 In
this Issue September 2003
Spring Feature
Early Bird IPCRG Registration - Act Now
Inhaled Corticosteroids: a practical perspective
Spirometry Audiovisual Resources
Food and Asthma Risk in Young Adults
Take up the Asthma Leadership Challenge
Conference Diary 2003/4
Spring Feature
With the warmer weather on its way, it is traditional to
undertake a spring clean. More daylight hours mean many people will have the
urge to clean out the house, work on the garden or go for a walk in the park.
For those people who suffer from asthma and allergy, it is a time to be aware of
allergen exposure. So while you are compiling the house and garden spring
cleaning checklist you should also put some thought into your own asthma
wellbeing checklist.
Spring Asthma Wellbeing Checklist
-
Do I have a Written Asthma Action Plan?
-
Is my Written Asthma Action Plan up-to-date and easy to
find?
-
Are all my asthma medications up-to-date?
-
Reliever medication (bronchodilators)
-
Preventer medication (anti-inflammatory
agents)
-
Symptom controllers (long-acting relievers)
-
Combination medications (preventer plus
symptom controller).
If you answered yes to all the questions, fantastic! If not,
take action today by going to
National
Asthma Council Spring Feature
Early Bird IPCRG Registration - Act Now
| The National Asthma Council urges primary care health
professionals to register now for the International Primary Care
Respiratory Group (IPCRG) Second World Conference and take advantage of
early bird registration which closes Friday 10 October 2003. |
 |
The IPCRG Conference covers all facets of respiratory medicine
including asthma, respiratory, allergy, chronic obstructive pulmonary disease
(COPD), tuberculosis, pneumonia, infectious diseases and cough. The organisers
of the Conference, to be held in Melbourne from 19 – 22 February 2004, expect a
strong Australian and New Zealand contingent and aim for global representation.
"The conference would be relevant for all countries as no country,
developed or developing, is free from respiratory conditions such as
asthma. Raised awareness and better asthma management within available
resources is a global priority.
The first IPCRG Conference
was held in Amsterdam in 2002 and it is a major coup to secure the
second world conference in Australia. This is testimony to our
commitment in leading the way in respiratory medicine. The 2004
conference program will showcase new developments in respiratory
disease, research and management and include clinical and scientific
issues presented in an atmosphere of friendliness and collaboration.
Open dialogue is crucial to identifying primary care solutions to
primary care problems."
Dr Ron Tomlins, Chair National Asthma Council |
As well as attracting a strong international presence, the
2004 conference will feature a number of local health experts. This will provide
an excellent opportunity for both international and local health professionals
to share the latest in research and best practice.
Keynote speakers include:
-
Professor Richard Beasley (New Zealand);
-
Dr H. John Fardy (Australia);
-
Dr Christine Jenkins (Australia);
-
Dr Isobel Martin (New Zealand);
-
Professor David Price (United Kingdom);
-
Professor Onno van Schayck (Netherlands); and
-
Professor Cheong Pak Yean (Singapore).
The current Co-Presidents of the International Primary Care
Respiratory Group are Dr H. John Fardy, Chair of the National Asthma Council’s
GP Asthma Group and Associate Professor Jim Reid, Head of General Practice,
Dunedin Medical School, New Zealand.
For further information and to register go to the official
conference website
IPCRG
2004 Melbourne (www.ipcrg-melbourne.org)
Inhaled Corticosteroids: a practical
perspective
 Released
in early September, "Inhaled corticosteroids: a practical perspective" presents
the rationale and evidence-based information indicating that optimal asthma
control can be achieved with lower doses of inhaled corticosteroids (ICS) than
were previously used.
Despite the advent of new asthma therapies, ICS remain the most
effective agents for gaining and maintaining control of asthma.
The underlying inflammatory nature of asthma means that inhaled
corticosteroids are the mainstay of management for patients with persistent
disease at any level of severity. The use of inhaled corticosteroids has been
associated with lower asthma mortality rates and a reduced need for
hospitalisation, as well as an improvement in quality of life for children and
adults with asthma.
The key goal of asthma management with inhaled corticosteroids
is to achieve optimal asthma control with the lowest effective dose. The dose of
ICS needed to gain control of asthma should be that which is most appropriate to
the severity of the underlying disease. Importantly, the dose should then be
reduced as necessary to maintain symptom control. There is now Level 1 evidence
to show that most of the clinical benefit of inhaled corticosteroids is derived
with low to moderate doses, with little or no further benefit at higher doses.
Regular review is important to enable proper assessment and
maintenance of asthma control.
"Inhaled corticosteroids: a practical perspective" shows the
latest approach to ICS use in asthma.
|
What's old?
-
High doses of ICS (400-1000 mcg HFA-BDP or FP;
800-2400 mcg BUD) were recommended for controlling moderate to
severe asthma symptoms and improving lung function.
-
The recommended doses were not based on evidence of
dose-response relationships for systemic effects.
What's new?
-
High doses of ICS achieve minimal additional
clinical benefit compared with moderate and low doses, while
significantly increasing the risk of adverse effects.
-
Risk of catastrophic treatment-related adverse
effects in children is associated with prolonged high-dose ICS.
-
Stepping down of ICS is recommended for maintenance
of asthma control.
-
Regular reassessment is important to monitor
response to treatment and adjust dose to minimum effective dose.
From "What has Changed?" -
Inhaled
Corticosteroids: a practical perspective
|
The minimum effective dose of ICS is achieved through
ongoing assessment of asthma control. Both symptoms and spirometry should be
used to monitor treatment, so that dose reductions take place against a
background of stable asthma.
For the full text and references go to
Inhaled
Corticosteroids: a practical perspective
Spirometry Audiovisual Resources
 Want
to include spirometry in your Asthma 3+ Visit Plan consultation?
Now you can review spirometry technique and interpretation at
your leisure with Associate Professor John Wilson, respiratory physician, and Mr
Bruce Thompson, respiratory scientist, from The Alfred Hospital.
Two short audiovisual presentations cover the role of spirometry
in the general practice setting for the diagnosis and management of asthma.
Video Clip One shows a practical example of the technique for
performing spirometry on a patient in the surgery including:
-
Introducing and explaining the test procedure to the
patient.
-
Coaching the patient through the test.
-
Obtaining the best possible patient effort.
Video Clip Two covers:
-
Advice for the patient about medication prior to coming for
the test.
-
What the patient can expect during the test.
-
When spirometry should not be attempted.
-
How to optimise results.
-
What the results show about asthma.
The preferred objective measurement for the diagnosis,
management and monitoring of asthma is spirometry. With practice, the GP can
deduce a great deal of information about the state of the lungs from the shape
of the flow/volume loop.
The National Asthma Council spirometry video resources should
assist you to make the most of lung function testing for all your patients with
asthma.
The Role of Spirometry in General Practice
Food and Asthma Risk in Young Adults
The media spotlight is constantly on diet and lifestyle, often
with little evidence-based information to back claims made. For the younger
person with asthma a well-balanced, nutritious diet is important to assist in
maintaining health and building bone mass. However some people may unnecessarily
exclude certain foods from their diet in the belief that their asthma will be
improved.
A recently published study of young adults has revealed some
interesting results in trying to determine whether the food and nutrient intake
differed between those with asthma and those without asthma. The
community-based, cross-sectional research of 1601 young adults was conducted in
Melbourne, Australia in 1999.
The participants completed:-
-
a detailed respiratory questionnaire,
-
a validated semiquantitative food-frequency questionnaire,
-
skin-prick testing, and
-
lung function tests, including a methacholine challenge test
for bronchial hyperreactivity (BHR).
A total of 25 nutrients and 47 food groups were analysed with
alternate definitions of asthma and atopy as the outcomes.
Some Food-Asthma Associations* |
| |
Current
asthma
|
Doctor-diagnosed asthma
|
Bronchial
hyperreactivity |
Atopy |
| Whole milk |
protect
against asthma |
protect
against asthma |
protect
against asthma |
protect
against asthma
|
| Apples and
pears |
protect
against asthma |
protect
against asthma
|
protect
against asthma
|
|
| Soy
beverage |
increased
risk of asthma |
increased
risk of asthma |
increased
risk of asthma |
|
| *Adapted from
Food and nutrient intakes and asthma risk in young adults, Rosalie K
Woods, E Haydn Walters, Joan M Raven, Rory Wolfe, Paul D Ireland, Frank
CK Thien and Michael J Abramson
American Journal of Clinical Nutrition, Vol. 78,
No. 3, 414-421, September 2003
|
The authors concluded that foods, rather than specific nutrients, are
associated with current asthma and alternative definitions of asthma and atopy
in young adults.
For people with asthma, avoiding certain foods may not be helpful
particularly where dairy products are concerned. Eating a well balanced diet,
including dairy products, and fruits, may better serve young people in managing
their asthma now and improve their long-term bone health into the future
Useful Resources
Asthma and
Food Fact File
Take up the Asthma Leadership Challenge
The Asthma Leadership Challenge (ALC) is an educational
initiative supported by the National Asthma Council and AstraZeneca Australia.
The aim is to bring together small groups of GPs and encourage
them to review their strategy for achieving minimum effective doses of inhaled
corticosteroids (ICS) for the majority of patients while maintaining or
improving asthma control.
The National Asthma Council has provided guidelines for best
practice in their recently released information paper entitled "Inhaled
corticosteroids: a practical perspective". A key objective of the ALC is to
increase GP confidence in back titration to achieve minimum effective dosing of
ICS alone or in combination with a long-acting ß2-agonist
(LABA).
Through participation in the ALC, GPs can earn 35 (Group 1
Activity) clinical audit CPD points with the chance to earn an extra 20 (Group 1
Activity) CPD points through Small Group Learning with four GPs or more.
‘Best Practice’ groups will be recognised with Asthma Leadership
Awards; offering publications, medical equipment, and electronic medical
resources.
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
|
 |
|
