 In
this Issue April 2002
Combination Therapy: its role in
asthma management
Asthma Control - A New Awareness
Campaign
Asthma Education Resources in Languages
other than English
Complementary therapies for
asthma - what advice should we give our patients?*
Asthma Innovative Management Project
Combination Therapy: its
role in asthma management
Information Papers
An important part of the National Asthma Council's
(NAC) role is to provide up-to-date information on
asthma medications to health professionals .
The NAC, with a team comprising a GP, pharmacist and
adult and paediatric respiratory physicians, has
produced a comprehensive information paper for health
professionals on the role of combination therapy in
asthma management.
There is currently one combination medication available
in Australia, Seretide, although Symbicort is expected
to be released later this year.
Combination Therapy
Experience with long-acting beta agonists (LABAs, or
'symptom controllers') over the last 10 years indicates
that these drugs are potent and effective
bronchodilators, capable of improving asthma control in
those with moderate to severe disease. They are
optimally used in combination with inhaled
corticosteroids (ICS), these two classes thereby
providing a dual anti-inflammatory and bronchodilator
action.
The paper sets out the scientific rationale and
evidence that supports and confirms the beneficial role
of the combination therapy in symptomatic patients.
Studies have shown that patients taking combination
therapy showed better symptom control and no evidence of
masking of underlying airway inflammation.
ICS have a vital role in gaining and maintaining
control in mild, moderate and severe asthma. Their use
is based primarily on the understanding that cellular
mechanisms cause inflammatory mediator release, airway
injury and remodelling, leading to poorer lung function
and unstable disease. LABAs are potent bronchodilator
drugs that are not suitable for use as monotherapy in
asthma. Their use in combination with ICS has led to the
rethinking of some important issues in asthma
management.
A message from Dr Ron Tomlins, Chairman of the National
Asthma Council
Combination Therapy : its role in asthma management -
full paper on-line
Medications used to Treat Asthma, Combination
Medications, AMH 2002
Asthma Control - A New
Awareness Campaign
- Ever wake up at night coughing or wheezing?
- Do you ever miss work or school because of
asthma?
- Do you use your reliever puffer more than
three times a week?
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These simple questions are the first step in a new
campaign to help people with asthma gain control. A
joint campaign, by the NAC, Asthma Australia and the
seven Asthma Foundations, was launched in April to
promote the awareness of asthma in Australia. National
advertisements for TV, radio and the Internet feature
the spearhead for the campaign, a dragon, symbolising
people with poor asthma control. The message urges
people to see their doctor if they answer yes to any of
the questions, as their asthma may not be under control.
People can also take The Asthma Test,which is available
on our web site.
Good asthma management requires a balance of sufficient
medication to minimise symptoms and side effects while
maximising and maintaining best possible lung function
to achieve the best quality of life for the person with
asthma. Good asthma control reduces illness from asthma
and ultimately prevents death from asthma.
The first step in assisting people with asthma to gain
control requires recognition by the patient that his or
her asthma is not under control. The Australia-wide
awareness campaign is a timely response to the key
findings of a Newspoll1 survey in February
this year that highlighted the gap between the health
professional's understanding of good asthma control and
the interpretation of people with asthma.
Key findings of the Newspoll1
Survey February2002
- One in 10 people with asthma describe their
asthma as severe
- One in 10 people with asthma have been
admitted to hospital for emergency asthma
treatment in the past twelve months
- A third of people with asthma use their
reliever medication at least once a day
- Half of the people with asthma only take
their preventer medication when they suffer
symptoms or when they feel their asthma is out
of control
- Of those describing their asthma as severe,
a third only take their preventer medication
when they suffer symptoms or when they feel
their asthma is out of control
- Of those describing their asthma as
moderate, one in five has been admitted to
hospital for emergency treatment in the past 12
months
1. Newspoll Asthma Medication Survey conducted
nationally among adults 18 years and over by
telephone over the period of 8-11 February 2002. |
Long-Term Aims of Asthma Management, AMH 2002
Asthma Education
Resources in Languages other than English
Asthma Victoria has recently developed
asthma education resources in six languages other than
English, for culturally and linguistically diverse
people with asthma and their carers.
The first of these resources, an
"Introduction to Asthma", is now available on the Asthma
Victoria Website in Italian, Greek, Turkish, Arabic,
Chinese and Vietnamese languages. Printed versions are
also available from Asthma Victoria.
The "Asthma - the Basic Facts" brochure
will also be available soon in the same languages,
Italian, Greek, Turkish, Arabic, Chinese and Vietnamese,
both on-line and in printed format.
Asthma Victoria is committed to reducing
the impact of asthma and believes that the availability
of these resources will assist people from all
communities to develop understanding and skills to
enable them to better-manage their asthma and to know
what to do when an asthma emergency occurs.
For more information go to the
Asthma Victoria website
Contact Asthma Victoria on (03) 9326 7088
or 1800 645 130.
Complementary
therapies for asthma - what advice should we give our
patients?*
Dr Chris Luttrell, general practitioner,
Launceston, Tasmania.
Member, National Asthma Council General Practitioners'
Asthma Group
Acupuncture, homeopathy, naturopathy,
manual therapies, traditional Chinese medicine, Buteyko
breathing technique, herbal medicine. These and many
others can be seen as either complementary or
alternative. 'Complementary' meaning their use is in
addition to, and hopefully in conjunction with,
treatment by trained medical doctors. 'Alternative'
meaning their use is in place of, and to the exclusion
of, treatment by trained medical doctors. Increasingly,
patients are turning to these therapies, reflecting
increasing consumer preferences for non-pharmaceutical
therapy. This may reflect our increasingly diverse
cultural background, a perception that natural products
are safe and that side-effects do not occur, or that
patients prefer the empowerment of using complementary
therapies when they feel traditional orthodox medicine
has failed them for some reason.
While the majority of our patients use
complementary therapies at some time, many choose not to
tell us. Or is it that we chose not to ask the question
for fear of the perception of personal failure if our
patients have gone elsewhere? If our patients are going
to use complementary therapies, common sense would have
us preferring to know of their choice so that we can not
only discuss their reasons for doing so, but to allow us
to assist them in monitoring for any change in their
asthma control. Planning with our patients before they
change their asthma management should occur whether the
change is in prescribed drug therapy, or the addition of
a complementary therapy.
More...
for Dr Luttrell's complete article in PDF format please
click here
What advice should we give
patients?
-
Think yourself lucky if your
patient trusts you enough to tell you they
wish to try another therapy.
-
Talk openly about their reason
for their choice and what benefit they hope
to get from it.
-
Discuss with the patient that
any change should be considered a trial to
attempt better control / reduced drug usage
in the same way you would trial a new
medication regimen.
-
Consider open discussion with
the therapist of their choice, just as you
would with a physiotherapist or
psychologist. Use their language so both
practitioners can understand monitoring of
the disease.
-
Consider methods for
self-assessment of improvement in asthma
control for some weeks before, during and
after the trial of complementary therapy. ·
Night-time waking. · Early morning
bronchoconstriction. · Exercise tolerance. ·
Use of bronchodilator. · Reduction in
preventer use · Days missed from school /
work.
-
Contract with the patient to
formally assess their asthma control before,
during and after the trial of complementary
therapy. · Quality of life symptom scores ·
Peak expiratory flow rates · Spirometry
-
Agree with the patient that
should there be an improvement in asthma
control, a reduction in the use of
prescription medication will be attempted.
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*This article first appeared in the
monthly RACGP newspaper, GP Review
For more information on complementary
therapies see:
Complementary therapies for asthma management, AMH 2002
Other Medications and Asthma, AMH 2002
Asthma Innovative
Management Project
The National Health Priority Action
Council (NHPAC) and the National Asthma Reference Group
(NARG) support activities that will improve the evidence
base around effective diagnosis and management of
asthma, particularly for disadvantaged groups. This
project provides the opportunity to expand the evidence
base and enable research to be undertaken at a local
level on interventions that have the capacity to improve
the diagnosis and management of asthma in target
populations.
The National Asthma Reference Group (NARG)
was established in December 2000 to provide the
Commonwealth Government with expert advice on key asthma
issues and activities to improve the health status and
quality of life for all Australians with asthma. The
Australian Government Department of Health and Ageing
through the NARG is offering funding of up to $60,000
(excluding GST) for innovative and practical projects
that will support the better understanding of the
barriers to good asthma management for particular target
populations and identify and test interventions to
overcome these barriers. The funding will be offered
under the Asthma Innovative Management (AIM) Project.
About the Asthma Innovative Management
(AIM) Project
The AIM Project will provide time-limited
funding to service providers and other interested groups
to determine:
-
findings around the nature of barriers
to optimal asthma management for a particular group;
-
interventions and tools that could be
used by consumers and health professionals to
overcome these barriers; and if possible
-
evidence that the interventions are
effective in the management of asthma.
The population groups targeted by the AIM
Project are:
-
indigenous communities;
-
people from rural or remote areas;
-
culturally and linguistically diverse
groups
-
adolescents with asthma;
-
older people with asthma;
-
those with moderate to severe asthma
who overuse asthma reliever medication; or
-
who are recurrent accident emergency
department and out-of-hours attendees.
For full application information for the
AIM Project and necessary forms
click here
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