In this Issue August 2006

Asthma link to sleep apnoea in young women

National Asthma Week 1-8 September 2006

Consider occupational asthma

Global prevalence change for allergic diseases

Pharmacy and Home Medicines Review

Ipratropium bromide in acute asthma management

Research Funding Opportunities 

Conference Diary 2006

Asthma link to sleep apnoea in young women

Recent American research has shown that young women with asthma are twice as likely to have symptoms of obstructive sleep apnoea - a condition that often goes undetected in women - compared with those who do not have asthma.¹

University of Cincinnati (UC) and Cincinnati Children's Hospital Medical Center (CCHMC) researchers  found that about 21 percent of young adult women with asthma experienced habitual snoring, the primary symptom of obstructive sleep apnoea.

According to the research team, these findings disprove a long-held notion that obstructive sleep apnoea predominantly affects males, and highlights the importance of identifying specific groups of women who are at high risk for the condition.

Obstructive sleep apnoea occurs when airways in the nose, mouth and throat narrow and disrupt a person's ability to breathe properly--primarily during sleep. When this happens, breathing can stop for short periods and cause blood-oxygen levels to become low.

Left untreated, obstructive sleep apnoea can lead to impaired memory, mood swings, restless sleep, and extreme day-time fatigue. Long term effects can include higher blood pressure and decreased heart function.

The research team also found that women who smoked cigarettes were at a higher risk for snoring than those who did not smoke.

Data was collected from 677 mothers of infants enrolled in the University of Cincinnati environmental health department's Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) about their history of snoring, respiratory symptoms and cigarette smoking.

The CCAAPS, funded by the National Institute of Environmental Health Sciences, is a five-year study examining the effects of environmental particulates on childhood respiratory health and allergy development.

All families enrolled in the study had at least one confirmed allergy, in either the mother or the father. Environmental tobacco smoke exposure and any history of asthmatic conditions were measured by questionnaire. Researchers used this data to compare snorers with non-snorers and determine risk factors for snoring in women under 50.

Reference

1. Kalra M, Biagini J, Bernstein D, Stanforth S,Burkle J, Cohen A,LeMasters G. Effect of asthma on the risk of obstructive sleep apnea syndrome in atopic women. Annals of Allergy, Asthma and Immunology 2006, vol. 97, no. 2, pp. 231 - 235

Resource

Newcastle Sleep Disorders Centre

http://www.newcastle.edu.au/centre/nsdc/aboutsleep/sleepapnoea.html

National Asthma Week 1-8 September 2006

National Asthma Week begins on 1 September. The Asthma Foundations around Australia are conducting a variety of events during the week, including information and training sessions for people with asthma and for health professionals.

See your local Asthma Foundation's website, or contact your Foundation on 1800 645 130 for further information.

Asthma Foundation of New South Wales		www.asthmansw.org.au
Asthma Foundation of Northern Territory		www.asthmant.org.au
Asthma Foundation of Queensland		www.asthmaqld.org.au
Asthma Foundation of South Australia		www.asthmasa.org.au
Asthma Foundation of Tasmania		www.asthmatas.org.au
Asthma Foundation of Victoria		www.asthma.org.au
Asthma Foundation of Western Australia		www.asthma.org.au

Consider occupational asthma

We know that occupational asthma is the most common occupational lung disease in Australia and many other Western countries. It has been estimated that up to 15% of new asthma in adults is directly attributable to occupational exposures. Even more workers with pre-existing asthma find that their asthma is aggravated by occupational exposures.

The most characteristic feature in the patient's medical history is symptoms of asthma that worsen on work days and improve on rest days or holidays. The history may comprise classical episodes of work-related wheeze, chest tightness and breathlessness. Often the onset of symptoms is delayed so that they occur at night or in the early morning after significant exposures.

A full occupational history should be taken, particularly noting known sensitisers and irritants to which workers may have been exposed. Although over 200 causes of occupational asthma have been identified, computerised databases (such as OSH ROM and CCINFO) can now be readily consulted in medical libraries or are available by subscription on the Internet.

Resources

Occupational Asthma - Asthma Management Handbook 2002

Asthma Triggers - Occupational asthma: Asthma and Allergy Information Paper  

Global prevalence change for allergic diseases

Allergic diseases, such as asthma, eczema and allergic rhinoconjunctivitis, are on the increase globally, particularly in younger children, says a study from researchers at The University of Auckland.

Results of the International Study of Asthma and Allergies in Childhood (ISAAC), led by Professor Innes Asher at The University of Auckland, have been published in this August edition of The Lancet.

The study compiles data from nearly 200,000 6-7-year-olds in 37 countries and over 300,000 13-14-year-olds in 56 countries, including developing countries such as South Africa, Brazil, Iran, and developed countries such as Australia, Canada, New Zealand, Sweden, and Britain.

The study suggests that prevalence of allergic disease has increased since Phase One of the study began in 1991, particularly in the 6-7 year age group, and in countries where these disorders are less common. In the older age group, prevalence of asthma symptoms in high prevalence countries like New Zealand has stayed the same or decreased, which was unexpected.

A group of Melbourne children taken from in the younger age group provided some of the research data. This Australian information showed increases in eczema and hayfever and decreases in asthma.

Resources

Occupational Asthma - Asthma Management Handbook 2002

Asthma Triggers - Occupational asthma: Asthma and Allergy Information Paper  

Information

The Allergy Expo and Gluten Free Food Show, 24-26 November, 2006

Sydney Convention and Exhibition Centre. 

For more details see: The Allergy Expo and Gluten Free Food Show (http://www.allergyexpo.com.au)

Pharmacy and Home Medicines Review

Victorian pharmacist conducts 1000 HMRs

Greg Luke, an accredited Home Medicines Review (HMR) facilitator based in Mount Evelyn, north east Melbourne, is believed to be the first Australian pharmacist to reach the milestone – an achievement since the program has only been running since 2001.

Mr Luke has worked as a pharmacist in and around Melbourne for the past 30 years, but in 2003 decided to move away from retail pharmacy, throwing himself into the community service side of the business. He now works with the Knox Division of General Practice, promoting HMRs and supporting GPs and pharmacists in the process.

Each year more than 140,000 Australians are admitted to hospital because of problems caused by their medicine. In up to 69 per cent of these cases the problem could have been avoided if patients had taken their medicine properly.

“HMRs are designed to help people manage their medicines so they can get better results and avoid side effects. The service has found to be particularly useful for those who take more than five medicines a day, or who have recently been hospitalised,” Mr Luke said.

“GPs are starting to embrace the trend of HMRs. They are now realising it’s a useful tool to help patients and reduce the number of hospitalisations from medicine mismanagement,” he said. In order to receive an HMR, people need a referral from their GP. The referral is given to the pharmacist who then interviews the patient in their home and sends a written report back to their GP. The GP will then discuss any recommendations with the patient and make appropriate change to their medication.

“One of the most complicated cases I had was a woman who was only on four medicines a day, but was suffering renal failure. It turned out she was taking a number of over-the-counter, or complementary, medicines as well, but hadn’t told either her GP or pharmacist. When I conducted the HMR and realised what was going on, her GP worked out a more suitable medicine regime for her and now she is fine,” Mr Luke said.

About Home Medicines Review

The HMR service was established in 2001 for older people living at home in the community. It entails the local pharmacist coordinating the process of a home visit by an HMR Accredited Pharmacist, and following up with the GP, in the comprehensive review of the older person’s medication regimen.

An HMR assesses a person's understanding of how and when their medications should be taken, and that the medications are achieving desired health benefits and not causing adverse effects. It helps an individual to maximise the benefit from their medication regimen, and prevent medication-related problems.

The service is an excellent idea for an older person with asthma who has additional health problems and associated medications to manage. The review is based on a team approach involving the person’s GP and preferred community pharmacist, along with the HMR Accredited Pharmacist.

Other relevant members of the healthcare team, such as nurses in community practice or carers may also be included, thus utilising the specific knowledge and expertise of each of the healthcare professionals as well as carers involved.

Resources

Ask your Pharmacist Week, 25-29 September 2006

Ask your Pharmacist Week (www.askyourpharmacist.com.au)

The Pharmacy Guild of Australia (www.guild.org.au/public/dmmr.asp)

Ipratropium bromide in acute asthma management

Emergency Care Community of Practice Program

The Evidence in Practice Series from the National Institute of Clinical Studies is an ongoing collection of brochures, each highlighting one evidence-practice gap of particular relevance within emergency departments. One of the topics in the first release of brochures is Use of Ipratropium Bromide for Acute Asthma.

The series was developed to raise awareness of clinical areas where evidence exists to inform best practice in emergency care settings, and prompt evidence-based change.

Each brochure outlines the importance of the topic, best available evidence, current practice and the implications for specific areas of emergency care practice.

The Use of Ipratropium Bromide for Acute Asthma brochure is available as a PDF document and may be downloaded from the National Institute of Clinical Studies website.

Use of Ipratropium Bromide for Acute Asthma (brochure) (175KB File)

Research Funding Opportunities