In this Issue February 2003

The Role of LTRAs in Childhood Asthma

Primary Care Special Interest Group

The Older Person and Asthma

Drug Delivery Devices

Conference Diary 2003/4

The Role of Leukotriene Receptor Antagonists (LTRAs)
in Childhood Asthma

The National Asthma Council has released an information paper for the Australian medical profession on the therapeutic role of Leukotriene Receptor Antagonists (LTRAs) in the treatment of children aged two to 14 years with mild persistent asthma or frequent episodic asthma. 

The paper, prepared by a group of asthma specialists, summarises the role LTRAs such as montelukast (Singulair) have on childhood asthma. Paediatric respiratory physicians, general practitioners and a pharmacist contributed to the paper. 

From 1 February 2003 montelukast was added to the Pharmaceutical Benefits Scheme (PBS) for first line, long-term preventive monotherapy for children with frequent episodic asthma and mild persistent asthma. 

LTRAs represent a new class of preventive drug therapy for childhood asthma management. GPs now have a choice of preventers available on the PBS.

The paper also provides a timely and appropriate update, expanding on the information provided in the Asthma Management Handbook 2002. It includes research evidence on the role of montelukast, information about asthma diagnosis, assessing asthma severity and patterns of asthma in children, and a suggested approach to preventive therapy in children.

Montelukast, the only LTRA currently available in Australia on the PBS, now provides an alternative to cromolyns or low dose inhaled corticosteroids. The paper does recommend that, as with any asthma therapy, a patient's need for treatment should be reassessed after a trial period of four to eight weeks. At that time, a decision about continuing or ceasing LTRAs should be made, based on the child's current asthma severity and management and the efficacy and tolerability of the treatment.

Inhaled corticosteroids are the preferred treatment for children whose asthma is inadequately controlled after the four- to eight-week trial period. LTRAs will not suit all children with frequent episodic or mild persistent asthma and regular review of a child's response to their asthma medicine/s is essential to facilitate timely therapy amendment if required.

To view a copy of the new information paper go to 

Leukotriene Receptor Antagonists (LTRAs) - Their Therapeutic Role in Children with Asthma

For previous information paper go to 

Combination Therapy : its role in asthma management 

Primary Care Special Interest Group

The Thoracic Society of Australia and New Zealand (TSANZ) establishes Primary Care Special Interest Group

Dr Ron Tomlins, RACGP representative on the TSANZ Council, will convene the first meeting of the new Primary Care Special Interest Group at the Adelaide ASM in April.

Dr Tomlins says, "The new SIG aims to provide a forum for discussion of respiratory issues in primary care within the TSANZ. We hope it will give primary care a focus and a voice within TSANZ and draw together the contributions of all health care professionals involved in the care of people with respiratory disease in the community."

While any TSANZ member is welcome to join the Primary Care SIG, Dr Tomlins thought that GPs, asthma educators and practice nurses, physiotherapists and community pharmacists would be particularly interested. Rural and remote area health professionals are a particular target group, as are New Zealand GPs and nurses, with whom closer contact is needed on issues of mutual concern.

Fellows of the RACGP are eligible for full membership of the TSANZ, and this is seen in general practice as a welcome incentive to join and participate in the TSANZ.

The Primary Care SIG will meet on Sunday 6 April 2003. Its agenda is being developed and will include a debate on the dissemination and implementation of respiratory guidelines in primary care.

For more information about the TSANZ meeting 4-9 April go to 

TSANZ Annual Scientific Meeting Adelaide

The Older Person and Asthma

The management of asthma in the older person may involve some special issues that require extra consideration with regard to diagnosis, other conditions that may exist and medications the older person may require.

Is it Asthma?

Establishing a diagnosis of asthma is important to prevent any confusion with other respiratory problems such as bronchitis, chronic obstructive pulmonary disease, heart problems, or post viral cough. 

A medications review should help to uncover ACE inhibitor induced cough, possible medication allergies or allergies to beta-blocker eye drops. The possibility also exists that treating other diseases, or the development of other diseases, may have unmasked asthma. 

Not just Asthma

Conditions that the older person may have could make their asthma more apparent. Treatment of conditions such as: 

• emphysema, bronchitis 
• hypertension, heart failure, cerebrovascular disease, myocardial infarction 
• arthritis, osteoporosis 
• glaucoma, cataracts 
• tremor, ecchymoses 

can influence asthma management or can make the asthma itself worse.

Even small gains made by good asthma management may help to improve quality of life.

Medication Management

The older person may need to cope with multiple medications and need to be aware of medications that may trigger their asthma such as aspirin, NSAIDs and beta blockers (either orally or in eye drops).

Apart from choosing the most appropriate medication for asthma management in the older person, consideration must be given to the physical abilities required to use the range of delivery systems available. 

Attention to vaccination and immunisation is particularly important for the older person with asthma and or other respiratory diseases. 

• Annual influenza vaccination is recommended for all people 65 years and over. 
• Pneumococcal immunisation every five years for all people 65 years and over. 

Clarity of Instructions

Extra guidance, explanation and review of all issues is necessary in the older person. Give clear written instructions in large print to the person and/or carer.

For more information go to 

Asthma Management Handbook 2002

Drug Delivery Devices

For any medication to work effectively it must reach the target activity site. An important aspect to consider for any asthma medication is the method of delivery and whether or not the person with asthma can adequately utilise a specific device.

All inhalation devices benefit from comprehensive demonstration and careful explanation of their use. A "hands-on" trial in the surgery would benefit the person with asthma and any carers. As many people do not use their inhalers correctly, their technique should be checked regularly, especially if symptom control is poor.     

With the range of delivery devices available today, a suitable combination of drug and delivery system can be tailored to suit special needs, children or older persons.

The Asthma Management Handbook describes the main devices available and the table below provides a brief overview only.

*Extracts from the Asthma Management Handbook 2002 - Drug Delivery Devices

Important Note

If any device used in acute asthma (dry powder, aerosol, or nebuliser) fails to produce an adequate response, medical help should be sought and/or an alternative device should be used to deliver beta₂ agonist treatment.

For more information on drug delivery devices go to

Asthma Management Handbook 2002

For a poster that identifies all the current inhaled asthma medications by device and colour go to 

LHPC Inhaled Asthma Medications Poster

For more information and assistance with asthma devices contact your local Asthma Foundation: on 1800 645 130 or see the following web sites:

Asthma Australia

Asthma New South Wales

Asthma Northern Territory

Asthma Queensland

Asthma South Australia

Asthma Tasmania

Asthma Victoria

Asthma Western Australia

Conference Diary 2003/4

Submit brief conference/meeting details to the National Asthma Council for possible posting in our Conference Diary by email to nac@NationalAsthma.org.au.

The Thoracic Society of Australia and New Zealand  2003 Annual Scientific Meeting  Adelaide Convention Centre  4 - 9 April 2003 TSANZ Annual Scientific Meeting Adelaide
Australian & New Zealand Society of Respiratory Science  2003 Annual Scientific Meeting  Adelaide Convention Centre  4 - 6 April 2003 ANZSRS Annual Scientific Meeting Adelaide
The Australasian Society of Clinical Immunology & Allergy (ASCIA) 14th Annual Scientific Meeting  Sheraton Towers Southgate & Sebel Lodge Hotel Yarra Valley, Melbourne, Australia October 10 - 13 2003  ASCIA Annual Scientific Meeting
2nd World IPCRG Conference  Respiratory Disease in Primary Care 'The Way Forward' 19 - 22 February 2004  Hotel Sofitel, Melbourne, Australia  IPCRG Melbourne 2004
The 2004 Australian Asthma Conference ‘A fresh breath – looking to the future’ 22 - 25 February 2004  Hotel Sofitel, Melbourne, Australia. Asthma Conference 2004