May is National Asthma and Allergy Awareness Month. It is also peak allergy and asthma exacerbation season across most of the country. And Drug Topics this week named the clinical opportunity directly: pharmacists are uniquely positioned to identify the patterns of underuse and overuse that drive preventable emergency department visits, and most are letting those opportunities walk out the door without acting on them.
The data behind the urgency is not subtle. Uncontrolled asthma places $81.9 billion in economic burden on the U.S. healthcare system annually, driven largely by hospitalizations and emergency visits. Pharmacists are the most accessible providers and often act as the first point of contact in primary care settings.
The Access Advantage No Other Provider Has
Community pharmacists are emerging as critical frontline providers for patients with asthma and allergies, leveraging their accessibility, medication expertise, and ongoing contact with patients to improve care and lower costs. Because pharmacists can review both prescription and refill histories, they are uniquely positioned to spot patterns of underuse or overuse, such as reliance on rescue inhalers, and intervene before conditions escalate.
A prescriber managing a 15-minute appointment three times a year cannot see what a pharmacist sees every time a patient presents at the counter. The pharmacist reviewing a refill history sees the entire medication picture at once: rescue inhaler fill frequency, whether a controller inhaler is on the profile, what OTC antihistamines the patient buys, and whether any of those patterns have changed since the last visit.
That view of the complete medication history is a clinical advantage that belongs exclusively to the pharmacist. Using it is the difference between practicing at the level the PharmD prepares you for and functioning as a dispensing interface.
The Three Patterns to Flag Right Now
Pattern 1: Rescue inhaler refills without a controller
The overuse of a short-acting beta agonist, defined as dispensing more than three canisters per year, may lead to worsening lung conditions. New GINA guideline updates have significantly shifted toward a preference for inhaled corticosteroids combined with formoterol as the primary reliever, moving away from traditional SABA monotherapy. This shift aims to treat underlying inflammation and prevent the life-threatening exacerbations associated with overusing rescue inhalers alone.
The practical trigger: any patient who has filled a rescue inhaler two or more times in the past six months without an active controller inhaler on profile. This is a GINA-defined indicator for uncontrolled asthma and a direct outreach opportunity.
Pharmacists should assess inhaler technique at every refill, identify excessive reliance on short-acting beta agonists, and perform adherence assessments during refill encounters. These practices are among the highest-impact interventions available in the community pharmacy setting.
Pattern 2: OTC oral antihistamines repeatedly purchased without a nasal corticosteroid
The ARIA guidelines favor the use of intranasal medications, particularly intranasal corticosteroids or fixed combinations of intranasal corticosteroids plus antihistamines, because they display higher effectiveness and faster onset of action than oral treatments. Intranasal treatments are superior to oral interventions for improving nasal and ocular symptoms and quality of life.
The patient buying loratadine or cetirizine month after month for nasal congestion is using a medication that is clinically inferior for the nasal symptom they are treating. Fluticasone and triamcinolone are both OTC, both cheaper per dose than repeat antihistamine purchases, and both far more effective for nasal congestion and obstruction. Most of these patients have simply never been told this. The pharmacist who tells them closes a clinical gap in 60 seconds.
Pattern 3: Multiple antihistamines combined
Using fast-acting inhalers as maintenance treatment and long-acting inhalers as rescue treatment are among the most common medication misuse errors pharmacists encounter. Patients often lack clarity on which medications target long-term control versus short-term relief.
The antihistamine version of this same confusion: patients combining a prescription antihistamine with an OTC one, often in different drug classes, believing more is better. The result is a cumulative anticholinergic burden, particularly dangerous in elderly patients, without any improvement in efficacy. Spotting this pattern at refill or at the OTC consultation window is a safety intervention the pharmacist is uniquely positioned to make.
The Comorbidity Signal Most Pharmacists Miss
One of the most clinically important and least recognized patterns in the allergy and asthma patient population is the bidirectional relationship between allergic rhinitis and asthma control.
For patients with asthma, the presence of comorbid allergic rhinitis is associated with higher total annual medical costs, greater prescribing frequency of asthma-related medications, and increased likelihood of asthma-related hospital admissions and emergency visits. Treating comorbid allergic rhinitis results in a lowered risk of asthma-related hospitalizations and emergency visits. The evidence highlights the potential for improving asthma outcomes by following a combined therapeutic approach rather than targeting each condition separately.
This means the patient who comes in for an albuterol refill and is also buying OTC antihistamines for seasonal symptoms is a dual intervention opportunity. Optimizing their allergic rhinitis treatment with a nasal corticosteroid may directly reduce their rescue inhaler use, not because the asthma changed, but because the inflammatory cascade driving both conditions is being addressed upstream.
The 2026 American College of Chest Physicians guidelines recommend either omalizumab or dupilumab for adult patients with moderate to severe allergic asthma and a history of one or more exacerbations per year requiring oral corticosteroids. For patients with more severe quality-of-life impairment and more than two exacerbations per year, omalizumab is preferred over dupilumab.
The patient who has been refilling rescue inhalers twice a year, whose asthma has never been formally assessed for severity, and who has comorbid allergic rhinitis inadequately managed on OTC antihistamines may be a biologic therapy candidate who has never been identified. The pharmacist who connects those dots and communicates with the prescriber initiates a clinical conversation that can transform that patient’s trajectory.
The Inhaler Technique Gap That Undermines Every Prescription
An estimated 30 to 70% of adults and up to 50% of children have poor adherence to asthma treatment. Poor adherence leads to uncontrolled asthma and reduced quality of life. A systematic review and meta-analysis demonstrated that pharmacist-led interventions significantly improve medication adherence in asthma patients.
Pharmacists can assess inhaler technique at every refill, which is likely more frequent than the patient’s follow-up with their prescribing clinician. They can address barriers to adherence and work with the patient on solutions. Pharmacists also play a key role in helping patients navigate the financial side of care, recommending generics, OTC alternatives, discount programs, and manufacturer coupons to reduce out-of-pocket costs and prevent unnecessary physician or emergency room visits.
Different inhaler types require specific techniques. The patient who has been on a dry powder inhaler for two years but was never observed using it has likely been underdosing for two years. A 90-second technique check at a refill visit costs the pharmacist nothing and may be the single most impactful intervention that patient receives this season.
Your Clinical Action List for This Week
Three specific steps that require no new tools, no new systems, and no new workflow beyond what your dispensing software already allows:
Pull the rescue inhaler report. Query your dispensing system for every patient who has filled an albuterol or levalbuterol inhaler two or more times in the last six months. Sort by fill frequency, descending. That list, starting from the top, is your clinical outreach priority this week.
Build the proactive outreach script. For each patient on that list, the call takes three minutes: “I noticed you’ve been using your rescue inhaler more frequently recently. I wanted to reach out and make sure we’re doing everything we can to keep your asthma well controlled. Can I ask a few quick questions about how your symptoms have been?” That call is documentable, billable in increasing numbers of states, and prevents emergency department visits. It also builds the kind of patient loyalty that no chain pharmacy and no mail-order service can generate.
Scan OTC purchases for the antihistamine pattern. During any allergy-related OTC consultation this week, ask directly: “Are you using a nasal spray in addition to the antihistamine, or just the tablet?” Most patients who answer “just the tablet” have never been told that a nasal steroid spray works better for congestion and is available OTC. That recommendation, made in 60 seconds, closes a guideline gap and positions you as the clinical resource your patients didn’t know they had.
The Business Case Hidden Inside the Clinical Case
Beyond clinical impact, community pharmacists also play a key role in helping patients navigate the financial side of allergy and asthma care. Recommending generics, OTC alternatives, discount programs, and manufacturer coupons can reduce out-of-pocket costs and potentially prevent unnecessary physician or emergency room visits.
That financial guidance is a clinical service, not a customer service function. The patient who was spending $45 a month on brand-name oral antihistamines and OTC decongestants separately, and who now uses generic fluticasone nasal spray at $8 a month, saves money and gets better symptom control. The patient who understands that their rescue inhaler overuse is a clinical signal and not a maintenance routine becomes a more engaged, more adherent, more loyal patient who calls your pharmacy before they call the ER.
The allergy and asthma patient is standing in your door right now. The clinical intelligence to help them is already in your dispensing system. The only missing element is the intentional decision to use it.
Sources: Drug Topics (Community Pharmacists Boost Asthma and Allergy Care, May 2026), Drug Topics (Pharmacists Improve Asthma Care Despite Gaps in Practice, May 2026), Pharmacy Times (Better Asthma Control Starts at the Pharmacy: Evidence, Interventions, and Outcomes, May 2026), Pharmacy Times (The Pharmacist’s Role in Aiding Patients With Asthma and Allergies, January 2026), Pharmacy Times (Regimens, Adherence, and Adverse Events: The Role of the Pharmacist in Asthma Management, January 2026), StatPearls / NCBI (Asthma Medications, April 2026), Journal of Allergy and Clinical Immunology: In Practice (Intranasal Versus Oral Treatments for Allergic Rhinitis: Systematic Review With Meta-Analysis, 2024), ScienceDirect / JACI (Intranasal Antihistamines and Corticosteroids in Allergic Rhinitis: Systematic Review, 2024), ARIA 2024 to 2025 Revised Guidelines on Intranasal Treatments, Wiley Allergy (December 2025), PMC (Allergic Rhinitis: Evidence for Impact on Asthma)