In this Issue February 2006

Smoking and asthma

Extra health risks for older people with asthma

TSANZ Annual Scientific Meeting

Finding reliable health information

Research Funding Opportunities

Asthma Targeted Intervention Grants 2006 (Updated information) 

Conference Diary 2006

Smoking and asthma

New graphic health warnings for Australian cigarette packs

Despite the known additional health risks, just as many people with asthma smoke as people without asthma. Rates of smoking among people with asthma are highest in young adults.¹ Overall, around 40% of children who have asthma live with smokers and are likely to be exposed to passive smoke.

For people with asthma who do smoke and for smokers around people with asthma, providing support to quit smoking is vital. The introduction of new graphic health warnings on Australian cigarettes packs from March 2006 may provide an extra impetus.

Why have graphic health warnings on cigarette packs?

Even in countries where consumers have had reasonable access to information about the health effects of smoking, the evidence suggests that there are widespread misconceptions about these effects, due, in part, to cigarette packaging and labelling. Prominent warnings and messages increase awareness of the risks of smoking and increases motivation to quit. Rotating the messages keeps the information from becoming stale and worn out.

Generally there is high awareness that smoking is harmful by Australian smokers, but research shows that there is still a lack of appropriate awareness of the range of diseases caused by smoking and of the risk smoking poses for their health. However, evidence suggests that warning labels can still be effective in this situation, provided that they are large, prominent, and contain hard-hitting and specific factual information.

According to research from the International Tobacco Control (ITC) Policy Evaluation Project, warning labels act as health interventions. A pack a day smoker may be exposed to these warning labels over 7000 times a year leading to increased salience, and increases in stubbing out early and motivation to quit.

Their research indicates that the labels make smokers:

• Think about the health risks
• More likely to quit smoking
• More likely to stay quit

Seventy-five percent of smokers want to quit and research has shown that to be effective, warnings need to be noticed, persuasive and provide guidance for appropriate action by smokers.

Evaluation undertaken nine months after Canada introduced graphic warnings found that 58% of smokers said the pictures had made them think more about the health effects of smoking; 44% said the warnings increased their motivation to quit smoking and 38% of smokers who tried to quit in that year said that the new warnings were a factor in motivating this.

What the warnings entail

Picture based health warnings will appear on cigarettes packs and cartons, occupying 30% of the front and 90% of the back of packages. The back will include a graphic picture, text warning, explanatory message, quitting website and Quitline logo and number. The front will include a picture and text warning.

A new information message is also required on one full side of all cigarette packs replacing misleading tar, CO and nicotine levels. It states:

Smoking exposes you to more than 40 harmful chemicals

• These chemicals damage blood vessels, body cells and the immune system
• QUIT NOW to reduce your risk of chronic illness or premature death

There are two sets of seven warnings.

Set A is required to appear on all tobacco manufactured from 1 March 2006 and will be appear on packs at least, until 31 October 2006. There will then be a transition period (1 November 2006 – 28 February 2007) where Set A or Set B can be displayed. From 1 March 2007 – 31 October 2007 only Set B may be placed on packs. The warnings are to appear equally on packages.

Set A warnings are:

• Smoking causes peripheral vascular disease (pic – gangrene foot)
• Smoking causes emphysema (pic – emphysemic and healthy lungs)
• Smoking causes mouth and throat cancer (pic- mouth cancer)
• Smoking clogs your arteries (pic – artery with fatty material)
• Don’t let children breathe your smoke (pic - child in bed with nebuliser)
• Smoking – a leading cause of death (pic – graph of causes of death in Australia)
• Quitting will improve your health (pic – Quitline operator)

Set B warnings are:

• Smoking harms unborn babies (pic – premature baby on oxygen)
• Smoking causes blindness (pic – eye)
• Smoking causes lung cancer (pic – lung cancer)
• Smoking causes heart disease (pic – heart bypass operation)
• Smoking doubles your risk of stroke (pic – brain with stroke)
• Smoking is addictive (pic - tar stained fingers with cigarette)
• Tobacco smoke is toxic (pic – beaker of tar with scull and crossbones label)

Further information can be found at

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-pubhlth-strateg-drugs-tobacco-warnings.htm 

Taking action

To capitalise on this unprecedented opportunity, several of Australia’s most prominent tobacco control organisations are joining together to develop a national campaign, focusing on making the new pack warnings personally relevant to smokers. It is hoped that by adding depth and meaning to the new pictorial health warnings, the campaign, will increase the likelihood of smokers making a successful quit attempt.

Executive Director of Quit, Mr Todd Harper said, "The new graphic pack warnings, combined with the implementation of state-based tobacco reforms, offered a once in a lifetime opportunity to get smoking rates lower than ever before in Australia.”

The introduction of graphic health warnings means that every time someone buys a pack of cigarettes they will be exposed explicitly to the harms of smoking, and then once again, each time they reach for a cigarette. These important changes will be backed up with media campaigns highlighting the dangers of smoking and providing smokers with encouragement to call the Quitline. 

1. AIHW Australian Centre for Asthma Monitoring 2005. Asthma in Australia 2005. AIHW Asthma Series 2. AIHW cat. no. ACM 6. Canberra: AIHW.

For help to Quit smoking, call 13 QUIT (13 7848)

Resources Available from Quit

Smoking, Pregnancy and Infants Background Brief. Downloadable from www.quit.org.au
Smoking and pregnancy brochure.
Staying stopped after pregnancy brochure
Passive smoking and your children brochure
Important information for fathers who smoke brochure
Can you think of a better reason to quit? postcard
Smoking and Asthma brochure
Stop smoking for your loved ones poster (multi language)

Extra health risks for older people with asthma

New research shows that older adults with asthma are at an increased risk for developing cancer, and adults with asthma are twice as likely to suffer from heart disease and other chronic health conditions.¹ A study from South Australia published in the February issue of CHEST, shows that adults with asthma over age 55 have an increased risk of developing cancer, compared with adults without asthma. Additionally, the study shows that adults with asthma are twice as likely than those without asthma to suffer from at least one comorbid chronic condition, including heart disease, diabetes, arthritis, stroke, cancer, and osteoporosis.

Lead author Dr Robert Adams from The Queen Elizabeth Hospital, said, "Asthma and allergy-related diseases are usually associated with lower cancer levels. However, our study found an increased cancer risk among older patients with asthma."

The researchers examined the prevalence of common, chronic medical conditions in adults with and without asthma and how comorbid chronic health conditions affect quality of life. Asthma status, demographics, quality-of-life scores, and information about work/activity impairment were gathered from 7,619 adults in three Australian states.

Of those surveyed, 834 adults reported current doctor-diagnosed asthma. Overall, adults with asthma were twice as likely as those without asthma to report having other chronic conditions, with the most prominent conditions being heart disease and stroke. For those over age 55, cancer was significantly more prominent than in adults under age 55. All other chronic conditions, except diabetes, were significantly more common in older adults with asthma. Among adults with asthma aged between 35 and 54 years, arthritis was substantially increased in frequency.

"Asthma's link to other chronic conditions appears to be age-related. As adults with asthma age, the likelihood of developing other chronic conditions becomes greater," said study co-author Professor Richard E. Ruffin. "Clinicians caring for older adults with asthma need to consider comorbid chronic conditions when developing asthma action plans. Young adults with asthma, who are at risk for developing other chronic conditions, also should be targeted for primary or early secondary prevention of these conditions."

Researchers stress that following the principles of a healthy lifestyle, such as healthy eating, good asthma control with minimal medication, and annual medical exams, will help reduce a person's risk of developing chronic health conditions.

Although it is unclear which condition developed first, researchers believe a number of factors may contribute to the co-occurrence of asthma and other chronic conditions.

"It is possible that respiratory problems related to asthma may limit a patient's activity, which can lead to weight gain and associated chronic conditions like diabetes, heart disease, arthritis, and sleep disorders," said Dr Ruffin. "Depression is common for patients with chronic conditions and may contribute to further decreased health and quality of life."

Overall, people with asthma were more likely to report

• recent impairment in work or usual activities,

• decreased physical health, and

• significant impairment in physical quality of life due to illness.

The additional presence of any of the chronic conditions was associated with significant further impairment of physical health and quality of life.

Physical scores also were much lower in people with both asthma and the chronic conditions then would be expected from asthma or a chronic condition alone. The negative impact of combining asthma with other chronic conditions was not seen in adults under 35 but was significant in adults over 35 years and became more marked in those aged 55 years and over.

Adams RJ, Wilson DH, Taylor AW, Daly A, Tursan d'Espaignet E, Dal Grande E, Ruffin RE. Coexistent chronic conditions and asthma quality of life: a population-based study. Chest. 2006 Feb;129(2):285-91.

TSANZ Annual Scientific Meeting

The Thoracic Society of Australia and New Zealand Annual Scientific Meeting will take place at the National Convention Centre, Canberra from 24 - 29 March 2006.

National Asthma Council Australia Breakfast Session
7.15 - 8.15 am, Tuesday 28 March 2006.

Title:

'Preventing severe asthma and asthma mortality - what did we do to reduce the death rate, and what should we be doing now?'

Focusses:

Advances in asthma care, roles of primary and secondary care physicians in prevention and reduction of severe asthma and of ICU admissions and deaths, challenges still to be addressed. What have we (the medical fraternity and asthma organisations) achieved, and what still needs to be done?

Speakers:

Assoc. Prof. John Wilson (chair)

Introduction including overview of NAC's major activities/successes over past 15 years

Dr David Pilcher, intensivist (TBC)

Improved outcomes of acute severe asthma in ICU

Dr Kerry Hancock, GP

GP perspective including sources of information, difficulties in implementing guidelines in GP setting and role in prevention of severe asthma/ICU admissions

Assoc. Prof. Peter Van Asperen, paediatric respiratory physician

Paediatric perspective including diagnosis, medications and optimal management in children and reference to paediatric ICU study

Assoc. Prof. Jo Douglass, adult respiratory physician

Adult respiratory perspective including patient education and issue of under diagnosis in the elderly

Summary discussion: panel and audience

For more information about the TSANZ Meeting go to

(http://www.thoracic.org.au/asm2006.html)

Finding reliable health information

The Cochrane Library

Information about health is everywhere.

One of the ways health professionals and consumers can make sense of all the research going on around the world is to access the Cochrane Library.

The Cochrane Library

• brings together in one place research which looks at the effectiveness of different health care treatments and interventions.
• is recognised as the best single source of information on the effects of health care.
• is designed to provide information and evidence to support decisions taken in health care and to inform those receiving care.

All residents of Australia with access to the Internet can utilise this highly respected international collaboration of health professionals, consumers and researchers for free. 

You may get to the Cochrane Library by clicking on the NAC Search button at the top of the page. or go to

The Cochrane Library 
(http://www.nicsl.com.au/cochrane/index.asp)

Research Funding Opportunities