January 2007

Back to school asthma epidemic looms

Asthma Cycle of Care

Exercise-induced asthma - make sure you are up-to-date

Advance information about conferences

Research Funding Opportunities 

Conference Diary 2007

Back to school asthma epidemic looms

As Australian children get set to head back to the classroom, the National Asthma Council Australia is warning parents, teachers and health professionals to prepare for a corresponding spike in asthma emergencies.

According to National Asthma Council spokesperson, Professor Peter van Asperen from The Children’s Hospital at Westmead, the ‘February Epidemic’ is a well documented phenomenon that will hit in a couple of weeks.

Australian research, conducted in Sydney from 1994 to 2000¹, found that the increased risk of hospitalisation for asthma in February was threefold in children aged five to 14 years and double in pre-schoolers, with the peak occurring three and a half weeks into the new school year.

Increased risks were also recorded at the start of each subsequent school term; however the ‘February Epidemic’ is by far the most significant.

Prof. van Asperen attributes the back to school asthma spike to increased exposure to respiratory viruses, predominately rhinovirus – the same virus that triggers the common cold – and also a relaxing of the asthma management regime over the summer.

Many parents and a lot of doctors will also allow children to have a break from their asthma preventer medication over the longer holidays, when they are exposed to less triggers.

According to Prof. van Asperen, it is absolutely essential that medications are restarted prior to going back to school as most preventer medications need about a week’s use to become effective.

He also encourages parents to use the final days of the holidays as an opportunity to update their child’s written Asthma Action Plan, in consultation with their general practitioner, and ensure that they provide a copy of the new plan to the school at the start of the term.

The February asthma epidemic will happen, but preventative measures can be taken now and during the first few weeks of school to help keep children with asthma out of hospital.

Reference

1. Lincoln D, Morgan G, Sheppeard V, Jalaludin B, Corbett S, Beard J. Childhood asthma and return to school in Sydney, Australia. Public Health (2006) 120, 854-862

Resources

Asthma Action Plans

First Aid for Asthma

Asthma Foundations of Australia www.asthmaaustralia.org.au

Asthma Foundation of the ACT www.asthmaact.org.au/

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.asthmawa.org.au

Asthma Cycle of Care

Formerly the Asthma 3+ Visit Plan

The Asthma Cycle of Care initiative has replaced the Asthma 3+ Visit Plan. The changes to the GP Asthma Initiative have been introduced as a direct response to feedback provided by respiratory physicians, GPs and consumers and is based on the latest knowledge about how to treat asthma most effectively.

The Asthma Cycle of Care involves at least two asthma related consultations within 12 months for a patient with moderate to severe asthma, noting that at least one of these visits (the review visit) must be planned.

These visits will include:

1. Document diagnosis and assessment of asthma severity and level of asthma control

2. Review the patients use of, and access to, asthma related medication and devices

3. Provide a written asthma action plan (or documented alternative if the patient is unable to use a written action plan)

4. Provide asthma self management education

5. Review the written or documented asthma action plan

Resources

Asthma Cycle of Care
www.nationalasthma.org.au/html/management/acc/index.asp

Australian Government Department of Health and Ageing website
www.health.gov.au/internet/wcms/publishing.nsf/content/phd-asthma-cycle

Exercise-induced asthma - make sure you are up-to-date

Excerpt from the Asthma Management Handbook 2006

(Content is subject to copyright and the references shown are directly linked to the AMH 2006)

Impact on quality of life, asthma and sporting performance

Exercise-induced asthma/exercise-induced bronchoconstriction should not be allowed to interfere significantly with quality of life because treatment is so successful in preventing the problem.

• Because exercise-induced asthma/exercise-induced bronchoconstriction occurs after exercise, it should not provide a physiological limitation to exercise performance. However, there are some minor changes in lung function during exercise¹⁸ and, in competitive sport, these may contribute to performance.
• When exercise is performed within one hour of recovering from exercise-induced asthma/exercise-induced bronchoconstriction, approximately 50% of people become refractory and will have significantly less exercise-induced asthma/exercise-induced bronchoconstriction a second time.¹⁹
• There is no evidence that exercise-induced asthma/exercise-induced bronchoconstriction impacts on asthma control but it may be regarded as a sign that asthma is not well controlled.

Detection

The best question to elicit a history of exercise-induced asthma/exercise-induced bronchoconstriction is to ask: "Do you feel more breathless/wheezy/symptomatic five to ten minutes after you stop exercise than during exercise?"

• People without asthma will also get short of breath if they exercise hard enough, but the symptoms subside rapidly after the exercise stops.
• In someone with exercise-induced asthma/exercise-induced bronchoconstriction the symptoms get worse for the next 5 to 10 minutes before spontaneous recovery occurs over the next 30 minutes.
• Recovery from exercise-induced asthma/exercise-induced bronchoconstriction can be aided by the use of a bronchodilator to reverse the airway narrowing.
• Exercise-induced asthma/exercise-induced bronchoconstriction cannot be excluded on the basis of a negative test to inhalation of methacholine and histamine, particularly in people with normal spirometry.²⁰ Leukotrienes and prostaglandins are considerably more potent in causing bronchial smooth muscle contraction than histamine and methacholine²¹ and they are the most important mediators of the airway narrowing provoked by exercise.

Effect of training

Asthma severity, as reflected by exercise-induced asthma, is not altered by training, but the threshold for respiratory symptoms can increase. This means that after training, the person is likely to:

• have less exercise-induced asthma

• be less breathless

• be less anxious about activity

• feel good

• be less dependent on treatment

• lose less time from school.

Some athletes find warm up prevents them getting exercise-induced asthma during the main game. This beneficial effect may be due to improved delivery of water to the airway surface by the bronchial circulation.

Practice Points

Respiratory symptoms during exercise are poor indicators of the presence of exercise-induced asthma, therefore, objective testing is recommended. (IV)

Being physically fit can increase the intensity of exercise required to provoke exercise-induced asthma, although exercise-induced asthma can still occur. (I)

Note: The Asthma Management Handbook 2006 uses the NHMRC levels of evidence (I-IV), which are familiar to most Australian practitioners, supplemented by the tick symbol for practice points based on best practice consensus. 

For full details see The Asthma Management Handbook 2006 Exercise-induced asthma

Advance information about conferences

EAACI 2007

From 9 June to 13 June 2007, the XXVI Congress of the European Academy of Allergology and Clinical Immunology, EAACI 2007 will be held in Göteborg, Sweden, where more than 5000 delegates are expected.

Patient-Centred Healthcare

The International Alliance of Patients' Organizations (IAPO) will be holding a meeting on Patient-Centred Healthcare at the UN, New York on 30 March, 2007.

More information will be posted as it becomes available. For more on patient-centred healthcare go to Patient-Centred Health Care.

IAPO Global Patients Congress

The International Alliance of Patients' Organizations (IAPO) is pleased to announce that it will be holding the next Global Patients Congress in Budapest, Hungary in February 2008.

More information will be posted on all three events as it becomes available.

Research Funding Opportunities