Hay fever in practice. Case 2
A woman in her early thirties wants some advice. She tells you that she has hay fever and a blocked nose and is finding it difficult to breathe. You find out that she has had the symptoms for a few days; they have gradually got worse. She gets hay fever every summer and it is usually controlled by chlorphenamine tablets, which she buys every year and which she is taking at the moment. As a child, she suffered quite badly from eczema and is still troubled by it occasionally. She tells you that she has been a little wheezy for the past day or so, but she does not have a cough, and has not coughed up any sputum. She is not taking any other medicines.
The pharmacist’s view
This woman has a previous history of hay fever, which has, until now, been dealt adequately with chlorphenamine tablets. Her symptoms have worsened over a period of a few days and she is now wheezing. It seems unlikely that she has a chest infection, which could have been a possible cause of the symptoms. She should be referred to the doctor at once since her symptoms suggest more serious implications such as asthma.
The doctor’s view
This woman should be referred to her doctor directly. She almost certainly has seasonal asthma. In addition to the hay fever treatment recommended by her pharmacist, it is likely that she would benefit from a steroid inhaler such as beclometasone. Depending on the severity of her symptoms, she would probably be prescribed a beta-agonist, such as a salbutamol inhaler, as well. This consultation is a complex one for a doctor to manage in the usual 10 min available in view of the time required for information-giving, explanation about the nature of the problem, the rationale for the treatments and the technique of using inhalers.
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