In this Issue August 2005

Complementary Therapies and Asthma 

Asthma and Smoking 

Asthma in Community Medicine 

National Asthma Council Website 

Research Funding Opportunities 

Conference Diary 2005

Complementary Therapies and Asthma

In recent years there has been increasing use of complementary therapies for the treatment of many conditions, including asthma. There are many reasons why people might choose to use complementary therapies. For example, they may not be happy with Western medicine or may see complementary therapies as ‘safe and natural’. Some people feel that using complementary therapies gives them more control over their treatment.

Whatever the reason for using a complementary therapy for the treatment of asthma, the decision should be based on accurate information and informed, objective opinion - and made in consultation with your doctor.

Overall, there is less information available about the safety and effectiveness of complementary therapies than is available about pharmaceutical treatments (medicines). However, we are learning more about complementary therapies and information is increasing and constantly being updated.

Information about Asthma

The National Asthma Council recruited an advisory panel of eight leading Australian health experts to review and assess a wide range of complementary therapies for asthma – from vitamins, herbs and nutritional supplements, to chiropractic, acupuncture, hypnotherapy and even speleotherapy (spending time in caves or salt mines).

The result is a consumer information booklet and a health professional guide specifically designed to demystify complementary therapies, highlighting areas that may benefit people, as well as therapies that need to be treated with caution.

Useful Resources

Asthma and Complementary Therapies - An evidence-based guide

Asthma and Complementary Therapies - A guide for health professionals

Asthma in Community Medicine

The July edition of Australian Family Physician has useful a series of article collected under the theme of "Shortness of Breath".  Two articles, in particular, address acute asthma attack and spirometry in community practice.

Management of an acute asthma attack

An acute severe asthma attack is one of the most common emergencies a general practitioner will encounter. The author Professor Amanda Barnard (Associate Dean (Rural and Community School), and Head, Academic Unit of Rural Health, Medical School, The Australian National University, Canberra, ACT) explains the need to have a clear and simple plan and a systems approach for staff to deal with the acute situation. There is also a need for GPs to be proactive and have an awareness of who is more likely to present in an emergency situation, as well as having careful follow up plans in place for those who do present acutely.

Spirometry: an essential clinical measurement

The use of spirometry by GPs, practice nurses and physiotherapists is now practicable and supported by a comprehensive range of devices, training courses and reference materials. Professor Rob Pierce (Professor of Respiratory Medicine, University of Melbourne, and Director, Respiratory and Sleep Medicine and Institute for Breathing and Sleep, Austin Health, Victoria) explains that the systematic use of lung function assessment both in the clinic and with a person self monitoring of peak flow and FEV₁ has the capacity to improve patient understanding, confidence in self management, and quality of life for those with asthma and other lung diseases.

Several important points are highlighted by Professor Pierce including:

• Spirometry should be performed in all people over 40 years of age who have ever smoked, and in those with any symptom of possible respiratory origin.

• COPD is easily detected before symptoms develop, and smoking cessation at this point is of major benefit.

• Spirometry is vital in the management of asthma to assess severity and response to treatment and to guide management.

• An increase in FEV₁ of >12% (or >200 mL) suggests asthma, although normal spirometry in a well patient does not exclude it.

These articles may be found at

Australian Family Physician - "Shortness of Breath"
(http://www.racgp.org.au/folder.asp?id=1202)

Useful Resources

3+Visit Plan

Asthma Action Plans  

First Aid for Asthma  

Asthma and Smoking

Asthma and active cigarette smoking interact to cause more severe symptoms, accelerated decline in lung function, and impaired short-term therapeutic response to corticosteroids.¹ Yet around the world in developed countries some 25% of adults with asthma are cigarette smokers. One of the most distressing sights is a person with a pack of cigarettes and a reliever puffer in the same hand.

Current smoking rates among people with asthma from the USA and UK range from 17–35%. Data from the USA show that adults presenting to hospital emergency departments with acute asthma had particularly high rates of smoking. Also an additional number of adults with asthma were former smokers, with prevalence rates ranging from 22–43%. So, at least one-half of adults with asthma are likely to be current or former cigarette smokers.

Why is this Important?

Published data on airway pathology, although limited, does point to changed inflammatory responses. There is a corticosteroid resistance in people with asthma.

Apart from any physical challenges, current smokers with asthma are less likely to:

• use appropriate methods to manage their condition. A study of patients presenting with acute asthma to emergency departments in the USA found that current smoking was a predictor for lack of asthma knowledge and self-management skills.
   

• use inhaled corticosteroids or peak flow meters, and to alter treatment during an exacerbation compared with nonsmokers, according to a UK community-based study of chronic asthma.
   

• attend asthma education programmes. An outpatient-based study of 125 adults with asthma, showed that only 4% of smokers, compared with 31% of former smokers and 65% of never-smokers, completed an asthma education programme.

What can be done?

Every effort should be made to encourage people with asthma who smoke to stop.

The person with asthma who smokes may be in need of extra support to initiate the quit process as well as alternative or additional therapies to inhaled corticosteroids for those who are unable to quit smoking.