In this Issue July 2006

Beware the stress of a winter cold

It's never too late....to improve your lung function

IPCRG: Norway in the northern Summer

Excerpts from the IPCRG 3rd World Conference Highlights Bulletin

  - Allergy

  - Experiences from Downunder

  - International perspectives on national asthma programs

Research Funding Opportunities 

Conference Diary 2006

Beware the stress of a winter cold

Common colds are quite different to influenza, which is a more serious illness. Many people use the term 'flu when they are really describing a common cold.

Flu symptoms usually start suddenly with a high fever and you may feel sick enough to go to bed, whereas the common cold usually affecting the nose and throat only means that many people carry on with their normal routine.

Colds are also very common with more than 200 different viruses around. Children can get as many as five to ten colds per year while adults can get two to four. Children get more colds than adults because they less immunity  to the many cold viruses compared with adults.

Asthma and a cold may be a challenge

While colds may not be as serious as influenza, catching a cold may be quite a challenge for a person with asthma, particularly an older person because of other conditions for which they are already being treated such as:

• emphysema, bronchitis 
• high blood pressure and heart problems
• arthritis, osteoporosis
• glaucoma, cataracts
• tremor.

A sensible winter approach

If you notice that you are using your reliever a bit more often than usual it could be a sign that you have worsening asthma. It may be a good time to check your Written Asthma Action Plan, make sure you are taking your preventer medication regularly or visit your doctor to discuss or update your Written Asthma Action Plan.

Resources

Asthma Action Plans

First Aid Chart

Asthma & Influenza - the Facts

Vaccine Update for people with asthma, COPD, or diabetes

Common Colds need Common Sense

It's never too late....to improve your lung function

For the one in four adults with asthma who smoke, quitting smoking can improve lung function test scores rapidly.

Your doctor may have asked you to have a lung function test (a breathing test) to help identify if you have asthma or work out how severe your asthma is.^1,2 There are two breathing tests used for asthma – spirometry and peak flow measurement. Both measure how well your lungs are working and how much your asthma affects your breathing.

Spirometry is the most accurate breathing test for asthma to:

• help identify if you have asthma

• help work out how severe your asthma is

• see if your asthma is getting worse

• see if your asthma is improving with treatment.

In a study recently published in American Journal of Respiratory and Critical Care Medicine, Dr Neil C. Thomson of the Departments of Respiratory Medicine and Immunology at the University of Glasgow found that adults who quit smoking improved their lung function by more than 15 percent in less than two months.³

Dr Thompson and his colleagues studied 11 people with asthma who continued to smoke and 10 who quit for six weeks. After only one week of no cigarettes, the researchers said that the lung function test results of the non-smoking patients had improved to a "considerable degree."

In addition to the improved lung function test scores, the "quit" group also showed a reduction in sputum neutrophil counts when compared to those of smokers. Neutrophils are white blood cells (phagocytes) that engulf bacterial and fungal infections, along with ingesting foreign debris.

Quitters across the ages

The smokers with asthma recruited for this study were aged 18 to 60 and had lung function score results of less than 85 percent of their predicted level. They all had a cigarette history of over 10-pack-years and smoked more than 10 cigarettes a day. The clinicians saw no differences in the baseline physiological characteristics between the smoking group and those who quit.

How they quit

Of the 10 subjects who successfully stopped smoking and completed the six-week study, five used nicotine patches, one employed acupuncture and four quit without any aid. The researchers believe that their findings highlight the importance of smoking cessation for adults with asthma.

Whole body benefits

As soon as you stop smoking, not only do your lungs improve but your body begins to recover as well.

Perhaps the most promising aspect of this study highlights that it is never too late to do something about your health. Young or old, you can benefit quickly from giving up the "smokes".

References

IPCRG: Norway in the northern Summer

The International Primary Care Respiratory Group (IPCRG) 3rd World Conference
8-11 June 2006, Radisson Plaza Hotel, Oslo, Norway

The National Asthma Council Australia has, through its General Practitioners’ Asthma Group (GPAG), been a member of IPCRG from its inception in 2000.

The conference attracted 420 delegates from 29 countries around the world, including 12 from Australia. NAC committee members who took part included

• Dr Kerry Hancock, chair of the NAC GPs’ Asthma Group (GPAG),

• Dr H John Fardy and Prof. Nicholas Glasgow of GPAG,

• Prof. Justin Beilby (Asthma Management Handbook Guidelines Committee) and

• Dr Ron Tomlins, immediate past-chairman .

Participants included GPs/primary care physicians, nurses and other health professionals working in primary care settings. While most were from the UK, northern and southern Europe, the Netherlands, Scandinavia, Greece and Turkey, a number of GPs from the Asia-Pacific region, such as Malaysia, Sri Lanka, Bangladesh and the Philippines, attended.

Overview of Topics and Approach

Many of the topics were predictable for a respiratory conference - asthma diagnosis and management, COPD, smoking cessation and, especially relevant for developing countries, infectious diseases management. However, the conference adopted a novel approach to the three major plenary sessions (asthma, COPD, infectious diseases). Instead of being lengthy didactic presentations, the sessions were extremely interactive and challenging to the audience. Each plenary presented an overview of the topic followed by a pros and cons debate on a controversial diagnostic or treatment issue, with much comment, disagreement and often, hilarity as some speakers tried to defend the indefensible. Then two different case studies were presented for group discussion.

Excerpts from the IPCRG 3rd World Conference Highlights Bulletin

Allergy

Professor Nicholas Glasgow, Australia

As the 'pro' speaker in a 'pros' and 'cons' debate, Professor Glasgow tried to convince the audience that there is a role for prevention in allergy. Allergy according to World Allergy Organization definitions is a hypersensitivity reaction initiated by immunological mechanisms. Allergy can be antibody- or cell-mediated. In the majority of cases the antibody typically responsible for an allergic reaction belongs to the IgE isotype and these individuals may be referred to as suffering from an IgE-mediated allergy.

Atopy is a clinical definition of an IgE antibody high responder. Primary prevention is the prevention of immunological sensitisation. Secondary prevention is the prevention of the expression of symptoms of atopic disease following sensitisation. Using Medline, Prof. Glasgow and co-workers decided that a few primary prevention activities are clearly supported with good evidence, including avoidance of smoking and exposure to ETS during pregnancy and early childhood, breastfeeding and for young children at high risk, reduced exposure to aero allergens. Regarding secondary prevention, treatment of atopic eczema and allergic rhinoconjunctivitis may prevent the onset of allergic disease. So both primary and secondary prevention reduces the incidence and severity of atopic diseases, or simplified: smoking kills and breastfeeding helps, according to Prof. Glasgow.

Experiences from Downunder

Australian presentations on organising asthma care

While the conference emphasised that many issues in respiratory care were the same the world over, different approaches to similar problems have been tried. In Australia, the national asthma guidelines (in the form of the Asthma Management Handbook) are well accepted and widely used by GPs and other health professionals (Gupta et al, 1997). However, there are real problems in patient adherence to medications and in regular patient attendance at GP surgeries for review of their asthma. Australia does not have a GP patient list system like the UK, for example, where patients MUST attend a specific GP, so Australian patients may ‘doctor-shop’, if they attend at all between acute presentations of asthma. Thus the focus has been on organising asthma care in the primary care setting, with a view to improving patient recall for review, promoting the role of one GP (not ‘any’ GP) as the caregiver, and providing systematic asthma care and education. Among the Australian oral presentations were projects with international implications.

International perspectives on national asthma programs

Dr Justin Beilby

There is agreement from the WHO down that the most effective way to reduce the morbidity and mortality burden of asthma is to address it at a national level. However, by 2004 few countries had developed national asthma strategies or plans and these countries included Finland, France, the USA and Australia. Dr Beilby’s project reviewed the peer-reviewed asthma literature and published policy and program documents available on the web, as well as asthma specific Australian policy documents. Beilby reported that those countries that have developed programs have used varying models, but all contain these key elements:

• primary prevention (including smoking, occupational exposure, allergen exposure, breastfeeding);

• improved management (medication, spirometry, asthma education, written asthma plans);

• systems support (guidelines, detailed monitoring, ongoing epidemiological research, advocacy and planning, policy).

For the full report see the forthcoming Highlights Bulletin.

Register for the NAC’s IPCRG Oslo Report

Research Funding Opportunities

Two Research Grants Available for 2007

The Asthma Foundation of Victoria is awarding two Research Grants for research projects benefiting people with asthma to be undertaken in Victoria during the 2007 calendar year.

These are:

•  The Helen Macpherson Smith Trust Grant for general asthma research.

• The Asthma Foundation of Victoria Research Grant of children’s/adolescent asthma research

Both grants will be for an amount up to $25,000 (plus GST).

Application Forms and Conditions of Award are available from The Asthma Foundation of Victoria on (03) 9326 7088 or email Garry Irving,  girving@asthma.org.au

Both the 2007 Grant Application Form and the Grant Conditions are available from the Asthma Foundation of Victoria website  www.asthma.org.au.  

Conditions of Award 2007
(http://www.asthma.org.au/Portals/0/Research%20Grant_Conditions%202007.pdf)

Research Grant Application Form 2007
(http://www.asthma.org.au/Portals/0/ResearchGrants_Application%20Form%202007.doc)

The closing date for Grant applications for 2007 is Friday 11 August 2006.

The Foundation particularly encourages applications from young researchers commencing their investigative research careers.