Advice on common questions being asked during the Covid-19 pandemic

Pharmacist and Primary Care Respiratory Society (PCRS) executive committee member Darush Attar-Zadeh gives advice for asthma-related pharmacy queries during the coronavirus pandemic.

Q. Could a patient’s hayfever (allergic rhinitis) or smokers nicotine withdrawal symptoms be mistaken for Covid-19?

Fever is a common symptom in Covid-19, but not in hayfever or nicotine withdrawal in a smoker who has recently stopped. However, a dry cough and loss of smell and taste (anosmia) can be seen in Covid-19 and hayfever. A cough and sore throat can be seen when a person initially stops smoking.

It is important that pharmacy staff protect themselves and patients from suspected Covid-19 symptoms. Advise patients to stay at home and arrange alternative means of receiving treatments to treat fever, cough, sore throat in particular.

Asthma UK's symptom checker is helpful for pharmacy staff and patients to distinguish between Covid-19 and other illnesses (note anosmia is missing from the table).

Q. Are non-smoking customers buying Nicotine Replacement Therapy (NRT) as they think it can help protect against Covid-19 symptoms?

The French government recently banned online sales of over the counter NRTs and restricted shop sales to pharmacies where maximum one month could be supplied to existing users only after research suggesting that smokers maybe less at risk of developing Covid-19.

However, so far, there is currently no evidence from UK Covid-19 hospital admission data to suggest tobacco smoking (which contains nicotine) in having a protective effect against Covid-19 symptoms. The UK prevalence of smoking was around 7.9% in the over 65’s from the 2018 data which isn’t dissimilar hospital admission data in the UK study. It is important to be open minded to examples of further research on this.

Advice for pharmacy staff:

NRT must not be sold to never smokers who want to use it for personal consumption. A never smoker will experience side effects, e.g. nausea and light headedness, and may develop dependence as nicotine is addictive. Panic buying and stockpiling will take away from people who genuinely want to stop smoking or stay stopped.

NRT should be used with caution by some patients with multi-morbidities – see SPC for individual NRT products - and should not be used by anyone under the age of 12.

Advice for smokers:

Compared to other components of tobacco (of which there are over 4,000), nicotine is relatively harmless and there is no better time to stop smoking, using NRT treatments with NHS support.

Amazingly, around 300,000 smokers have already quit smoking due to growing concerns around Covid-19. Smoking damages the lungs and weakens the immune system. This makes it more likely that smokers will get complications and take longer to recover from illnesses. Overall, smokers are five times as likely to get influenza and twice as likely to get pneumonia than non-smokers

The Quit for Covid campaign (#QuitForCovid) gives further advice.

For clinicians:

Smoking by those with asthma is associated with more rapid decline in lung function and worse symptoms. According to the National Review of Asthma Deaths (NRAD), smoking was identified as a modifiable factor in 19% of asthma deaths.

Useful resources include:

Become a QUIT Catalyst

National Review of Asthma Deaths (NRAD) report

North Region Respiratory Programme Delivery pack

The What’s in a cigarette? resource

Q. Should all people with asthma be issued with rescue packs?

At the present time, there is no evidence to suggest that either antibiotics or corticosteroids are useful or appropriate in the early stages of Covid-19 infection. Their use may delay patients seeking advice if they become increasingly short of breath.

People with exacerbation action plans developed through shared decision making that include the use of rescue packs should ensure they have adequate supplies to follow the agreed plan.

Rescue packs should not be put on repeat prescription. Every attack needs a review to understand why before adjusting any treatment plan.

PCRS offers further information on this.

About the Primary Care Respiratory Society (PCRS)

For other frequently asked questions, visit the PCRS pragmatic guidance.

About PCRS and why pharmacists with a respiratory interest should join:

PCRS offers a wealth of clinical and every day practical support and information for its respiratory interested members. What’s unique is that you are part of a very close-knit respiratory community which includes pharmacy, nurse, GP, physiotherapy and patient representative experts. The PCRS scientific journal, npj Primary Care Respiratory Medicine, annual PCRS Respiratory Conference, membership magazine, the Primary Care Respiratory Update and the Fit to Care documents have helped shape my respiratory career in CCG, primary care and community pharmacy. I’m proud to say there are now approximately 100 pharmacy colleagues who are current members, including a few pharmacy technicians.