Asthma and October Fun
The excitement about pumpkin patches, corn mazes, haunted houses, and Halloween are upon us.
Pumpkin patches and corn mazes are notorious for having mold spores and dust mites. Experts suggest buying pumpkins from a local store instead of taking a chance with worsening asthma symptoms.
Haunted Houses
While some people enjoy the thrill of haunted houses, people with asthma need to be aware that emotions, such as fear, can trigger symptoms or an attack. Haunted houses may have smoke machines too, which can induce an asthma attack. Therefore, if you plan on attending a haunted house be sure to bring your rescue inhalers along.
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Halloween Costumes
Halloween is a fun time for kids to dress up in costumes and go door-to-door in search of candy or sweets. But costumes, particularly masks that have been in storage for a year, may contain dust, nickel, or even latex that could trigger an asthma attack. It is best to read labels on Halloween costumes, wash stored costumes in hot water before using, and avoid masks if these allergens are a trigger for you or your child.
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Pharmacist Actions
Remind children and their caregiver to bring their rescue inhaler trick-or-treating or when attending events which may trigger an asthma exacerbation. If they don’t have a rescue inhaler, suggest they refill it to have on hand. Many children have food allergies that require an epinephrine pen. Remind them to carry it in case they eat or are exposed to something they are allergic to during Halloween.
Shelby Brooks, PharmD Candidate, Kyle Van Eimerem, PharmD Candidate, Rachael Zins, PharmD, AE-C
Diabetes and Statins
SAMS (Statin Associate Muscle Symptoms)
Statin non-adherence or discontinuation is often due to SAMS, muscle aches and pains (myalgia), either real or perceived, that occurs in 5-25% of statin users. Assessing whether myalgia is due to the statin can be made easier if, before starting therapy, the patient is questioned about their present conditions such as arthritis and existing muscle soreness. The SAMS-CI is a list of questions that can be used to assess a patient’s likelihood of statin intolerance.
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The SAMSON trial was a small study designed to look at the muscle pain complaints of people taking statins and concluded that 90% of the statin side effect burden was also reported by the placebo group. This encourages the practitioner to further pursue statin therapy for those at-risk patients who have experienced intolerance. |
Myalgia is more likely due to the statin if:
- Symptoms begin within weeks to months after statin initiation in the absence of other findings
- There is bilateral and proximal muscle involvement
- Symptoms resolve after discontinuing statin
Factors increasing potential for statin intolerance:
- Drug interactions that increase statin exposure can raise the risk of statin related adverse effects. Statins have different pharmacokinetic properties that can influence choice based on the potential for a drug interaction.
- Predisposing factors:
- Low vitamin D
- Hypothyroidism
- Low BMI
- Female gender
- > 75 years of age
Accepted options for statin-intolerant patients:
- Discontinue and reintroduce after a two-week washout
- Try a different statin
- Reduce the daily dose
- Use a long half-life statin (e.g., rosuvastatin or atorvastatin) 2-3 times weekly
Pharmacist Actions
Use of statin therapy in people with diabetes is a CMS quality measure that affects star ratings for health plans and providers. The quality measure is recognized by MTM intermediaries such as Outcomes MTM, and pharmacies are paid to facilitate obtaining and dispensing a statin prescription for patients with diabetes. Therefore, there is an opportunity to get paid for doing good work for the patient. Additionally, having a good understanding of the reasons for statin intolerance and/or hesitancy allows the pharmacist to take appropriate action to reduce risk of cardiovascular events in people with diabetes.
James Bennett BsPharm, CDCES, BCGP
Diabetes References:
ACC/AHA 2018 Guideline on Management of Blood Cholesterol
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2021
Cholesterol Lowering Drugs, K. Feingold MD ncbi.nim.nih.gov
Centers for Disease Control Diabetes Statistics 2020
TRC Healthcare: Pharmacists Letter accessed online 9-14-2021
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