In this Issue August 2003

Occupational Asthma

What is occupational asthma?

Occupational asthma is the most common occupational lung disease in Australia and many other Western countries. It has been estimated that up to 15% of new asthma in adults is directly attributable to occupational exposures. Even more workers with pre-existing asthma find that their asthma is aggravated by occupational exposures.

What causes it?

Broadly speaking, there are two types of occupational asthma. One type is where there is a period of exposure to a compound that causes the immune system to react and the response develops into asthma. The second type may be a response to extremely high levels of exposure to irritant gases such as chlorine and ammonia.

Symptoms of Occupational Asthma

The most characteristic feature for the person with occupational asthma is symptoms that worsen on workdays and improve on rest days or holidays.

The person with occupational asthma may have work-related wheeze, chest tightness and breathlessness. Often these symptoms may occur at night or in the early morning after significant exposures.

Who gets occupational asthma?

Workers in many occupations may be exposed to substances in the air that may cause occupational asthma in susceptible people. Many of these substances are very common and not ordinarily considered hazardous, with only a small proportion of exposed workers going on to develop occupational asthma.

As occupational asthma may take several years to develop, the condition should be suspected whenever someone begins to develop respiratory symptoms.

A thorough physical examination and medical history for the person with asthma symptoms should include a detailed listing of his or her work history and workplace or environmental conditions.

Investigation and Management

As in other types of asthma, objective lung function testing is essential. All people with suspected occupational asthma should have spirometry and assessment of response to bronchodilator.

The most effective management is to stop exposure. Unfortunately, for many people this will mean a change of job or even loss of job. In all other respects, people should be managed by following the six steps of the Asthma Management Plan.

Long Term Outcome

Many people with occupational asthma do not fully recover, despite absence of further exposure. The duration of symptoms before removal from exposure is an important factor in final outcome and full assessment of permanent lung damage may take several years.

Prevention

The risk of occupational asthma can be significantly reduced by reducing exposures to known respiratory sensitisers and irritants, keeping them below the limits prescribed by health and safety regulations.

It is often possible to substitute less toxic materials. It may be possible to modify the process, or there may be engineering solutions such as fume extraction to prevent exposure to respiratory toxins. If exposure is unavoidable, the worker should wear appropriate respiratory protection.

It is also important to recognise that smoking may make the occupational asthma more severe. Smoking also increases the chances of getting other complicating lung diseases, such as emphysema, chronic bronchitis, or lung cancer.

So in addition to changing a job environment, the person with occupational asthma who also quits smoking is more likely to recover fully than someone who changes jobs but continues to smoke.

Useful Resources

Occupational Asthma - Asthma Management Handbook 2002

“A Fresh Breath – looking to the future”

2004 Australian Asthma Conference, Monday 23 – Wednesday 25 February 2004

The 2004 Australian Asthma Conference will explore the theme ‘A Fresh Breath – looking to the future’ at the Hotel Sofitel in the heart of Melbourne. With the program and registration available online, now is the time to book for the opportunity to consolidate your knowledge and understanding of asthma and its management as we look to the future challenges that will face us in asthma management in Australia.  

The Conference is for all people involved in the care and management of people with asthma. Asthma educators, practice and respiratory nurses, community health workers, general practitioners, pharmacists, researchers and indeed those who deal with asthma will benefit from being a part of this informative and interactive conference.

The 2004 Australian Asthma Conference will combine a mix of keynote plenary sessions together with streamlined small group workshops from leading Australian and international speakers including:

• Assoc Prof Guy Marks – The burden of asthma
• Professor David Price – The impact of asthma on the individual and quality of life
• Professor Lloyd Sansom – The cost of asthma to the community
• Assoc Prof Gary Anderson – An international research update
• Dr Peter Gibson – Evidence-based asthma education
• Professor Grant Sutherland – Genome medicine and asthma
• Professor Peter Sly – The changing face of asthma
• Assoc Prof Susan Sawyer – Paediatric asthma management

Call for Abstracts

The 2004 Australian Asthma Conference Program will include poster and a limited number of oral presentations selected from submitted abstracts. Details of how to prepare and submit an abstract are included on the conference website.

The closing date for submission of abstracts is 21 November 2003.

Register Now

Full details of the 2004 Australian Asthma Conference program, social activities, accommodation options and conference registration are available on the Conference website.

Website and Contact Details

Australian Asthma Conference 2004

Registration Australian Asthma Conference

Phone: Asthma Victoria (03) 9326 7088

Email: Conference Secretariat  convention@optushome.com.au

Device Dilemma

Choosing the right delivery device

All people with asthma need to know how to use their medication delivery device. Correct technique and proper approach to cleaning are necessary to obtain the best response from the medication.

The choice of delivery device for use by special groups of people such as children, the elderly, sight impaired, hearing impaired, people with reduced hand dexterity or strength and people with reduced ability to inhale with any force is vital.

Careful explanation and demonstration of device use should be made initially. Regular assessment of a person's device technique should also occur and not just if symptom control is poor. Increasing the amount of medication may not be necessary if a poor technique can be corrected. Alternatively, improved technique may allow for titration down of medication.

Staying current

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:

• Metered Dose Inhalers (MDIs) - various products
  Autohaler - beclomethasone and salbutamol
   
• Dry Powder
  Accuhaler - salmeterol, fluticasone, and the combination of salmeterol and fluticasone
  
  Aerolizer - eformoterol
  
  Rotahaler - salbutamol
  
  Turbuhaler - terbutaline, budesonide and eformoterol and the combination of budesonide and eformoterol
   
• Valved spacers
  AeroChamber, Breath-A-Tech, Fisonair, MEDI-Spacers, Nebuhaler, Space Chamber, Volumatic

Improving adherence

As demonstration of delivery devices is a routine requirement in managing patients with asthma, all health professionals should be familiar with the range of devices available. An excellent resource is available to assist with patient education "How to Correctly Use Inhaled Respiratory Medication Devices" from the Lung Health Promotion Centre at the Alfred.

The CD Rom is specifically designed for GPs and other health professionals and is suitable for both professional and patient education on the correct use of inhaled respiratory medication devices.

With research showing that up to 80% of patients with respiratory illnesses do not use their inhaled medication devices correctly, a rewarding question to ask in every asthma consultation may well be "Show me how you use your inhaler?".

Useful Resources

For more information on drug delivery devices go to Asthma Management Handbook 2002

For the device CD Rom go to
Lung Health Promotion Centre (www.lunghealth.org/resources.htm#devices)

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

A Smoke Screen

Asthma and smoking just do not go together. People with asthma and who smoke need all the help they can get to quit. 

Therefore it was very disappointing to read in a major daily newspaper published recently that "scientists have found evidence that smoking might, in some circumstances, help prevent the onset of various dementias." The evidence behind this statement was not presented, only an English dementia specialist is quoted.

A review of the Action on Smoking and Health (ASH) website revealed an interesting media release reporting on research showing that smoking in all circumstances accelerated memory loss.
 

So now there is research from the UK that shows smoking makes you cranky, incompetent and forgetful.
 

Useful Resources

For the full story on 'cranky and incompetent' smokers

For access to ASH 'Smoke Signals' newsletter

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 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
IPCRG 2nd World 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. Australian Asthma Conference 2004
The Thoracic Society of Australia and New Zealand  2004 Annual Scientific Meeting  Sydney Convention Centre  19-24 March 2004 TSANZ Annual Scientific Meeting Sydney
Australian & New Zealand Society of Respiratory Science  2004 Annual Scientific Meeting Sydney Convention & Exhibition Centre, Darling Harbour 19 - 21 March 2004 ANZSRS Annual Scientific Meeting Sydney