.³

“Asthma Australia strongly recommends anyone who suspects they have hay fever to discuss their symptoms with their doctor or pharmacist,” Ms Goldman said. “A few months of evidence-based preventer treatment could mean the difference between good health and a catastrophe.”²

High reliance on reliever medications means the symptoms of asthma are treated but not the cause. Therefore, the use of preventer medication is important.

National Asthma Council Australia Director and respiratory physician Professor Peter Wark emphasises that preventer medication should be taken for optimal asthma control.

“Good asthma control is critical during thunderstorm asthma season, so keep taking your preventer medication as prescribed by your doctor,” he advised.

“Most people with asthma over the age of six years should be using a preventer to keep their asthma under control. A blue reliever inhaler doesn’t stop the inflammation that causes asthma and will not prevent an asthma attack.

“If you need a reliever more than a couple of times a month, you should be taking a preventer, and in spring and early summer, and if you’re going to be in an area where there is ryegrass pollen, make sure you talk to your doctor.”

Intranasal corticosteroid sprays are important in the treatment of hay fever and work to reduce the symptoms of nasal inflammation, congestion and runny nose. When used regularly, intranasal corticosteroid sprays are effective in preventing swelling and mucus production.⁴

Professor Wark advises those affected by hay fever that regular use of a nasal corticosteroid spray every day, at least during pollen season, is the best treatment to control allergy symptoms.

“Hay fever can cause upper and lower airway inflammation and result in itchy watery eyes, runny nose and sneezing, but even more concerning, hay fever can lead to an increased risk of serious asthma flare-ups,” he said.⁵

Learn more about asthma first aid: nationalasthma.org.au/asthma-first-aid 

References:

1. Asthma Australia. ‘Asthma Triggers’. 2021. org.au/triggers/thunderstorm-asthma/
2. Asthma Australia. ‘Find out if you are at risk of thunderstorm asthma’. 2022. org.au/about-us/media/find-out-if-you-are-at-risk-of-thunderstorm-asthma/
3. Asthma Australia. ‘Medicines’. 2021. org.au/medicines/
4. Australian Allergy Centre. ‘Nasal sprays and management of allergic and non-allergic rhinitis’. 2015. com.au/nasal-sprays-and-management-of-allergic-and-non-allergic-rhinitis/
5. National Asthma Council. ‘Time to prepare for thunderstorm asthma’. 2022. nationalasthma.org.au/news/2022/time-to-prepare-for-thunderstorm-asthma

This feature was originally published in the November issue of Retail Pharmacy magazine. 

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Thyroid issues usually occur when the gland becomes overactive (hyperthyroidism) or underactive (hypothyroidism). An incorrectly functioning thyroid can lead to hormones not being regulated properly.

Pharmacy plays an important role in the management and correct use of thyroid medications.

Role of the thyroid

The thyroid gland is an integral part of the endocrine system, responsible for hormone production. The hormones it produces help control the body’s metabolic processes. These hormones are thyroxine (T4), triiodothyronine (T3) and calcitonin.

The main hormone produced by the thyroid is T4, which is then changed into T3, the active thyroid hormone.² T4 and T3 help to control energy levels, body temperature, metabolism, the health of muscles and bones, and brain development.² Calcitonin aids in controlling the amount of calcium and phosphate within the body.

Thyroid issues 

Common thyroid issues include:

• Hyperthyroidism.
• Hypothyroidism.
• Graves’ disease.
• Thyroid nodules.

Hypothyroidism occurs when the thyroid gland is underactive, meaning it fails to produce enough hormones. Symptoms can include sensitivity to the cold, fatigue, dry skin, constipation, weight gain, depression, irregular periods, swollen face and difficulty becoming pregnant. Hypothyroidism is treated through thyroxine replacement therapy.²

Hyperthyroidism occurs when the thyroid is overactive, meaning that hormones are overproduced. Hyperthyroidism is most commonly caused by Graves’ disease, an abnormality in the immune system.³ The symptoms of Graves’ disease include thyroid eye disease, eye swelling and coarsening, and reddening of the skin on the shins. Hyperthyroidism can be diagnosed through a blood test that measures the levels of thyroid hormones within the body.³

Thyroid nodules are solid fluid-filled lumps, formed within the thyroid, that can cause hyperthyroidism. In most cases, thyroid nodules are not serious. However, a small percentage of them can be cancerous or cause the increased production of the T4 hormone.⁴ This can cause weight loss, increased sweating, tremors, nervousness and rapid and irregular heartbeat.⁴ 

Iodine deficiency and supplementation 

Iodine, an important element in the proper functioning of the thyroid gland, is present in seawater and within the soil. In Australia, a relatively low level of iodine is found within the soil where food is grown and livestock grazes.⁵

Iodine deficiency is the most common cause of thyroid disorders and occurs when not enough iodine is present in the diet. Such deficiency can cause hyperthyroidism, due to the thyroid becoming enlarged.⁵ Iodine can be found within iodine-enriched foods such as dairy products, seafood and iodised salt, and in iodine supplements.

“To protect your family from iodine deficiency and the consequences of a sluggish thyroid function, ensure you include iodine-enriched foods on your shopping list,” Australian Thyroid Foundation CEO Beverley Garside said.⁶

The thyroid hormone has a particularly important role in the normal development of the brain and nervous system before birth, in babies, and in young children.⁷ Taking 220µg per day of iodine is recommended for pregnant women and 250µg per day for breastfeeding mothers.⁷ The National Health and Medical Research Council recommends that all women who are pregnant, breastfeeding or considering pregnancy take an iodine supplement of 150µg per day.⁷

Medicines 

In the management of thyroid issues, medication plays an important role. Thyroid medications work through either replacing the missing hormone in the case of hypothyroidism or blocking the hormone product in the case of hyperthyroidism to prevent the body from producing too much of the thyroid hormone.⁸

There is no cure for hyperthyroidism. However, it can be managed through several medications that block hormone production in the thyroid gland. All these medications are covered under the PBS, but some brands cost more than others.⁸

For those diagnosed with hypothyroidism, medicines are usually prescribed to replace the hormones. Levothyroxine is commonly used to replace the T4 hormone, and liothyronine is used to replace the T3 hormone.⁸ Multiple different brands of levothyroxine tablets are available, but not all brands can be substituted, and some need to be stored in the fridge. Ensuring patients are aware of this is important for the correct use and storage of the medicines.⁸

References: 

1. Hormones Australia. ‘Thyroid gland’. 2023. hormones-australia.org.au/the-endocrine-system/thyroid/.
2. ‘Thyroid gland’. 2023. healthdirect.gov.au/thyroid-gland.
3. Better Health Channel. ‘Thyroid – hyperthyroidism’. 2011. vic.gov.au/health/conditionsandtreatments/thyroid-hyperthyroidism#graves-disease
4. Mayo Clinic. ‘Thyroid nodules’. 2022. org/diseases-conditions/thyroid-nodules/symptoms-causes/syc-20355262.
5. Australian Thyroid Foundation. ‘Iodine Deficiency’. 2023. org.au/Iodine-Deficiency.
6. Australian Thyroid Foundation. ‘Avoid Iodine Deficiency with Healthy Food Choices’. thyroidfoundation.org.au/news/13186421.
7. National Health and Medical Research Council. ‘Iodine supplementation for pregnant and breastfeeding women’. 2010. gov.au/about-us/publications/iodine-supplementation-pregnant-and-breastfeeding-women#block-views-block-file-attachments-content-block-1.
8. ‘Thyroid medicines’. 2023. healthdirect.gov.au/thyroid-medicines.

This feature was originally published in the November issue of Retail Pharmacy magazine. 

The post Thyroid disorders and management appeared first on Retail Pharmacy.

To preserve eye health and comfort the film needs to remain intact between every blink. When this function is impaired, through not producing enough tears or through the tears not remaining in place between blinks, this causes dry eye and over time can damage the surface of the eye.¹ 

Dry eye is common in older people, although can affect anyone and while it cannot be cured there are methods to alleviate the discomfort and relubricate the eyeball. Often when patients experience dry eye the pharmacy is the first place, they go to seek advice to manage the condition.

Causes of dry eyes 

Dry eyes can be caused by a variety of reasons. However, certain factors increase your risk:

• As we age our tear production reduces meaning dry eyes are more common in older people.²
• Women two times more likely to develop dry eye disease.³
• Wearing contact lenses can limit oxygen flow interfering with tear production.
• Using the computer or screens for a prolonged period can interfere with blinking patterns.²
• Some medications.
• Certain autoimmune diseases increase the likelihood of dry eyes.²
• Being exposed to wind, smoke, or dry air.²

Pharmacy’s role 

Wizard Professional Services, Chief Pharmacist, Jeanette Drury says that pharmacy plays an important role in managing dry eyes.

“Dry eye is common and can affect anyone and Pharmacy is often the first port of call for patients experiencing this uncomfortable condition,” Ms Drury said.

“A pharmacist will assess the symptoms and ask questions to help determine the cause. They can offer suitable solutions for everyday conditions such as hay fever or conjunctivitis and refer patients to their GP for more serious conditions.”

OTC management 

Dry eyes can be managed through a range of OTC products, and all should be recommended based on the individual needs of the patient. “There are a range of artificial tears, gels, and ointments to help manage the symptoms of dry eye. A Pharmacist can recommend and advise on the best type for a patient’s individual needs,” Ms Drury said.

Patient use 

“Artificial tears, gels or ointments come in bottles, single vials or tubes,” Ms Drury said, advising the following steps will help patients to use these products:

1. Firstly – wash your hands to prevent the spread of germs.
2. Tilt your head back, look up and pull down your lower eyelid with your finger.
3. With the other hand, position the bottle over your open eye and squeeze out the correct number of drops or gel drops recommended by your Pharmacist or GP.
4. To avoid contamination, do not touch the tip of the bottle or let it touch your eye.
5. Close your eye and keep it closed for a little while.
6. Avoid rubbing your eyes.

Ms Drury says it is important to remind patients “that thicker gels or ointments may cause blurred vision for a short period of time”.

Additionally, some medications can contribute to dry eye symptoms. “If you think your medication may be causing dry eye symptoms, talk to your pharmacist or GP. Some prescribed medicines can contribute to dry eye e.g., antidepressants, oral contraceptives, and antihistamines. It is important that you do not stop taking any prescribed medicine without getting medical advice from your health professional first,” she said.

GPs and pharmacists are appropriate health professionals to manage mild dry eyes. However, for dry eyes that cause severe symptoms such as pain, it is important to refer the patient to an optometrist to investigate the condition further.³

References: 

1. Better Health. ‘Dry eye’.2021. <vic.gov.au/health/conditionsandtreatments/dry-eye#what-is-dry-eye>.
2. Health Direct. ‘Dry eye disease’. 2022. <gov.au/dry-eye-disease>.
3. Quan Findlay and Kate Reid. ‘Dry eye disease: when to treat and when to refer’. Australian Prescriber 41(5). <ncbi.nlm.nih.gov/pmc/articles/PMC6202299/>.

This feature was originally published in the October issue of Retail Pharmacy magazine. 

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According to Allied Health Professionals Australia, allied health is a new term without a universally accepted definition. However, core components of allied health do not belong to the medical, dental, or nursing practitioner but have a university degree or qualification that makes them specialised in various conditions and illnesses.¹

A person’s health is multifaceted and requires input from various health professionals. For those with chronic conditions such as diabetes, heart disease, osteoporosis, and COPD, many complications can arise that require input from multiple health professionals. A collaborative approach is necessary to ensure that patient health needs are met.

Professional Service Pharmacist Rebecca Miltiadou from Direct Chemist Outlet says building relationships with allied health is essential for patient care. “Engaging and building relationships with allied health professionals is significantly important.”

“Collaboration between a pharmacist and allied health professionals can significantly enhance patient care and health outcomes by allowing health care professionals to put together a care plan, optimise a patients’ medication and provide patient education,” Ms Miltiadou said.

Engaging with allied health
Ms Miltiadou says pharmacists can engage with allied health professionals in several ways – through medication reviews, care plan development, and sharing health records, pharmacists can play an active role in enhancing patient services.

Ms Miltiadou said: “Pharmacists can participate in medication reviews along with other healthcare professionals to ensure the patient’s treatment plans are aligned and address any potential medication-related issues.”

“Care plans can also be developed between a team of health care professionals which outline each professional’s contribution to that patient’s treatment and ongoing care.”

She added: “We can share documents and information through electronic health records such as My Health Record to ensure everyone is informed and can make informed decisions about the treatment for the patient.”

Pharmacists also play a significant role in education and awareness about the use of medications and how their medications help to manage their conditions. “We can also work together to provide education about their condition and medications, which includes lifestyle advice,” Ms Miltiadou said.

Ms Miltiadou shares why working with allied health was necessary for a patient with diabetes. Through collaborating with a podiatrist, Ms Miltiadou ensured the patient’s ailments were adequately managed, optimising care.

“I have collaborated closely with a podiatrist for one patient with diabetes and a history of foot ulcers. Working together ensured the patient got the most from their treatment, which involved wound care support, disease and medication management (including regular monitoring of BGC and medication adherence checks), and ensuring the patient had regular podiatrist check-ups.

“With regular contact with the patient’s doctor and assigning a diabetes educator, we were all able to develop a care plan to optimise the patient’s treatment and ensure they can manage their condition. A lot of the time when questioning patients, you find that diabetes medication management and compliance with podiatrist appointments are lacking.”

References:
Allied Health Professionals Australia. ‘What is allied health?’.2023. com.au/what-is-allied-health/

This article was first published in Retail Pharmacy October, Health Series: Integrated Care

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Iron: the mighty mineral 

Iron’s importance in red blood cell function includes its role in oxygen transportation in the blood and storage of oxygen in the muscle cells. Iron is a key component of enzymes found throughout the body and contributes to proper immune function.¹

For men aged 19 to 50 years, the daily recommended intake is 8mg a day, but for women, it’s 18mg a day. This increases to 27mg a day during pregnancy, when the baby’s iron stores also build up. For breastfed babies, 0-6 months, 0.2mg is recommended. For babies who are formula-fed, iron is absorbed less, and therefore formula (in Australia) is iron-fortified to ensure babies gain the recommended daily intake.¹

Iron is found in food sources and comes in two types: haem and non-haem. Haem iron is easily absorbed by the body, but for non-haem iron, this is more difficult to achieve. Non-haem iron is found in plant-based foods. Those following a plant-based diet need to consume up to 80 per cent more iron than those with meat in their diets, to reach the recommended daily intake.²

Haem iron sources include meat, poultry, seafood, and organ meats. Non-haem iron sources include nuts and seeds, dried fruit, wholemeal pasta and bread, legumes, dark leafy green vegetables, and tofu.²

Iron deficiency 

Developing when not enough iron is being consumed, iron deficiency often causes tiredness and headaches, and makes concentration difficult. It can also cause anaemia.

If a patient is worried about iron deficiency, they should speak with a doctor, who can prescribe iron supplements. These are also available OTC in tablet and liquid forms, but it’s important that iron deficiency isn’t self-diagnosed, as too much iron within the body can interfere with its absorption of other vitamins and minerals, and in some cases can be toxic to the body.²

Folate: the B vitamin for growth and development 

The body needs folate, the natural form of vitamin B9, to grow and develop. In food, folate occurs naturally. When in supplement form, it’s known as folic acid.

Folate is important to everyone, but especially pregnant women, because a lack of folate can cause abnormalities in the development of the brain and spinal cord in babies.

Folate is also important for making DNA, forming red blood cells, and growing and repairing cells and tissues.

Unless one is pregnant, folate can be obtained through diet. It’s added to many foods, such as cereals, bread, juices, and Vegemite. In Australia, flour manufacturers are required to add folic acid to wheat flour used in bread.³

Folate is also found in green vegetables, legumes, rice, avocado and fruit.

Folate deficiency is rare in Australia, but some people don’t get enough. Supplements are available OTC and through prescription.⁴ However, the dosage differs depending on the person, so talking to a GP about folate deficiency is recommended to ensure the correct dose is being administered.

Folate for a healthy pregnancy 

Folate is essential in the growth and development of the baby during pregnancy. It’s recommended that a folic acid supplement be taken one month before conception and for the first three months of pregnancy.⁵

Pregnant women are advised to look for supplements containing at least 400mcg of folic acid, and the American College of Obstetricians and Gynaecologists recommends that all pregnant women should get at least 600mcg of folic acid daily. Although pregnancy multivitamins contain folic acid, it’s important for optimal effectiveness that they contain a high enough dose of folic acid.⁴

References:

1. Better Health Channel. ‘Iron and Iron Deficiency’. 2022. vic.gov.au/health/conditionsandtreatments/iron#what-is-iron.
2. ‘Foods high in iron’. 2023. healthdirect.gov.au/foods-high-in-iron#contain.
3. NSW government. ‘Folate’. 2021. com.au/wp-content/uploads/2021/02/Good-Bite-No69-at-home_webOpt.pdf .
4. Australian government. Pregnancybirth&baby. ‘Folate and pregnancy’. 2021.org.au/folate-and-pregnancy.
5. Government of Western Australia. ‘Folate and pregnancy’. 2022. wa.gov.au/Articles/F_I/Folate-and-pregnancy.

This feature was originally published in the September issue of RP magazine. 

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Discussions about pharmacists using their specialised knowledge and training to practice to their full scope have dominated debate around community pharmacy’s future. However, the full scope of practice issue is not new and the objective has been contested throughout the healthcare profession for decades.

In Retail Pharmacy’s second-ever issue, in June 1991, an article titled ‘Leave the patient advice to us: doctors’ highlighted the tensions between GPs and pharmacists on patient advising. Pharmacists argued that they’d been advising for years, but the then national president of the Royal Australian College of General Practitioners, Dr Tony Buhagiar, countered: “Advising and counselling patients has nothing to do with the chemist. It’s none of their business. The chemist is there to dispense drugs.”

Present-day Australia’s healthcare system is facing significant accessibility issues, with GP wait times steadily increasing and almost 20 per cent of surveyed Australians reporting having waited for an unacceptably long time to get a GP appointment.¹ Accessibility issues are intensified in rural and regional Australia, where shortages in the health workforce are limiting access to care, despite the greater need for medical services within these areas.²

It is in this environment that full-scope practice for pharmacists is being extended, with pilot programs in Queensland, NSW and Victoria, in that order, aimed at burden sharing and alleviating health access issues. These trials make it clear that full scope is going ahead with or without GPs on board.

Yet as full-scope initiatives continue to roll out across the country, historical tensions between GPs and pharmacists have resurfaced in the modern healthcare environment.

For example, the Australian Medical Association urged the NSW government to abandon the state’s trial of appropriately trained pharmacists treating uncomplicated urinary tract infection (UTI), following a similar trial in Queensland that allowed pharmacists to prescribe antibiotics for UTIs.

“There are critical issues facing general practice, with years of underfunding pushing significant numbers of GPs to retire earlier, while fewer doctors are choosing general practice as a speciality,” AMA President Professor Steve Robson said in a media release.

“Governments need to come to the table with viable solutions to support general practice and build collaborative models of care – not changes that completely undervalue the quality of care that is provided through general practice, and fragment patient care.

“This dangerous [NSW] experiment signals a lack of respect for general practice and the years of training, experience and knowledge required to properly diagnose and treat a medical condition. If implemented in NSW, it will have dire consequences for the future of the workforce.”³

The Pharmacy Guild hit back, calling for the focus to shift to better patient outcomes, dismissing the AMA’s comments as “disappointing, yet not surprising”, and pointing out that pharmacists are qualified professionals, with UTI prescribing undertaken only when additional training is given.

“Appalling and downright degrading” was how Pharmacy Guild Queensland Branch President Chris Owen described the labelling by AMA Queensland (AMAQ) of pharmacists as untrained.

“The need to continually rebut AMAQ’s statements about community pharmacists’ education and training is tiring but necessary,” he said.

“Community pharmacists have undertaken a four-year accredited university degree, a one-year internship, and two registration exams, as well as maintaining annual professional development. Education and training for pharmacists to provide health services within the UTI Pharmacy Pilot – Queensland and North Queensland Pharmacy Pilot is in addition to the years of training and on-the-job clinical experience as a community pharmacist.

“Pharmacists taking part in the North Queensland Pharmacy Pilot are required to undergo further post-graduate level training over a 12-month period, which includes supervised practice hours and a structured clinical exam – not the few hours per week as concocted by AMAQ.”⁴

Despite scepticism from the medical community, strong consumer support for pharmacists practising to their full scope is apparent in Australia today. A survey conducted in December 2022 by the Consumers Health Forum showed that consumers interviewed as part of ‘Australia’s Health Panel’ were largely in favour of pharmacists being given some prescribing powers, especially within the area of repeat prescriptions.⁵

Community pharmacy is not only a trusted source of advice but also a health services provider, and it’s clear that pharmacists’ scope of practice will be expanded.

As the debate continues and its complexities emerge, all healthcare professionals should be prioritising high standards of consumer care with patients at the centre. Shifting to a focus on collaborative care in which health professionals are working together, and not apart, should be paramount.

References 

1. Australian Institute of Health and Welfare. ‘Patient experiences in Australia by small geographic areas in 2019–20’. 2021. aihw.gov.au/reports/primary-health-care/patient-experiences-small-geographic-areas-2018-19/contents/about.
2. Australian Institute of Health and Welfare. ‘Rural and remote health’. 2022. aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health.
3. Australian Medical Association. ‘Pharmacist prescribing a dangerous proposition which won’t fix workforce issue’. 2022. ama.com.au/media/pharmacist-prescribing-dangerous-proposition-which-wont-fix-workforce-issue.
4. Pharmacy Guild of Australia. ‘Sadly, more lies from AMAQ’. 2022. guild.org.au/news-events/news/qld/sadly,-more-lies-from-amaq.
5. Consumers Health Forum of Australia. ‘What Australia’s Health Panel said about pharmacy prescribing- December 2022’. 2023. chf.org.au/ahp-pharmacy-prescription.

This feature was originally published in the June issue of Retail Pharmacy magazine. 

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Studies suggest that the gut plays an important role in metabolic function, protection against pathogens, and immune function.¹ Due to this, nurturing the gut can produce positive effects on overall health and well-being. According to Accredited Practising Dietitian and nutritionist Annaleise Collier, “gut health plays a key role in supporting our immune system”.

“Our gut microbiome – the trillions of bacteria residing in our gut – and our immune system work together to create our body’s first line of defence against potential invaders, such as harmful bacteria and/or pathogens,” she said.

“Interestingly,” she added, “approximately 70 per cent of our immune cells live in our digestive tract and help shape the composition of bacteria in our gut.

“Our gut bacteria communicate with our immune cells, ‘training’ them to differentiate between what’s a dangerous invader, such as a virus, and what are healthy and/or friendly substances, such as our cells and tissues.

“This ‘training’ also helps to regulate our immune system’s responses so that it doesn’t overreact – that is, it doesn’t go into defence mode against substances such as new food or dust. If our immune system overreacts, in extreme cases this can result in autoimmune conditions and/or allergies.

“In summary, a healthier gut means a more robust immune system capable of warding off unwanted pathogens and/or invaders.”

Food for thought 

The types of food we consume can have positive benefits on the gut microbiome and therefore support in optimising immune function. Ms Collier suggests that adding pulses, and fermented food to the diet can be beneficial, as well as experimenting with herbs and spices to add flavour.

“Aim to choose as many whole and natural foods as possible, limiting how often you have ultra-processed and pre-made or packaged foods,” she advised.

“Incorporate pulses – beans and legumes – into your meals. This will provide all-important fibre and prebiotics for your gut bacteria.”

“Add fermented foods such as natural yoghurt, kimchi, kefir, miso, tempeh and sauerkraut that contain probiotics – living bacteria – which can help to create a healthier balance of microbes living within your gut.

“Add flavour to your food by experimenting with herbs and spices. These contain beneficial compounds for your gut bacteria.”

Polyphenols and limiting sweeteners 

Polyphenols are natural compounds found in plants, including in many foods. The gut’s microbiome breaks down these compounds.² Ms Collier advises that to optimise gut health, “food and drinks with high levels of polyphenols” should be chosen.

“Polyphenols are antioxidants that act as fuel for microbes,” she said. “Food sources include nuts, seeds, berries, olive oil, dark chocolate, coffee and tea.”

She adds that limiting the intake of artificial sweeteners such as aspartame, sucralose and saccharin may also be beneficial.

“These sweeteners can disrupt the metabolism of microbes and reduce gut diversity,” she said. “In animal studies, this has led to obesity and diabetes.”

Probiotics 

Research indicates that probiotics enhance innate immunity and assist to modulate pathogen-induced inflammation.³ However, it’s important to note that larger studies and more research are needed to determine which strains of probiotics work best, the correct dosage amounts, and who would benefit most from taking probiotics.

“Probiotics contain live organisms, usually specific strains of bacteria, that positively affect your health,” Ms Collier said.

“There’s currently a large amount of research investigating the role of probiotics in improving gut health. There’ve been positive outcomes from small-scale studies. However, further research is warranted to determine how probiotics improve gut health, as there’s a limited understanding of the specific type and dosage required to elicit benefits. Some gastrointestinal conditions that may be improved by increasing probiotics in your body include diarrhoea – specifically caused by antibiotics or C. difficile infection), constipation, IBS and IBD.”

Ms Collier says that if people want to introduce probiotics into their diet, gradually increasing their intake of probiotic-rich foods is a good place to start.

“You can do this through food sources or supplements,” she said. “I’d recommend starting with probiotic-rich food such as sauerkraut, kimchi, kefir, or Greek yoghurt, and paying attention to any side effects, both positive and negative.”

She advises that those considering a probiotic supplement should talk to their healthcare provider before starting to take such a supplement, “particularly people with an increased risk of infection, such as those with a weakened immune system, young infants, [and those who’ve had] recent surgery or [are] critically unwell”.

Tips for optimising gut health

Ms Collier suggests the following gut health tips:

• Eat a diverse range of plant-based food and aim to have many different colours and types of fruits, vegetables, whole grain bread and cereals and legumes/lentils – aim for 30g a day.
• Increase your dietary fibre intake. For the most part, Australians are consistently below the recommended level of 30g per day with their fibre intake. This can be increased by eating whole fruits, vegetables, nuts and seeds, wholegrain bread, and cereals and pulses. “Your gut bugs love to eat fibre!”
• Keep stress levels down by exercising regularly, practising mindfulness and getting enough sleep.
• Try adding fermented foods to your diet.
• Don’t believe all the hype and/or fads you see in the media. Take time to do proper research or, if you’re in doubt, see a trusted health professional such as your GP or dietitian.

References 

1. Andrew B Shreiner et al. ‘The gut microbiome in health and in disease’. 2015. nlm.nih.gov/pmc/articles/PMC4290017/pdf/nihms-649791.pdf.
2. Cardona F. ‘Benefits of polyphenols on gut microbiota and implications in human health’. 2013. com/science/article/pii/S0955286313000946.

Yan F, Polk DB. ‘Probiotics and immune health’. 2014 ncbi.nlm.nih.gov/pmc/articles/PMC4006993/#:~:text=Probiotics%20have%20been%20found%20to,regulated%20signaling%20pathways%20%5B1%5D

This feature was originally published in the May issue of Retail Pharmacy magazine. 

The post Putting trust in your gut appeared first on Retail Pharmacy.

In 2022, the World Health Organisation published its first fungal priority pathogens list, which recognised that fungal infections are a growing risk to public health. Of concern is the emergence of pathogens that are resistant to antifungal medications.

“Invasive fungal diseases are rising overall and particularly among immunocompromised populations,” the WHO said.¹

“The diagnosis and treatment of invasive fungal diseases are challenged by limited access to quality diagnostics and treatment, as well as the emergence of antifungal resistance in many settings.

“Despite the growing concern, fungal infections receive very little attention and resources, leading to a paucity of quality data on fungal disease distribution and antifungal resistance patterns. Consequently, it’s impossible to estimate their exact burden.” ¹

Researchers are emphasising that fungi and the infections they cause are under-researched and should be an area of priority over the coming years.

“Fungi are the ‘forgotten’ infectious disease,” said Dr Justin Beardsley, from the University of Sydney’s Infectious Disease Institute, a contributor to the study group for the WHO fungal list.² “They cause devastating illnesses but have been neglected so long that we barely understand the size of the problem.

“For this project, our team of 30 researchers from across Australia and New Zealand screened over 6000 papers and recruited more than 400 international mycology experts. It was a comprehensive effort to describe current knowledge, understand what drives priorities, and allow the WHO to set an objective research agenda.”²

Fungi can grow in different kinds of environments and cause infection. When we think of fungal infections, usually unpleasant things come to mind: peeling skin, pus, and broken nails, for example. However, fungal infections can affect us all, and antifungal drugs can help by targeting structures in fungal cells to fight the infection.

Community pharmacy is a leader in treating and caring for minor fungal infections in Australia, as antifungal medications are readily available.

Common fungal infections 

Fungal infections typically affect the hair, skin and nails. Common infections caused by fungus are:

• Athlete’s foot.
• Jock itch.
• Ringworm.
• Onychomycosis, or fungal infection of the nail.
• Thrush.

Other types of fungal infections can affect the respiratory system and pose a significant risk to people with weakened immunity and asthma.

Greater risk for the immunocompromised  

Immunocompromised people such as those living with diabetes, HIV and cancer are at a greater risk of developing a fungal infection because such infections are opportunistic, meaning they will target weakened immune systems, which makes it easier for fungi to invade the body. Therefore, where customers have compromised immune systems, it’s important to look for signs of fungal infections, and if these are found, to refer them to a GP.

Types of antifungal medication 

Four classes of antifungal medications are used in clinical practice: azoles, echinocandins, pyrimidines and polyenes. These can be applied both topically and orally. Topical application is usually given only for minor fungal infections and has varying success rates, while more serious infections and those that fail to respond to topical application warrant oral medications.

Candida 

Candida is a type of fungus that naturally occurs within the body, especially in warm and moist areas. However, when in excess, it can cause fungal infections. Most commonly, Candida is responsible for thrush or yeast infection occurring when an overgrowth of Candida occurs within the body.

Thrush can affect the penis, groin, vagina and mouth.^{3<superscript>} Vaginal thrush causes itching and burning of the vagina or vulva, white vaginal discharge, pain during sex, swelling of the vagina and vulva, stinging when urinating, and splits in the skin of the vulva.

According to Jean Hailes, around 75 per cent of women will experience thrush once in their lifetime. It’s important to note that thrush is not an STI, although sexual activity can make symptoms worse.

Women will often go to the pharmacy as the first port of call for over-the-counter antifungals, usually via a cream or vaginal pessary. But if this treatment doesn’t work, it’s important to see a GP for a vaginal swab. People are at greater risk of developing vaginal thrush if they’ve recently taken antibiotics, are using a higher dose of the combined oral contraceptive pill, are pregnant, or have vulval skin conditions.^{4<superscript>}

Tinea  

Tinea is a fungal infection found in warm and moist parts of the body and is responsible for athlete’s foot, jock itch, onychomycosis and ringworm.⁵ Tinea is common among athletes and those who regularly share communal change rooms. Symptoms of tinea include a red, flaky rash that can crack, split and peel, as well as cause blistering and itching.

Tinea is contagious, so if it’s been diagnosed, it’s important to remind customers to not share towels, bathmats, flannels or footwear.²

Tinea is usually treated through creams, ointment, gel or nail lacquer, all available OTC from any pharmacy. Tinea can take weeks or even months to clear up, depending on the fungus type. Patients should keep using the antifungal medication as instructed, even if the tinea appears to have resolved. In treating tinea, the area must be kept clean and dry, as the infection prefers moist environments.

Athletes foot 

Athlete’s foot refers to when tinea affects the skin of the feet and can spread to the toenails and the hands. This is a minor fungal infection spread by contact with the fungus tinea, which can be found on surfaces such as those in showers, locker room floors, swimming pools, or through contact with a person with the fungal infection. For people with diabetes or those immunocompromised, a GP must be consulted.⁶

Athlete’s foot thrives in damp, moist and warm environments, so keeping the skin clean and changing footwear and socks are advisable for preventing contraction.

Athlete’s foot can be treated with topical over-the-counter antifungals. If these aren’t successful, a GP can prescribe oral antifungals.

Jock itch 

Jock itch is also caused by the fungus tinea and affects moist areas of the groin. It’s typically called jock itch because it usually affects people who sweat frequently, such as athletes. Jock itch causes an itchy and painful rash.⁷

Onycholysis

Onycholysis is a common disorder that occurs when tinea affects the nails. In some cases, the nails can become thickened with yellow, white or brown streaks. If the infection worsens, the nail can separate from the nail bed. If left untreated, onycholysis can deform the nail or destroy it. While onycholysis can be treated with topical medications, this can have varied success, with oral antifungals needed in most cases. The most common antifungal used for onycholysis is terbinafine, used for three to six months. When diagnosed and treated early, onycholysis usually resolves following antifungal dissemination.⁸

Ringworm 

Ringworm of the body (tinea corporis) and ringworm of the scalp (tinea capitis) is also caused by the fungus tinea.

Tinea corporis appears as an itchy red circular rash and develops on the top layer of skin. It’s contagious and can be spread through contact with people and animals. Antifungals are used to treat mild ringworm, usually through a cream. However, if the infection doesn’t clear within a week, it’s best to advise patients to see a GP.⁹

Tine capitis is the most common fungal infection affecting children, but can also affect adults. It can present in a variety of ways, such as an itchy and dry scalp with areas of hair loss, black dots in areas of hair loss, and yellow crust throughout the scalp. A severe infection can cause fever and swollen lymph glands.¹⁰

Tinea capitis is diagnosed by a doctor and involves taking a scalp scraping to confirm. When not detected early enough, it can cause permanent hair loss as well as scarring.¹⁰

Prevention 

Fungal infections are treatable and preventable. According to Healthline, maintaining good hygiene is key to avoiding fungal infections.

Fungal infections can be avoided by:

• Keeping skin clean and dry, particularly the folds of the skin.
• Washing hands often, especially after touching animals or other people.
• Avoiding using other people’s towels and other personal care products.
• Wearing shoes in locker rooms, community showers, and swimming pools.
• Wiping gym equipment before and after use.¹¹

References 

1. World Health Organisation. ‘WHO fungal priority pathogens list to guide research, development and public health action’. 2022. int/publications/i/item/9789240060241.
2. University of Sydney. ‘First WHO ‘watch list’ of health-threatening fungi released’. 2022. edu.au/news-opinion/news/2022/10/26/first-who-watch-list-of-health-threatening-fungi-released.html.
3. Health Direct. ‘Thrush’. 2021. gov.au/thrush.
4. Jean Hailes. ‘Thrush’. 2022. org.au/health-a-z/vulva-vagina-ovaries-uterus/vulval-vaginal-conditions/thrush.
5. Health Direct. ‘Tinea’. 2021. gov.au/tinea.
6. ‘Athletes foot’. 2019. healthline.com/health/athletes-foot#treatment.
7. Australasian College of Dermatologists. ‘Tinea onychomycosis’. 2019. edu.au/atoz/tinea-onychomycosis/
8. Health Direct. ‘Ringworm of the body’. 2017. gov.au/ringworm.
9. Raising Children Network. ‘Ringworm or tinea’. 2021. net.au/guides/a-z-health-reference/ringworm.
10. Australasian College of Dermatologists. ‘Tinea capitis’. 2015. edu.au/atoz/tinea-capitis/
11. ‘Everything you need to know about fungal infection’. 2019. healthline.com/health/fungal-infection#prevention

This feature was originally published in the April issue of Retail Pharmacy magazine. 

The post When fungus infects appeared first on Retail Pharmacy.

With the colder months approaching, people with dry skin will increasingly present within our community pharmacies. Whether they’re hoping to add something new to a tried and tested skincare regime or just looking for one product that can help reduce dryness, pharmacies are often the first place customers look to for advice in this space.

Dry skin is a common problem for many Australians, especially the elderly, and can be triggered by a number of factors, both environmental and genetic. By providing a good moisturiser and recommending customers avoid irritants, pharmacists can help in the effective management of dry skin.

What is dry skin? 

Dry skin, or xerosis, refers to when the outer layer of skin becomes dehydrated, meaning small splits or cracks form, resulting in flaking or scales.¹ Dry skin is a recurring condition that usually appears in winter, due to low humidity levels, which leaves the skin deprived of moisture.

Studies suggest that low humidity can cause scaling in healthy normal skin and exacerbates existing skin dryness.² Skin dryness is also common in skin conditions such as psoriasis and eczema.

Dry skin is more common in older people, for whom the condition increases the risk of developing pruritus (itchy skin), which leads to lesions and skin infections. The occurrence of dry skin in older patients is multifactorial but can be linked to the use of diuretics and similar medications, humidity, overuse of heaters and air conditioners, as well as exposure to skin sensitisers.³

“There are multiple factors that may contribute to dry skin,” Associate Professor Deshan Sebaratnam, Dermatologist at Liverpool Hospital in Sydney, said. “This may be genetic, for example, variants of the gene coding for filaggrin contribute to dry skin, or environmental, for example, ambient low humidity [or] the use of soaps that strip the skin of natural oils. Rarely, some dermatological conditions can also cause significant dryness of the skin.”

Aggravators  

For those with dry skin, a number of factors can aggravate the condition. Associate Professor Sebaratnam says these include low humidity and wind, irritating clothing such as woollens, and soaps and detergents.

Some active ingredients can also cause dry skin to worsen, including:⁴

• Chemical peels.
• Retinoids.
• Glycolic acid.
• Salicylic acid.
• Benzoyl peroxide.
• Fragrance.

“If your skin is dry or chapped, it may be more prone to inflammation with exposure to ‘actives’,” Associate Professor Sebaratnam said.

Putting moisture in motion 

Moisturisers work by rehydrating the top layer of skin and sealing in moisture. Common ingredients within skin moisturisers are humectants, which help to attract moisture, those that help to seal in the moisture, such as petroleum jelly, and emollients, which fill in the space between skin cells, which has a smoothing effect.⁵

Associate Professor Sebaratnam recommends regularly applying a moisturiser to add moisture back into the skin.

“The best thing to do is use a regular moisturiser – ideally, one that’s bland, greasy and free of food products and unnecessary fragrances or preservatives,” he said.

“Examples include Vaseline, or products from QV, Cerave or Dermeze. Soap-free products can also help – for example Cetaphil – over normal soaps or handwashes.”

References 

1. Australasian College of Dermatologists. ‘Xerosis’. 2017. edu.au/atoz/xerosis/
2. Goad N, Gawkrodger DJ. ‘Ambient humidity and the skin: the impact of air humidity in healthy and diseased states’. 2016. ncbi.nlm.nih.gov/27306376/.
3. Foy White-Chu E, Reddy M. ‘Dry skin in the elderly: Complexities of the common problem’. 2011. com/science/article/abs/pii/S0738081X10001203?via%3Dihub.
4. ‘The ultimate skin care routine for dry skin’. 2022. healthline.com/health/beauty-skin-care/skin-care-routine-for-dry-skin#things-to-avoid.
5. Harvard Health. ‘What to do about dry skin in winter’. 2011. harvard.edu/womens-health/what-to-do-about-dry-skin-in-winter.

This feature was originally published in the April issue of Retail Pharmacy magazine. 

The post The cold facts of dry skin season appeared first on Retail Pharmacy.

However, when multiple medications are involved, the risks of adverse effects from medication interactions are heightened, meaning potential medicine-related harm can occur. This is why clear communication and medication review are important, especially in the population groups more likely to take multiple medications, such as the elderly.

When patients are given multiple medications, problems arise with adherence, sub-optimal prescribing, and medication interactions. The more medications a person takes, the more difficult it can be to obtain a medical history, and the greater the risk of adverse drug reactions.

When a person is taking five or more medications simultaneously, this is called polypharmacy, which is a significant barrier to medication adherence, due to the complexity of medication regimes and the increased risk of medication errors. ¹

The polypharmacy problem

Polypharmacy is common in older people as they often experience multiple chronic illnesses. According to the Australian Commission on Safety and Quality In Healthcare, two-thirds of those aged over 75 take five or more medications. Additionally, the commission provides that 49 per cent of people with polypharmacy had seven or more, and 11 per cent had 11 or more medications dispensed in 2018/19.² Another issue presents when more medicines are prescribed to treat symptoms that are caused by adverse effects of drugs. This is known as the prescribing cascade.¹ 

The most recent review of Australians aged over 70 taking five or more medications – the University of Western Australia (UWA) study in collaboration with UNSW Sydney in 2019, published in the <itals>Medical Journal of Australia<itals> – found a 53 per cent increase from 2006 to 2019 in the number of people taking five or more medicines.

“The medicines we looked at don’t include medicines purchased without a prescription, such as vitamins, minerals, herbal supplements or medicines not listed on the Pharmaceutical Benefits Scheme, meaning that the estimates in the paper may be conservative,” said lead researcher Dr Amy Page, from UWA’s Centre for Optimisation of Medicines.

“The rates in comparable years are also much higher in Australia than in the US or the UK.

“There have been many awareness-raising activities recently about the risks of taking multiple medicines, and there’s evidence of poor health outcomes in older people. However, the number of older people taking multiple medicines has increased.

“Strategies to increase people’s understanding of the potential risks involved in taking multiple medications are needed to target health professionals and the public.

“Taking multiple medications may be necessary, but it needs to be carefully assessed by a medical professional and balanced against the potential risks.”³

Risks

Certain combinations of medicines present a greater risk than others, including, according to NPS MedicineWise:

• When taking medications that affect the brain and nervous system, people are more prone to confusion, drowsiness, and memory problems. This can lead to falls and accidents.
• Older people are more susceptible to dizziness, light-headedness and confusion. In addition, some medications can cause these effects, such as those for blood pressure, and those for pain relief that contain opioids and drugs for psychotic conditions.
• Some medicines can interact with each other and affect existing medical conditions. For example, NSAIDs taken to relieve pain can worsen high blood pressure and kidney function.⁴

Managing the effects of polypharmacy 

Consumers can take control of their medications by implementing medication organisers and keeping a medicines list. Those taking proactive steps and working with their healthcare providers can more effectively manage their medications and mitigate the risks associated with polypharmacy.

Additionally, a home medicines review can be requested from a patient’s GP if the doctor believes the patient will benefit from such a review and an accredited pharmacist checks the medication the patient is taking at home, including any supplements. The pharmacist will check that the medicines are working correctly.⁵ If needed, two follow-up services can be offered to resolve medication-related problems.⁶

Pharmacists help to manage polypharmacy by asking follow-up questions when prescribing, and ensuring clear communication is given regarding medicines, and further, by encouraging the patient to involve a single prescriber and single pharmacist in managing their medication intake. Additionally, raising awareness regarding the harms associated with taking multiple medications means consumers can make informed decisions.²

Another method of managing the effects of polypharmacy is deprescribing, which refers to discontinuing drugs that may be harmful or no longer required. In older people, this has been linked to improved health outcomes. The process should be collaborative between the patient, doctor and pharmacist. Further, it should be carefully monitored, and the dose should be gradually tapered. Pharmacists can assist in the deprescribing process by helping to identify targets for deprescribing and planning the tapering of doses.⁷

The power of pharmacy-led interventions

Research from the University of South Australia indicates that regular visits to pharmacists for people in aged care can reduce problems with medication and improve health outcomes. The study involved 248 aged-care residents across 39 facilities in South Australia and Tasmania. Pharmacists met with the residents every eight weeks. The results showed that 60 per cent of residents had problems with their medication at each visit, and 309 recommendations were made to change residents’ medication. The study also showed that cognitive scores changed, with those residents monitored by pharmacists less likely to experience negative effects.⁸

“Medicines are the most prescribed health intervention for older people, yet they’re also the catalyst for concern for many aged-care residents,” lead researcher Professor Libby Roughead said in a 2022 media release.

“People living in aged-care homes rely on the support and care they receive, yet previously, residents have only received a medication review every two years, or earlier if required.”

“Our research highlights the need for personalised and continuing support by pharmacists more frequently.”

“It’s important to realise that the new on-site pharmacists will not only need to monitor and review medications but also be able to recognise the early onset of medicine-induced deterioration, such as changes in a person’s cognition or activity, to prevent harms such as injurious falls or delirium.

“More comprehensive support will not only avoid the many medicine-induced health issues currently experienced by aged-care residents but may also help in preventing frailty and declining cognition.”⁹

In March last year, before the election of an ALP-led government, the Coalition administration announced funding for on-site pharmacists to improve medication management in government-funded aged-care facilities, to begin in January 2023, after medication management was highlighted as a critical area of concern in the Royal Commission into Aged Care Quality and Safety.¹⁰

References 

1. NPS MedicineWise. ‘The dilemma of polypharmacy’. 2008. org.au/australian-prescriber/articles/the-dilemma-of-polypharmacy#r1
2. Australian Commission on Safety and Quality in Healthcare. ‘Polypharmacy, 75 years and over’. 2021 gov.au/our-work/healthcare-variation/fourth-atlas-2021/medicines-use-older-people/61-polypharmacy-75-years-and-over#:~:text=Polypharmacy%20is%20when%20people%20are,Atlas%20of%20Healthcare%20Variation%202021
3. University of Western Australia. ‘Older Australians taking multiple medicines may be putting health at risk’. 2019. <uwa.edu.au/archive/2019071511498/research/older-australians-taking-multiple-medicines-may-be-putting-their-health-risk/>
4. NPS MedicineWise. ‘Managing your medicines’. 2019. org.au/consumers/managing-your-medicines#risks-of-taking-multiple-medicines
5. ‘Home medicines review’. 2022. healthdirect.gov.au/home-medicines-review
6. Pharmacy Programs Administrator. ‘Home Medicines Review’. 2022. com.au/programs/medication-management-programs/home-medicines-review
7. NPS MedicineWise. ‘Deprescribing in older people’. 2020. org.au/australian-prescriber/articles/deprescribing-in-older-people#tools-to-support-deprescribing-decisions
8. Roughead E et al. ‘Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial)’. 2022. ncbi.nlm.nih.gov/35460410/
9. University of South Australia. ‘In-house pharmacists essential for aged care’. 2022. edu.au/media-centre/Releases/2022/in-house-pharmacists-essential-for-aged-care/
10. Greg Hunt MP. ‘On-site pharmacists to improve medication management in RACFs’. 2022. health.gov.au/ministers/the-hon-greg-hunt-mp/media/on-site-pharmacists-to-improve-medication-management-in-racfs

This feature was originally published in the March issue of Retail Pharmacy magazine. 

The post Managing multiple medications appeared first on Retail Pharmacy.