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Pharmacy teams will know only too well what a challenging season winter can be: no sooner does the temperature drop than numerous illnesses start to soar. While many minor ailments such as coughs, colds and sore throats can usually be treated at home, the chilly weather can also have more serious consequences, increasing the risk of heart attack, stroke and pneumonia, to name just a few conditions.
In fact, according to the latest winter mortality figures from the Office for National Statistics (ONS) “an estimated 13,400 more deaths occurred in the winter period (December 2021 to March 2022) compared with the average of the non-winter periods” (the preceding August to November and following April to July). And if that seems shockingly high, most years the seasonal difference is even greater – these new figures are the second-lowest since the early 1950s.
With the colder months piling extra pressure on patients and health services alike, there are many ways in which pharmacy teams can help. “Pharmacies usually have a wide range of cold and flu remedies in stock, and staff will be able to help people choose what’s right for them, and make sure that any products don’t interact with prescribed medication,” says Chloe MacArthur, senior cardiac nurse at the British Heart Foundation (BHF). “They can also let people know if seeing their GP would be better in their case.”
Matters of the heart
Cold weather increases the risk of heart and circulation problems. “When you are cold, blood vessels tighten in your skin, fingers and toes, so that less heat gets lost,” explains Chloe. “Tightening also puts pressure on your heart to work harder and can increase our heart rate and blood pressure.” While this response is natural, the extra strain can trigger symptoms in patients with a pre-existing heart condition, “especially during physical activity”.
Heart attacks and strokes were more than twice as likely to happen for people aged over 60 during cold spells lasting at least four days, according to BHF-funded research carried out by scientists at the University of Bristol and University College London.
“Angina patients may notice that their symptoms get worse in winter,” continues Chloe. “In addition to this, our blood can become thicker and stickier, which means that it could be more likely to form clots, which can lead to a heart attack or stroke.”
The BHF has lots of helpful information on its website (bhf.org.uk) explaining ways that people can keep warm and protect their heart during winter. Tips include:
- Keep the room where most time is spent heated to at least 18°C
- Wear lots of thin layers to help trap heat
- Make the home more energy efficient and claim any financial help you may be entitled to, such as Cold Weather Payments
- Have warming meals and drinks
- Customers should also rest and drink plenty of fluids if they think they are getting a cough/cold.
Chloe says that heart patients who are currently on medication should check with their doctor or pharmacist before taking OTC products. She adds that if patients notice their symptoms are getting worse, it’s important that they talk to their doctor or nurse, and try to stay indoors on the coldest days where possible.
Alarm bells
Pharmacy teams can also help their customers by raising awareness of the warning signs of heart attacks and strokes. According to the BHF, heart attack symptoms can include:
- Sudden pain or discomfort in the chest that doesn’t go away
- Pain that spreads to the patient’s left or right arm, neck, jaw, back or stomach. “For some people the pain or tightness is severe, while for others it’s uncomfortable, or a burning similar to indigestion,” says Chloe
- Feeling sick, sweaty, light-headed or short of breath
- Less common symptoms can include a sudden feeling of anxiety (similar to a panic attack) and lots of coughing or wheezing. 999 should be called for a suspected heart attack.
- Meanwhile, to help recognise the signs of stroke, the charity recommends the F.A.S.T. approach – “because timing is critical”, says Chloe. “You could lose millions of nerve cells for every minute without treatment.”
- Facial weakness: can they smile? Has their mouth or eye drooped?
- Arm weakness: can they raise both arms?
- Speech problems: can they speak clearly and understand what you’re saying?
- Time: it’s time to call 999 immediately if you see any of these symptoms.
Skin conditions often worsen in winter.
Looking after lungs
According to Asthma + Lung UK, hospital admissions for respiratory conditions are twice as high in winter compared to summer.
“Patients with lung conditions such as asthma, COPD [chronic obstructive pulmonary disease] and bronchiectasis are more likely to have flare-ups of their condition in winter months because of the increase in viruses that circulate during the winter,” explains Dr Andy Whittamore, practising GP and clinical lead at Asthma + Lung UK. “Inflammation, mucus and immune system responses increase to try to fight the virus. These factors can also increase due to cold air and reactions to airborne triggers such as mould spores.
“Pharmacy teams have a crucial part to play in keeping people with long-term respiratory conditions well throughout the winter,” continues Dr Whittamore. “They are an important source of information on managing symptoms and medication.
“A pharmacist can check whether someone is using their inhalers correctly while minimising possible side-effects; they can check whether someone has had a formal asthma or
COPD review, and that they have a written self-management plan.” Some pharmacies also offer vaccinations, “which are an important feature of preventing illness during the winter”, he adds.
Pharmacy staff can also help patients with long-term lung conditions by sharing self-care tips to prevent winter flare-ups. These will vary depending on their specific diagnosis, says Dr Whittamore; however, “some things common to all these conditions include stopping smoking, keeping active and keeping up to date with vaccinations – especially influenza, pneumococcus and Covid if eligible.
“People should also take any preventer medication regularly, as prescribed. Everyone who has a prescription for inhalers should have a check of their inhaler technique on a regular basis. They can also check their inhaler technique on our website (asthmaandlung.org.uk).”
Like the BHF, the charity also recommends that people keep their homes heated to at least 18°C.
Meanwhile, patients and health professionals should stay vigilant for the warning signs of pneumonia or other complications. According to an analysis released in 2022 by Asthma + Lung UK, more people die from pneumonia in the UK than anywhere else in Europe.
“Anyone who has a lung condition, such as asthma, COPD, or bronchiectasis, and who has a worsening of their symptoms should consult their self-management plan and contact their GP surgery, or 111 if that isn’t possible,” advises Dr Whittamore. “It may be that they need treatment for any infection that is affecting their lungs, or treatment for the flare-up itself.
“If someone is getting more breathless than usual, has a fever or pain in the chest they should contact their GP or 111 urgently. These symptoms can be a feature of pneumonia or other conditions so an assessment by a healthcare professional is essential.”
The NHS website advises anyone to call 999 if they are struggling to breathe, suddenly feel confused or have pale, blue or blotchy skin (or lips/tongue), or if their baby feels floppy and can’t be woken up.
The cold air can put pressure on the lungs, making conditions like asthma more severe.
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