In this Issue September 2002

Getting on top of seasonal allergic asthma

World COPD Day 20 November, 2002

NAC Journalism Award 2001-2

The Asthma 3+ Visit Plan Update

Originally developed by the National Asthma Council's General Practitioners' Asthma Group, the Asthma 3+ Visit Plan has become the cornerstone of the Federal Government GP Asthma Initiative, aiming to reduce the morbidity and mortality of people with moderate to severe asthma.

The Asthma 3+ Visit Plan assists GPs with planned asthma education and management within the normal consultation setting. It involves at least three visits to your GP over a short period of four months for the sole purpose of improving the management of asthma.

The visits incorporate:

diagnosis and assessment (including appropriate spirometry tests)
development of a written asthma management plan, and
patient education and review of asthma management plan.

The Asthma 3+ Visit Plan encourages partnerships in proactive asthma care between the patient and their health professionals.

The Department of Health and Ageing has produced a range of support material for the 3+ Visit Plan for patients, carers and health professionals.

For all the details on the brochures and further information go to

The asthma 3+visit plan resources

Getting on top of seasonal allergic asthma

by Dr Victoria Taylor*

Asthma and allergy

In spring many asthmatic patients may suffer from increasingly severe asthma or more frequent bouts. It is the time to think why, and not just increase medications to regain control. The most likely cause for the flare-up is allergies, in particular to pollens from grasses, weeds and trees.

In spring the number of pollens in the air increases. They may also travel many miles and thus be difficult to avoid. Cold air and changes in temperature can also trigger asthma, as can irritants, exercise, infection, reflux, some medicines, some food additives, emotional upheaval and stress. Unlike most other asthma triggers, allergen exposure may be reduced or avoided.

In sensitised patients, high exposure to the offending allergen(s) is associated with more severe disease and increased frequency and severity of asthma exacerbations. Evidence of this exists for indoor allergens such as pets, house dust mite and cockroaches, as well as outdoor allergens like pollens and moulds. It can be difficult to show a direct relationship between allergen exposure and symptoms in some patients as they may be sensitised and exposed to a number of allergens. There are also different magnitudes of response between individuals to the same level of allergen exposure.

In the allergic patient, asthma may be aggravated by two major factors. The first is an allergic inflammation in the airways. This causes infection and increased mucus secretion. The second is the action of the aero allergen on the nasal passages. The allergic reaction causes obstruction and increased mucus production. The post nasal discharge which trickles into the airways, particularly overnight, is a precipitator of asthma.

Asthma management thus aims to address both the bronchospasm and the airway inflammation. Management includes:

identification of allergen triggers;
allergen avoidance measures, where possible;
appropriate medication;
specific allergen immunotherapy (SIT) when appropriate.

Management

Allergy testing is used to detect IgE to selected allergens.

Skin prick tests (SPT): are the most sensitive for confirming allergic triggers for asthma.
RAST tests: research had shown that compared to skin prick testing, blood (RAST) tests will detect approximately 70-75% of those allergic people who have positive skin prick tests. RAST tests are useful in cases where
- the patient is unable to have skin prick testing performed due to time factors, or, if a child, unwillingness to undergo the procedure;
- the patient has taken medications that may interfere with skin testing (e.g. antihistamines or tricyclic antidepressants);
- the patient has skin rashes that make it impossible to apply the test;
- the patient has had a serious allergic reaction in the past; and
- you do not have the materials or experience to perform the skin tests.

The most commonly tested allergens are

cat, dog, house dust mite (HDM);
grasses - rye, couch, dock and sorrel;
moulds; and
flowers, trees.

The objective of SPT is to determine the aero allergens that may be causing the asthma with the idea of reducing exposure or desensitisation. Desensitisation, or immunotherapy, is proven to be effective in treating allergic rhinitis, and for selected individuals with asthma for house dust mite, cat and grass pollen allergies.

It is suitable for people with asthma when

exposure to a particular allergen is causing symptoms
allergy is confirmed to a particular allergen using SPT or RAST
asthma is stable
further allergen exposure is unavoidable or only partly reducible
there is significant allergic rhinitis or allergic conjunctivitis
an effective allergen extract is available
the patient is able to understand the process and give informed consent (or if a child, has a parent/guardian who can do so).

Desensitisation is done by a series of injections, which are done weekly, then extended to monthly. These are continued for 3 to 5 years. It is a rewarding but slow process and is best supervised by a doctor well versed in this field i.e. an allergist.

Pollens

Allergies to airborne pollen grains from grasses, trees and weeds

are common in people with asthma;
worsen asthma symptoms during the pollen seasons (spring, summer and the the dry season in tropical regions);
can cause asthma outbreaks after thunderstorms;
are usually caused by imported grasses, weeds and trees, which are wind pollinated; pollens can travel many kilometres from their source;
are not usually caused by Australian native plants (an exception is Cypress Pine);
are not usually caused by highly flowered plants as they produce less pollen (transported by bees) than wind-pollinated plants;
occur mainly outside; and
occur mainly in the morning, when pollen counts are high.

Diagnosis

Consider allergies

Eczema - Often people with asthma have a history of eczema. This may be due to allergies to HDM, or foods, such as eggs and milk.
Hay fever - Is the most common symptom of an atopic person. It usually signifies allergies to the airborne i.e. grass, weeds, and trees.
Family history - Atopy runs in the family, look for asthma, eczema, or hay fever.
Reactions to food chemicals - People can be intolerant to various foods, such as salicylates, glutamates, various food colourings, preservatives and additives. This intolerance may present as hay fever or asthma type symptoms.
Time of year - Allergies to pollens are more prevalent in spring, and may continue till 'Feb'. Allergens to HDM tend to be more prevalent in winter.

It is difficult to avoid pollens and thus treatments such as desensitisation and non-sedating antihistamines are appropriate. Topical nasal corticosteroids are the most effective long-term medication for hay fever and may improve the control of asthma and lessen the need for asthma medication.

Pollen avoidance measures that may be suggested to the patient include:

remaining indoors as much as possible before midday during the pollen season, on windy days and after thunderstorms;
avoiding activities known to cause allergen exposure, such as grass-mowing, taking picnics in parks;
frequent hand and face washing and/or showering after outdoor activities; and
removing known allergens from areas close to the house, such as outside windows.

These may help reduce allergic symptoms but are yet to be proven to improve asthma.

Summary

Spring with its welcome sunshine and new grass is a reminder to us all to think laterally about asthma. Don't just treat - but look at the cause, it may not be related to pollens arriving with spring, but HDM or cat. To think of allergy and treat it may result in a marked improvement in asthma control.

*Dr Taylor is a general practitioner in Launceston, Tasmania. She has had a major interest in asthma and allergy for many years, and is GP Liaison Officer for the Australasian Society of Clinical Immunology and Allergy (ASCIA)

The Woolcock

Many of you will be familiar with the Institute of Respiratory Medicine in Sydney. On August 31 this year the Institute changed its name to the Woolcock Institute of Medical Research in memory of the founding Director, Ann Woolcock.

Australia's best known and most prominent respiratory physician, Professor Ann Woolcock died in February 2001 at the all too young age of 63.

Ann had international standing and recognition as one of the world's experts on asthma and was an excellent friend to the NAC.

Her irreverent sense of fun, her caring attitude to her patients and her scientific success made her admired and loved by many people. She was rewarded by many national and international honours including an Officer of the Order of Australia and a Fellow of the Australian Academy of Science.

So, for those of you wondering what has happened to the Institute of Respiratory Medicine, please go to the

Woolcock Institute of Medical Research

Why Me? Asthma

“Why Me? Asthma" is a video education program on asthma and self-management, for people who are newly diagnosed with asthma.

The 40 minute video explains what asthma is and what you need to do to continue living a healthy, normal life.

Real life case studies provide excellent examples and the latest treatments for asthma are outlined.

The production of "Why Me? - Asthma" by Business Essentials was supported by the RACGP, Asthma Victoria and the National Asthma Council.

For a preview clip of the video and details on how to order go to

Asthma resources - video, "Why Me? Asthma"

World COPD Day 20 November, 2002

The Global Initiative for Chronic Obstructive Lung Disease (GOLD), is organising the first World COPD Day, for November 20, 2002. The event represents a partnership between health care groups and respiratory educators to raise awareness about chronic obstructive pulmonary disease (COPD).

COPD is a highly prevalent disease and can also affect people with asthma. It has a high impact on quality of life, and kills many people.

The early stages of COPD are often unrecognised, but it is easy to determine whether a person is at risk. If COPD is detected early, treatments are available to prevent further deterioration of lung function.

The objective of the first-ever World COPD Day is to increase awareness of COPD as a global health problem.

The theme "Raising COPD Awareness Worldwide!" will be used by health professionals, medical and patient organisations, health authorities, patients, and the general public to highlight the need for every person to learn about the symptoms of COPD, talk to their doctor about diagnosis of COPD, receive appropriate treatment, learn to manage COPD in partnership with a health professional, and reduce exposure to environmental risk factors that make their disease worse.

For more information go to

Global Initiative for Chronic Obstructive Lung Diseases

NAC Journalism Awards

The National Asthma Council would like to thank all contributors to the NAC Journalism Awards 2001-2 which closed late last month.

All entries have been made available to our judging panel and we look forward to announcing the winning entry shortly.

The overall winner from all categories receives a grant of $2,000 to attend an appropriate respiratory conference plus $500 worth of equipment relevant to the journalist’s line of work.

Four finalists will also receive $500 each towards a piece of equipment to assist with their line of work.

To all who entered, thank you for your efforts in helping to raise awareness and understanding of asthma and good luck!

Created September 24, 2002