In this Issue September 2004

Making the most of your Environment this Spring

The Pharmacist and the Asthma 3+ Visit Plan

Position Paper on Spirometry Training Courses

Food for Thought

Research Funding

Conference Diary 2004

Making the most of your Environment this Spring

For those people who suffer from asthma and allergy, it is a time to be aware of allergen exposure. Allergens are common asthma triggers, and where appropriate, you may benefit from simple avoidance strategies that you can practise every day.

Advice on effective strategies is an essential part of managing allergic asthma.

Indoors

If you are allergic to dust mite, you should consider ways to reduce house dust mite in your home. Make sure you encase mattresses and pillows in mite-proof covers. Your pharmacist can advise on this. Remove soft furry toys and soft furnishings, if possible. Soft toys can be placed in the freezer overnight to kill dust mites.

Wash your bedclothes weekly in hot water (over 55°). Shake and air pillows and quilts in the sun weekly.  (Except for days with high pollen counts as pollen may adhere to material.)

When you are cleaning, wear a mask and dust with a damp or electrostatic cloth.

Rather than vacuuming, use a wet or electrostatic mop or consider installing a ducted or well-filtered vacuum-cleaning system.

Outdoors

People with asthma are commonly allergic to airborne pollen grains from grasses, trees and weeds. For the keen gardener, imported grasses, weeds and trees that are wind pollinated may cause airborne allergens.

Airborne allergens tend to worsen asthma symptoms during the pollen seasons, including Spring, Summer and the dry season in tropical regions, and following thunderstorms.

Note: Australian native plants are less likely to cause allergies, as are highly flowered plants because they produce less pollen (transported by bees) than wind-pollinated plants. Also remember that pollens can travel many kilometres from their source.

Avoiding Pollens

Some tips for avoiding pollens, particularly when the pollen count is high, are as follows:   remain indoors as much as possible before midday during the pollen season, on windy days and after thunderstorms; avoid activities known to cause allergen exposure, such as grass-mowing, taking picnics in parks; wash hands and face frequently and/or shower after outdoor activities; and  remove known allergens from areas close to the house, such as outside windows.

Pollen counts are often provided in various electronic and print media during Spring and Summer.

Spring Activities

So while you are compiling the house and garden Spring cleaning checklist you should also put some thought into your own asthma wellbeing checklist.

At Home   Clean the curtains and blinds* Steam clean the carpet* Discard old clothes	In the Garden   Clean out the garage* Paint the outdoor furniture* Dry mulch the garden*
*Don't forget to use a protective mask, clothing and gloves as appropriate.

Useful Resources

Asthma and Allergy

First Aid for Asthma

Asthma Action Plans

For more information or support, contact your local Asthma Foundation on 1800 645 130.
 

Asthma Foundations of Australia

Asthma Foundation of the ACT

Asthma Foundation of New South Wales

Asthma Foundation of Northern Territory

Asthma Foundation of Queensland

Asthma Foundation of South Australia

Asthma Foundation of Tasmania

Asthma Foundation of Victoria

Asthma Foundation of Western Australia

For more information on allergies go to
Australasian Society of Clinical Immunology and Allergy 

The Pharmacist and the Asthma 3+ Visit Plan

Community pharmacists –
essential partners in asthma care

The community pharmacist sees many people with asthma on a regular basis. Given this regular contact and their role as the patient’s medication expert, a pharmacist can assist by identifying and recruiting patients to the Asthma 3+ Visit Plan.

The Asthma 3+ Visit Plan is the GP intervention developed and promoted by the National Asthma Council's General Practitioners' Asthma Group. The Asthma 3+ Visit Plan rearranges the Australian Six Step Asthma Management Plan to allow the GP to work with the patient by conducting at least 3 asthma-specific consultations over a period of four weeks to four months. Care planning will also involve GPs working with the pharmacist and other health professionals in the management of people with asthma.

The Guild and the Pharmaceutical Society in consultation with the National Asthma Council’s Pharmacists’ Asthma Group have developed an Asthma 3+ Visit Plan information resource kit for pharmacy. The kit will assist the pharmacist to inform patients of the Asthma 3+ Visit Plan, reinforce its benefits to asthma management and encourage them to become involved or complete the Asthma 3+ Visit Plan.

Elements of the kit may be accessed on the Pharmacy Guild's website at
The Pharmacy Guild of Australia
(http://www.guild.org.au/public/currentissues/asthma3plus/)

Position Paper on Spirometry Training Courses

Components that should be taught at a spirometry training course are described by a position paper developed by the Australian and New Zealand Society of Respiratory Science and the Thoracic Society of Australia and New Zealand.

There are several spirometry training courses available to health professionals throughout Australia and New Zealand, but the content and practical components, course duration and quality, as well as experience and knowledge among course presenters/tutors/demonstrators, has wide diversity.

The desired outcome of endorsing Spirometry Training Courses is to set a minimum standard for course content and duration. This endorsement should help meet the needs of health professionals by assuring they are being taught the necessary skills to enable them to deliver a quality spirometry service to patients.

For a copy of the Position Paper please go to

Spirometry Training Courses

(http://www.anzsrs.org.au/spirotrainingposition.pdf)172 KB PDF File, Acrobat Reader required.

From the Asthma Management Handbook

Spirometry is preferred for diagnostic testing in asthma, and should be used for both diagnosis and assessment of progress in general practice.

The aim of spirometry in general practice is to assess variability of airflow obstruction, and to measure the degree of airflow obstruction compared to predicted normal. 

Accurate measurement of respiratory function is necessary to assess and manage asthma. Successive measurements before and after bronchodilator use allow you to: 

• diagnose airway obstruction
• measure the degree of airway obstruction
• monitor the effects of treatment 
• demonstrate the presence and reversibility of airway obstruction to the patient
• provide objective feedback to the patient about the presence and severity of asthma
• accurately back-titrate preventive medication to determine the minimum effective dose.

The diagnosis of asthma is confirmed by demonstrating the presence of variable airway obstruction.

Spirometry is the method of choice as the measurement of peak expiratory flow (PEF) with conventional peak flow meters has significant limitations.

Most adults, and children over 7 years of age can perform spirometry.

The National Asthma Council recommends that all doctors managing asthma should have access to and use a spirometer for this purpose. 

Food for Thought

Where a person has an acute asthma attack triggered by a food allergy or a chemical intolerance, the reactions can be catastrophic. The triggers are largely avoidable and need to be identified by appropriate investigations organised by a doctor.

Fortunately food is not a common trigger for asthma with just 5% of people with asthma being affected by foods, drinks and food chemicals.

Nuts, fish, shellfish, milk, egg and various seeds can produce severe airway constriction in sensitised people. Reactions usually occur within minutes of eating, and asthma is usually just one of many reactions a person may experience.

Coexistence of unstable asthma and peanut allergy is particularly dangerous and has led to a number of deaths. Specialist advice about avoidance and a written Asthma Action Plan including adrenaline is strongly advisable.

What about dairy foods?

There is no clinical evidence that reducing or eliminating dairy products will improve asthma symptoms or control, despite a strong community belief that cows' milk allergy is an important cause of asthma. Cows' milk allergy usually causes skin or gastro-intestinal symptoms.

Respiratory symptoms are uncommon.

There is no medical foundation for the widely held view that dairy products increase mucus secretions.

Parents may need advice from a paediatric specialist or an allergy specialist and dietician to see if withdrawal of cows' milk is necessary.

Changing from dairy to soy may not be an answer as these products may possess similar allergic potential.

What about food additives?

Food additives can trigger asthma and can be difficult to diagnose. Only metabisulfite/sulphur dioxide (additive numbers 220-228) has been shown as a frequent trigger of asthma. It is found in many foods and beverages (including most 'fast foods' and sausages) and usually triggers asthma in susceptible individuals within minutes of eating.

Monosodium glutamate (additive No.621) is not a common precipitant of asthma attacks.

However, an attack of asthma induced by monosodium glutamate can be severe and it is difficult to establish cause and effect as symptoms may not appear until 12 hours after eating.

Because additives are found in a large and ever-changing range of foods, consultation with a clinician or dietitian who has specific expertise in this area may be helpful.

Should a person with asthma change their diet?

Diets for the treatment of asthma are only necessary where specific food or additive sensitivity has been demonstrated.

Any form of food or chemical challenges in people with asthma must be medically supervised in appropriate surroundings, which allow for monitoring and treatment of severe airway constriction or anaphylaxis resulting from a challenge test.

Aspirin Sensitivity

For people who have aspirin-sensitive asthma, dietary salicylates may contribute to poor asthma control. Check with your doctor, as salicylates are contained in some quite "ordinary" foods.

Just like everyone else, people with asthma should consume a wide variety of nutritious foods and talk with your doctor if you have any concerns about your diet.

Useful Resources

Asthma and Food Fact File

Asthma Management Handbook - Asthma and Food)

Australasian Society of Clinical Immunology and Allergy
(http://www.allergy.org.au)

Research Funding

The Victorian Public Health Research and Education Council (VPHREC) was established to foster cooperative research; strengthen links between research organisations, industry, educational, government and non-government institutions; and strengthen the culture of public health research and education. The VPHREC publishes a weekly newsletter that includes information about possible sources of funding for research.

If you would like to receive a copy of the VPHREC newsletter please contact Julia Veitch, Project Officer, Victorian Public Health Research and Education Council on email.
julia.veitch@vphrec.com.au

Current Research Opportunities

The CHATA Ann Woolcock Australian Fellowship

Call for Applications for 2005

Community Health and Tuberculosis Australia (CHATA) is offering a new 3-year full-time postdoctoral fellowship in biomedical, clinical or public health research anywhere in Australia.

The Fellowship is valued at approximately $100,000 per year and aims to encourage people of outstanding ability to develop research as a significant component of their career.

A Fellowship will support research relating to tuberculosis, respiratory diseases due to other infections, or respiratory diseases related to tobacco use. Research which also addresses community issues or the health of disadvantaged groups would be particularly welcome.

An information sheet and conditions of tenure for the 2005 award and other additional information and application forms can be found and downloaded from CHATA's website.

Applications close on Friday 1 October 2004

The CHATA Harry Windsor Australian Research Grants Scheme

Call for Applications for 2005

Community Health and Tuberculosis Australia (CHATA) is offering in 2005 several research grants of approximately $50,000 each.

These grants are offered nationally to support research in:

• Tuberculosis
• Respiratory diseases related to other infections
• Smoking-related respiratory diseases

Applications which particularly address community issues or the health of disadvantaged groups are particularly welcome.

Grants are available for projects in these areas which were submitted to the National Health and Medical Research Council (NHMRC) for consideration in 2004, were considered fundable by the NHMRC, but which did not receive funding for 2005.

Initial applications close on Friday 12 November 2004

Further more detailed information about both opportunities go to

CHATA
(http://www.chata.org.au)

The Asthma Foundation of NSW Research Grants for 2005

Applications are now open for the various awards available in 2005.

Biomedical/ Medical Postgraduate Research Scholarships

Applications are invited from researchers in biomedical and medical science seeking to undertake full-time research for higher degrees. The duration of these scholarships is 12 months and applications for further funding will need to be made on an annual basis. Scholarships are open to graduates who are Australian citizens or who have permanent residential status. Successful applicants will be advised in December 2004.
APPLICATIONS CLOSE AT 5pm on Monday 1st November 2004 for support commencing in 2005
 

Biomedical/ Medical Post Doctoral Research - Martin Hardie Travelling Fellowship

Applications are invited from researchers in biomedical and medical science seeking to travel overseas for post-doctoral experience during 2005-2006. The duration of the fellowship is at least 12 months and no longer than 24 months. Fellowships are open to PhD graduates who are Australian citizens or who have permanent residential status. Successful applicants will be advised in December 2004.
APPLICATIONS CLOSE AT 5pm on Monday 1st November 2004 for support commencing in 2005
 

Research Project Grants Project

Grants will ordinarily be awarded to institutions with appropriate research facilities in NSW or ACT. Project Grants will be for one year and must be used to support research programmes by a responsible investigator with the approval of the head of the appropriate department.

Project Grants may cover salaries for research, technical and other assistance or the cost of equipment, materials or other necessary items.

In 2005, the Project Grants that will be considered are those submitted in 2004 and assessed as “fundable” by the NHMRC project grants peer review process, but were not able to be funded by NHMRC in 2005.

For more information go to
Asthma Foundation of New South Wales
(http://www.asthmansw.org.au/research/researchindex.htm)