In this Issue March 2002

Asthma Management Handbook 2002

Asthma Management Handbook 2002 Online

Asthma Aerosol Inhalers - Transition Update

Common Colds Need Common Sense

Autumn Feature

National Asthma Council's 
Asthma Management Handbook 2002

The National Asthma Council has produced excellent publications from its inception as the National Asthma Campaign in 1990. The fifth and latest edition of the Asthma Management Handbook is no exception.

Since the publication of the last Asthma Management Handbook in 1998, we have changed our name to the National Asthma Council. The name change reflects the organisation's relevance, reputation and purpose beyond the original short-term promotional vehicle. As the peak body for asthma in Australia, we continue to highlight the importance of asthma education and management today and the ongoing need to take - and treat - asthma seriously.

Continuing priorities for us include educating people with asthma, ensuring that health professionals have access to the latest asthma management practices and encouraging public discussion of asthma among healthcare professionals, the Government, the media and most importantly, people living with asthma.

The Asthma Management Handbook is one of the most read guidelines documents in Australia. Relying on the best available evidence as the basis for recommendations, we aim to have the guidelines remain clear and user-friendly. For this latest edition, new developments in asthma over the past three years are included.

The importance of back titration of inhaled corticosteroids and the emerging role of symptom controllers (long-acting beta agonists) are covered along with information on the role of combination therapy. As new asthma therapies have come to market - such as combination medications and leukotriene receptor antagonists - it is important to be aware of the differences in dosing, administration and in particular the importance of back titration, in order to ensure optimal asthma management of patients.

Some changes have been made to the Handbook's familiar user-friendly format of previous editions. We now have a separate section dedicated to paediatric asthma management that draws together the management advice and treatment protocols for children, which differs in important ways to that of adults.

While patient information sheets are no longer included in the practical information section, they still appear on the National Asthma Council web site in a printable form. Other sources of comprehensive, reputable information for people with asthma are also covered in a detailed list of patient education resources and where to access them.

The has been compiled by the National Asthma Council mainly for general practitioners, community pharmacists and asthma educators, but will be useful for all health professionals working in asthma care, and for medical, pharmacy and nursing students. The Handbook is readily accessible to everyone via the National Asthma Council web site, as are many of our publications.

The National Asthma Council is a continuing collaboration of 

• the Thoracic Society of Australia and New Zealand, 
• the Royal Australian College of General Practitioners, · the Pharmaceutical Society of Australia, 
• Asthma Australia representing the Asthma Foundations, and 
• the Australasian Society of Clinical Immunology and Allergy.

These and many other organisations and individuals have contributed to the production of the Handbook.

Our thanks go to our contributors for their work, our constituent organisations for their support, and to GlaxoSmithKline for sponsoring this publication.

Asthma Management Handbook 2002 Online

The Asthma Management Handbook is the most visited publication on the National Asthma Council web site. The vast majority of our web site visitors enter the Handbook at the "Contents" page, which will now take you to the 2002 Edition. The new Handbook is a substantial web site itself that faithfully reflects the information contained in the printed publication and more. 

Moving around the Handbook you now have the ability to reach any topic from any page as well as a site map that links you to the each of the pages. 

The left hand menu appearing on each page, allows you to reach your destination page with just single click. 

We look forward to your comments and feedback on the Handbook web site.

The Asthma Management Handbook 2002.

Asthma Aerosol Inhalers - Transition Update

Australia is a signatory to the Montreal Protocol (1987) and subsequent adjustments and amendments. The Protocol is an international agreement which requires developed countries to phase out, with some strictly limited exceptions, all production and import of halons by 1994, CFCs by 1996 and methyl bromide by 2005. To comply with the Montreal Protocol, industry has had to develop and implement the use of several interim and long-term replacements for CFCs.

CFC consumption in Australia peaked in the mid-1970s at around 20,000 tonnes per year, largely from the aerosol, refrigeration and foam plastics industries. Adoption of a national strategy, guided by the Montreal Protocol, to protect the ozone layer, has resulted in CFC consumption in Australia dropping dramatically.

Historically, asthma aerosol inhalers have constituted less than 1% of the estimated half a million tonnes of CFCs released by all industries in Australia since their first use in the 1960s.

The first CFC-free inhalers were introduced in February 1999 and most asthma inhalers are now CFC-free. Some products, such as Becotide, Becloforte, Bricanyl Inhaler, Respocort Inhaler, Respocort Autohaler and Pulmicort Inhaler are being withdrawn this year, but there are good alternatives to these. Others still have to change to CFC-free by the end of 2005.

A stickiness problem has been found with some of the new propellants, especially Intal Forte CFC-free and Tilade CFC-free. As a result, these have packs with 2 actuators, one to use while the other is drying after washing. Cleaning instructions for all the new inhalers are included in the Consumer Medication Information in the pack and should be followed closely, as instructions vary.

CFC-free inhalers now available are Airomir, Airomir Autohaler, Asmol, Epaq, Ventolin, Intal Forte CFC-free, Flixotide, Qvar, Qvar Autohaler, Tilade CFC-free and Seretide.

CFC-containing inhalers available are Atrovent and Serevent. Becloforte, Becotide, Bricanyl Inhaler, Pulmicort Inhaler, Respocort Inhaler and Respocort Autohaler are still available but will be withdrawn this year.

Dry powder inhalers continue to be available - Bricanyl Turbuhaler, Flixotide Accuhaler, Flixotide Diskhaler, Pulmicort Turbuhaler, Foradile Aerolizer, Oxis Turbuhaler, Serevent Accuhaler, Serevent Diskhaler and Seretide Accuhaler. These dry powder inhalers are not affected by this change as they have no propellant.

During this changeover period, it is important for people with asthma to continue taking their prescribed medication. If you believe your CFC-free inhaler is not effective, you should speak to your doctor. It is more likely to be worsening asthma than a problem with the inhaler. It is important to read the instructions in the packet for any new inhaler.

A few of the CFC-free inhalers have a stickiness problem so it is very important to obtain advice on cleaning your inhaler.

The change to CFC-free inhalers is a good opportunity for your doctor to instigate a review of the your asthma management.

Current CFC-free and CFC containing Inhalers

*has a stickiness problem so comes in a pack with 2 holders, important to follow the cleaning instructions.

Dry Powder Inhalers 

(Not affected by the CFC issue)

For full article see Asthma Aerosol Inhalers - the CFC-free Transition

Common Colds Need Common Sense

For the people with asthma, a cold or the 'flu may worsen their asthma, but antibiotics are not the answer. Taking antibiotics when they are not required or useful means that the medication will become less and less effective.

Once again this year the National Prescribing Service, a non-profit organisation independent of government and the pharmaceutical industry, is promoting its national 'Common colds need common sense' campaign.

The NPS stresses that the common cold is a virus and antibiotics have no effect on the 45 million occurrences of the common cold and associated symptoms that occur in Australia each year.

Antibiotics will not speed recovery for common cold sufferers and you are better off using common sense to treat your illness. This includes: 

• taking it easy, 

• drinking plenty of fluids, and 

• treating the symptoms while the body's own defences defeat the illness.

Common colds are quite different to influenza, which is a more serious illness that can cause the whole body to ache and often makes you sick enough to go to bed. Common colds mostly only affect the nose and throat.

Inappropriate use of antibiotics remains a major concern for medical practitioners and the public. The NPS Consumer Survey 2000 found that one in five people believe taking antibiotics for coughs, colds, or the 'flu will help them get better faster.

So what can you do to ease the symptoms of the common cold?

Some practical suggestions are:

• drink plenty of fluids to replace fluids lost from your body 

• get plenty of rest to help your body's immune system fight off the viruses 

• avoid smoking or exposure to cigarette smoke 

• use medication to relieve aches and pains, and reduce fever 

• inhale steam to clear blocked sinuses and ease chest tightness in adults 

• use saline nasal sprays to help clear mucus 

• a decongestant, in the form of nasal spray, drops, tablets, or mixture, may help dry a runny nose or relieve blocked sinuses 

• suck ice or throat lozenges, or gargle warm, salty water to help soothe a sore throat.

And make sure you stick with your Asthma Action Plan.

Tips for the prevention of colds and 'flu. 

Droplets of fluid from your nose or mouth spread cold and influenza viruses to other people. To prevent this transfer this the NPS suggests:

• keep your hands away from your eyes, nose, and mouth 

• use paper tissues to blow your nose and throw them away after use 

• wash your hands thoroughly with soap after blowing your nose, after covering your mouth for a cough or sneeze, and before preparing or eating food 

• do not share cups or cutlery with other people (especially if they are showing cold symptoms)

Although the NPS is advising against antibiotics, it is not advising against visiting your doctor. Doctors can assess the severity of your illness, provide information about its expected duration, and advise you on treatment and influenza vaccination and help you to better manage your asthma through the illness.

It is especially important you consult your doctor if symptoms are severe, if they persist, or you develop severe headache, difficulty in waking up, a high fever, or if light hurts your eyes.

For information on Asthma & Influenza

View the National Prescribing Service web site

Autumn Feature - Pregnancy and Asthma

With the launch of our new "baby" the Asthma Management Handbook occupying our thoughts recently, our minds seem to naturally turn to pregnancy and asthma.

Pregnancy is often about what you should give up and drugs in general are at the top of the list, but not asthma medications. It is not good for your own health as well as the health of your baby to have uncontrolled asthma. Medications for asthma have been shown to be extremely safe for both the mother and the developing baby.

It is more dangerous to have untreated asthma during pregnancy than to continue with your prescribed asthma medications. Attacks of asthma may reduce the amount of oxygen available to the baby.

In pregnancy, some women find that their asthma improves, and some remain unchanged. Those whose asthma does get a little worse can be helped with good asthma management. It is important that your symptoms be well managed for your own health and that of your baby.

Taking more care to avoid your asthma trigger factors is a positive step. 

Finally you need to consult with your doctor regularly and follow your Asthma Action Plan very carefully for the best asthma control.

View Autumn Feature - Pregnancy and Asthma