September 2007

Asthma and allergic rhinitis - an important link to consider

Community Outcomes in Asthma Web Directory

Reducing asthma and allergies with "fruity vegetables" and fish

Children in affluent countries more likely to develop allergy-related asthma

Asthma medication may lower risk of heart disease

Managing Respiratory Illness into the 21st Century: An International Perspective

'Avian Influenza: from basic biology to pandemic planning'

Research Funding Opportunities 

Conference Diary 2007-8

Asthma and allergic rhinitis - an important link to consider 

For those people who suffer from asthma and allergic rhinitis, spring is a time to be aware of allergen exposure.

Effective asthma management involves accurate recognition and appropriate treatment of allergic rhinitis as well. Alone, allergic rhinitis can significantly affect individuals’ daily activities and impair quality of life; when it occurs in a person with asthma, it contributes to airway symptoms and must be considered in the management plan.

Contrary to the previous belief that allergic rhinitis was mainly a disorder of adults, it is now known to affect almost 8% of Australian children and adolescents.¹

How allergic rhinitis can affect your asthma

It is important to know if an adult or child has allergic rhinitis, because allergic rhinitis can make asthma harder to control. Effective treatment for allergic rhinitis can reduce the chance of severe asthma attacks. Allergic rhinitis can also cause problems with sleep and concentration at work or school. 

Treatment of allergic rhinitis with intranasal corticosteroids (INCS) reduces the risk of asthma-related emergency department visits and hospitalisation in patients with asthma and co-existing allergic rhinitis² and may improve lung function.³

People can mistake symptoms of allergic rhinitis for asthma. Allergic rhinitis is sometimes more easily recognised only after asthma has been stabilised.

The absence of classical "hay fever" symptoms does not rule out the diagnosis of allergic rhinitis. It may present as any combination of rhinorrhoea, itching/sneezing and blockage, including blockage alone.

Children with allergic rhinitis may show persistent throat-clearing but be unaware of nasal symptoms.

Allergic rhinitis is easily missed. Allergic rhinitis should be considered when any of the following are present:

• Symptoms suggestive of continuous or recurrent upper respiratory tract infections

• Frequent sore throats

• Hoarse voice

• Persistent throat-clearing

• Persistent mouth breathing, especially in children with perennial rhinitis

• Snoring

• Feeling of pressure over sinuses

• Recurrent headaches

• Recurrent serous otitis media, especially in children

• Coughing, especially in children (e.g. those who habitually cough soon after lying down at night)

• Halitosis

• Poor sleep and daytime fatigue or poor concentration

• Loss of sense of smell

• Persistent respiratory symptoms despite stable, well controlled asthma, appropriate treatment and good lung function on spirometry.

References

1. Australian Institute of Health and Welfare. Australia ’s health 2006. AIHW cat. no. AUS 73. Canberra : AIHW, 2006.

2. Fuhlbrigge AL, Adams RJ. The effect of treatment of allergic rhinitis on asthma morbidity, including emergency department visits. Curr Opin Allergy Clin Immunol 2003; 3: 29–32.

3. Taramarcaz P, Gibson PG. Intranasal corticosteroids for asthma control in people with coexisting asthma and rhinitis. Cochrane Database Syst Rev 2003, Issue 3.

For comprehensive information on asthma and allergic rhinitis see

Allergic rhinitis and your asthma: What you should know

Allergic rhinitis and the patient with Asthma: A guide for health professionals

Useful Resources

Asthma Action Plans 

First Aid Chart 

Asthma and allergy - Asthma Management Handbook 2006

Community Outcomes in Asthma Web Directory

The Community Outcomes in Asthma web directory has been created by the Asthma Foundation of WA to give health professionals and community organisations access to over 600 Australian Government Department of Health and Ageing-funded grant projects conducted between 2002 and 2005.

The National Asthma Community Grants Scheme has produced many high-quality and valuable community initiatives. However, much of the good work done at a community level has remained localised and not readily available to the broader community and other groups seeking to replicate successful project outcomes.

The Asthma Foundation of WA sought additional funding from the Australian Government Department of Health and Ageing to create the Community Outcomes in Asthma web directory, with the aim of increasing the awareness of the Grants Scheme and facilitating access to both the project results and the organisations behind them.

The directory allows health professionals and community groups to share information about successful projects, stimulating discussion and collaboration between different groups and leading to a broader dissemination of best-practice messages such as those promoted by the Asthma Cycle of Care (previously know as the Asthma 3+ Visit Plan).

It is hoped that this sharing of knowledge will contribute to the development of stronger health and community partnerships between groups interested in asthma or health promotion.

Most of the grant project summaries in the Community Outcomes in Asthma web directory will include the following information:

• The name of the project

• The organisation that co-ordinated the project (contact details are provided wherever possible)

• The grant period

• The grant amount

• The primary target area (a detailed list of the target audiences is also provided)

• A brief outline describing the project

• Whether or not resources were produced

• Who the grant co-ordinators worked with during their project

• What the grant co-ordinator’s comments were about the project

Community Outcomes in Asthma Web Directory
http://grants.asthmaaustralia.org.au

Reducing asthma and allergies with "fruity vegetables" and fish

Giving children a diet rich in fish and “fruity vegetables” can reduce asthma and allergies, according to a seven-year study of 460 Spanish children, published in the September issue of Pediatric Allergy and Immunology.

The findings also reinforce the researchers’ earlier findings that a fish-rich diet in pregnancy can help to protect children from asthma and allergies.

“We believe that this is the first study that has assessed the impact of a child’s diet on asthma and allergies and also taken into account the food their mother ate during pregnancy” says lead author Dr Leda Chatzi from the Department of Social Medicine at the University of Crete, Greece.

“Because we studied the children from pregnancy to childhood, we were able to include a wide range of elements in our analysis, including maternal diet during pregnancy, breastfeeding, smoking, the mother’s health history, parental education and social class.”

Researchers followed the progress of the children, on the Spanish island of Menorca, at regular intervals from before they were born until they were six-and-a-half.

They discovered that children who consumed more than 40 grams of “fruity vegetables” a day – namely tomatoes, eggplants, cucumber, green beans and zucchini - were much less likely to suffer from childhood asthma. In the study "fruity vegetables" was used to distinguish them from root vegetables or leafy vegetables.

And children who consumed more than 60 grams of fish a day also suffered less childhood allergies, echoing the protective effects they experienced when their mothers ate fish during pregnancy.

However the researchers noted that the dietary effects were quite specific and that other fruits and vegetables examined did not provide the same protective effect. Nor did other food groups included in the study, such as dairy products, meat, poultry and bread.

The mothers of 232 boys and 228 girls, who had been recruited during antenatal classes, completed detailed questionnaires on their children’s health, weight, diet and any breathing problems every year until their child was six-and-a-half.

Some 90%  of the children also underwent allergy testing – skin prick tests were used to check their response to the six most common allergens, including grass pollen and cats.

The researchers found that just under nine per cent of the children suffered from some degree of wheezing, including six per cent with an allergy-related wheeze. And 17 per cent reacted to at least one of the allergens in the skin prick test.

“After adjusting the results for a wide range of variables, we concluded that the link between symptom-free children and a diet rich in fruity vegetables and fish was statistically significant” says Dr Chatzi.

“The biological mechanisms that underlie the protective affect of these foods is not fully understood, but we believe that the fruity vegetables and fish reduce the inflammation associated with asthma and allergies.

“The interesting thing about this study is that it followed a large number of children from the womb to the age of six-and-a-half and incorporated a wide range of dietary, social and health factors” says the Journal’s Editor, Professor John Warner, Head of the Department of Paediatrics at Imperial College London.

“It provides parents with specific advice about the health promotion benefits of including fish and fruity vegetables as part of a balanced diet for both their children and the rest of the family.”

Reference

Chatzi L, Torrent M, Romieu I, Garcia-Esteban R, Ferrer C, Vioque J, Kogevinas M, Sunyer J. Diet, wheeze, and atopy in school children in Menorca, Spain. Pediatric Allergy Immunol 2007: 18: 480–485.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1399-3038.2007.00596.x

News release, Pediatric Allergy and Immunology.

Useful Resources

Asthma and Allergy

Asthma and Allergy Brochure

Asthma and Allergy Information Paper

Allergic rhinitis and your asthma: What you should know

Allergic rhinitis and the patient with Asthma: A guide for health professionals

Asthma Action Plans 

First Aid Chart 

Asthma and allergy - Asthma Management Handbook 2006

Children in affluent countries more likely to develop allergy-related asthma

Children with allergic sensitizations in economically developed countries are much more likely to develop asthma than similarly sensitized children in poorer countries, according to a team of international researchers.

The global research study is the first to link economic development to differences in rates of asthma symptoms and allergic sensitization, based on examination of a large, multi-center cross-sectional study of 8- to 12-year-old children who participated in Phase Two of the International Study of Asthma and Allergy in Childhood (ISAAC).

The findings were published in the second issue for September of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

“Atopic sensitization has long been known to be related to childhood asthma,” wrote Gudrun Weinmayr, MD, MPH, of the Institute of Epidemiology of Ulm University in Germany, and lead investigator of the study.

Dr Weinmayr noted that the strongest relationships have been found in studies in affluent western countries. “Thus, it may be that the link between asthma and atopic sensitization differs between countries.”

Dr Weinmayr and colleagues evaluated parents’ answers about their children’s respiratory symptoms from over 54,000 standardized questionnaires; assessed the results of more than 31,000 skin-prick tests; and analysed the serum levels of allergen-specific IgE in nearly 9,000 children from 22 countries, from rural African to urban Europe.

They then determined the degree to which allergic sensitizations and asthma symptoms varied with the gross national income per capita (GNI) of the country from which they were collected.

“We observed large variations in the prevalence of asthma symptoms and of atopic sensitization among populations,” wrote Dr Gundmayr. The association between current wheeze, an indicator of asthma, and skin prick sensitivity, an indicator of allergic reaction, was strong in virtually all affluent countries, but much weaker in less affluent settings.

Altogether, children living in affluent countries with allergic sensitizations were 4 times as likely to have asthma than their non-sensitized counterparts; in non-affluent countries, children with allergic responses were only 2.2 times as likely to have asthma.

“This means that local environmental factors may affect asthma and allergy in different ways,” said Renato T. Stein, M.D., Ph.D., of the Pontificia Universidade Catolica do Rio Grande do Sul, in Brazil, another researcher involved in the study.

“Another way to interpret these findings is that asthma in [more affluent] cities is predominantly atopic asthma, while in socially less developed areas asthma may be more of the non-atopic phenotype,” said Dr Stein.

The researchers speculated that a possible explanation could be that some factors that protect children with allergic sensitization from developing asthma are less present in affluent settings, or that acquired commensal bacteria (gut flora), which may also differ with GNI, play a role in development of tolerance and immune function.

“A wide range of different factors, including nutrition, microbial and allergen exposure, housing conditions, and exposure to pollutants, and so forth may have played a role,” they wrote, remarking that a “center level correlation with GNI does not imply a similar relation at the individual level with personal wealth.”

The research will continue with further investigations in other risk factors in asthma development, including diet, the presence of rhinitis, and eczema.

 “Data to study the impact of genetics in asthma and allergies has been collected and is a central part in the next steps of this study,” said Dr Stein.

Reference

Weinmayr G, et al "Atopic Sensitization and the International Variation of Asthma Symptom Prevalence in Children" Am J Respir Crit Care Med 2007; 176: 565-574.
http://ajrccm.atsjournals.org/cgi/content/abstract/176/6/565

Useful Resources

Asthma and Allergy

Asthma and Allergy Brochure

Asthma and Allergy Information Paper

Allergic rhinitis and your asthma: What you should know

Allergic rhinitis and the patient with Asthma: A guide for health professionals

Asthma Action Plans 

First Aid Chart 

Asthma and allergy - Asthma Management Handbook 2006

Asthma medication may lower risk of heart disease

The use of some asthma medications may lower the risk of cardiovascular disease in patients with asthma, according to a recent study from the USA.

The study involved measuring cardiovascular disease (CVD) inflammatory biomarkers and lipid levels in 161 patients receiving theophylline, 164 patients receiving montelukast, and 164 patients receiving a placebo. Serum levels of C-reactive protein (CRP), interleukin-6, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density cholesterol were measured at 1 month and 6 months after treatment. Patients with moderate to severe asthma receiving montelukast had significantly lower serum CRP and lipid levels compared to placebo at both time points.

Lipid levels also were significantly lower in the theophylline group compared with placebo in patients using inhaled corticosteroids. The researchers concluded that these asthma medications may have some beneficial value in patients with asthma in respect to CVD risk.

Reference

Hooman Allayee, Jaana Hartiala, Won Lee, Margarete Mehrabian, Charles G. Irvin, David V. Conti, and John J. LimaThe Effect of Montelukast and Low-Dose Theophylline on Cardiovascular Disease Risk Factors in Asthmatics  Chest Sep 2007: 868–874.

http://www.chestjournal.org/cgi/content/abstract/132/3/868

Managing Respiratory Illness into the 21st Century: An International Perspective

A Free Seminar For Primary Health Care Professionals
Wednesday 17th October 2007
(Note: Previously advertised as Thursday 18th October)
Adelaide SA

The Primary Care Respiratory Research Unit of the University of Adelaide is holding a seminar on Wednesday 17 October 2007, involving renowned international and South Australian speakers who will discuss trends in the management of respiratory illness in primary care.

Speakers include:

• Professor David Price
  GPIAG Professor of Primary Care Respiratory Medicine
  Department of General Practice & Primary Care University of Aberdeen,
  “COPD & Asthma – the UK perspective”

• Dr Jennifer Cleland
  Senior Clinical Lecturer in Medical Education & Primary Care,
  University of Aberdeen,
  "Improving the patient's journey in early stage COPD"

• Dr Mandy Moffat
  Post-doctoral Research Fellow University of Aberdeen
   “Patient-centred asthma management skills - training GPs & Nurses - a UK experience”

• Dr Hubertus Jersmann
  Respiratory Physician & Senior Lecturer in Medicine
  University of Adelaide
  “COPD & Asthma in Australia – where are we at?”

• Dr Nick Antic
  Sleep & Respiratory Physician
  Adelaide Institute for Sleep Health, Repatriation General Hospital
   “Sleep Disorders - what is the role of primary care?”

Time: Wednesday 17th October 2007 6:15pm - 7pm Light Dinner 7pm - 9:15pm Presentations

Venue: Charles Hawker Conference Centre Auditorium (D2 on Map) University of Adelaide, Waite Campus Waite Road URRBRAE SA 5064

More information: Enquiries and RSVPs to (08) 8303 4889 or daniel.blakeley@adelaide.edu.au by Friday 5th October.

Managing Respiratory Illness into The 21st Century: An International Perspective (940 KB)

'Avian Influenza: from basic biology to pandemic planning'

Educational Seminar - 30 November at the APSR Congress - Gold Coast

Bringing together experts from the World Health Organisation, Centres for Disease Control and Prevention, American College of Chest Physicians and Asian Pacific Society of Respirology, this educational seminar seeks to review the ecology and evolution of avian influenza H5N1 viruses from the perspective of pandemic risk; to address various aspects of human H5N1 disease in relation to its epidemiology, clinical presentation, pathogenesis, diagnosis, medical management; and finally to discuss issues relating to pandemic planning and preventive public health measures.

Register now at www.apsr.2007.org to make sure you can attend this important event.

Please note it is not necessary to register for the APSR Congress but you will need to complete the On-Line Registration Form for this Pre-Conference Course.

See APSR 2007

Research Funding Opportunities

The National Asthma Council Australia would be pleased to list funding opportunities that may be available for asthma research. Submit brief details for consideration by email to editor@nationalasthma.com.au.

 

Conference Diary

Submit brief conference/meeting details to the National Asthma Council Australia for possible posting in our Conference Diary by email to editor@nationalasthma.com.au.

	50th Annual Scientific Convention 2007 The Royal Australian College of General Practitioners 4 - 7 October 2007 Sydney Convention and Exhibition Centre New South Wales RACGP ASC 2007 (http://www.racgp.org.au/asc2007)
	CHEST 2007 Annual International Scientific Assembly of the American College of Chest Physicians 20-25 October 2007 Chicago, United States http://www.chestnet.org/CHEST/
	American College of Allergy, Asthma & Immunology 9-14 November 2007 Dallas, United States http://www.acaai.org/
	18th ASCIA Annual Scientific Meeting 14-16 November 2007 Esplanade Hotel, Fremantle, Western Australia ASCIA (http://www.allergy.org.au/) in conjunction with: Perth Immunopathology (PIP) Weekend 17-18 November 2007 31st ASEATTA Annual Scientific Meeting 15-18 November 2007 ASCIA Nurses Day 13 November 2007 ASCIA Primary Care Allergy Update Dinner 13 November 2007
	General Practitioner Conference & Exhibition 16-18 November 2007 Melbourne Exhibition Centre GPCE 2007 (http://www.gpce.com.au/melbourne-2007/)
	Asian Intensive Care: problems and solutions 28-30 November 2007 Hong Kong SAR, China Department of Anaesthesia and Intensive Care, the Chinese University of Hong Kong Contact: Ms. Rebecca Luk, Dept. of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong Fax: (852) 2637 2422 http://www.aic.cuhk.edu.hk/web8/Conference.htm
	Australian Asthma and Respiratory Educators Association 2007 Conference “Come and breathe new life into your practice” 29-30 November 2007 Legends Hotel Surfers Paradise Australian Asthma and Respiratory Educators Association (http://www.aareducation.org.au)
	12th APSR Congress 30 November - 4 December 2007 Gold Coast Convention & Exhibition Centre Broadbeach, Surfers Paradise, Queensland, Australia APSR 2007 (http://www.apsr2007.org)
	World Allergy Organization 2-6 December 2007 Thailand, Bangkok http://www.worldallergy.org/
	Annual Meeting of Taiwan Society of Pulmonary and Critical Care Medicine 8-9 December 2007 Taipei, Taiwan spccm@mars.seed.net.tw http://www.tspccm.org.tw/
2008
	Pulmocon 2008 Working together to promote lung health 20-22 February 2008 Dhaka, Bangladesh http://www.lungbd.org
	11th Asian Congress of Agricultural Medicine and Rural Health 22-24 February 2008 Aurangabad, Maharashtra, India 11asiancongress@pmtpims.org http://www.pravara.com/
	64th Annual Meeting of American Academy of Allergy, Asthma & Immunology 7-11 March 2008 Philadelphia, United States http://www.aaaai.org/
	16th Annual Meeting of The Asian Society For Cardiovascular Surgery 13-16 March 2008 Singapore http://www.ascvs2008.com/ mice@themeetinglab.com
	2008 Annual Scientific Meeting 30 March - 2 April 2008 Melbourne Convention Centre Melbourne, Victoria 2008 ASM TSANZ (http://www.thoracic.org.au/asm2008.html)
	ATS, Annual meeting of the American Lung Association & American Thoracic Society 16-21 May 2008 Toronto, Canada http://www.thoracic.org/