July 2008
Winter: warm
clothing, hot soup and a written asthma action plan
New indication for
ciclesonide
Asthma Management
Handbook 2006
Spirometry Workshop at WONCA
NAC Asthma Research
Awards
Advancing
Asthma Where? Conference
How gastric reflux
may trigger asthma
Research Funding Opportunities
Conference Diary
Winter: warm clothing, hot soup
and a written asthma action plan
As winter sets in common cold and flu viruses
abound. For families that have a child with asthma,
this is an especially stressful time of year because
even a simple cold virus can trigger a major asthma
attack or exacerbation.
Intermittent exacerbations (particularly those
due to upper respiratory viral infections) can
occur despite ongoing good asthma control overall,
in people with stable asthma.
While these exacerbations do not respond to
increased inhaled corticosteroid doses, children who
are taking regular preventive medication should
continue taking the same dose.1
Reliever medications are recommended and should be
administered via a puffer (MDI) and spacer, which is
equally as effective as nebulisation in children
with moderate-to-severe acute asthma.2
According to Dr Dominic Fitzgerald a spokesperson
for the National Asthma Council from The Children’s
Hospital at Westmead, Sydney, a large proportion of
the serious asthma-related children emergencies that
occur in winter could be prevented if asthma action
plans were adhered to.
A comprehensive written asthma action plan for
recognising and managing acute episodes is vital for
children and their parents, not only during winter
but throughout the year.
| For children:
When is an exacerbation an emergency?1
|
Urgent treatment is needed if any of the
following apply:
- The child is experiencing severe
respiratory distress.
- Response to reliever is not
immediate and sustained for at least 3
hours.
- There is further worsening of
symptoms despite treatment.
- The child's asthma action plan
indicates the need for urgent medical
care.
|
Useful Resources
Written Asthma Action Plans
First Aid for Asthma
References
1. Managing asthma exacerbations in children.
Asthma Management Handbook 2006
2. Cates CJ, Bara A, Crilly JA,
Rowe BH. Holding chambers versus nebulisers for
beta-agonist treatment of acute asthma. Cochrane
Database Syst Rev. 2003; (3): CD000052
New indication for ciclesonide
Alvesco (ciclesonide) is now available for
children over 6 years old with reimbursement on the
Pharmaceutical Benefits Scheme by prescription.
The novel steroid medication is taken only once a
day for 24 hour control,1
which may make it easier for parents to manage their
children’s asthma. Children are better at staying on
schedule with medication if it only needs to be
taken once a day compared to medication that needs
to be taken multiple times a day.2
“Parents often battle with their children to take
multiple doses of daily asthma preventative
medications and in many cases parents are also
anxious about steroid medications affecting a
child’s growth” Dr Dominic Fitzgerald
from The Children’s Hospital at Westmead, Sydney said.
Alvesco is an asthma preventative steroid
medication for children and adults that when taken
daily, reduces lung inflammation and helps to
prevent asthma attacks. The drug’s novel mechanism
of action allows it to work only once it hits the
patient’s lungs. It is quickly cleared from the body
via the liver and is associated with a low incidence
of expected side effects such as growth retardation
in children.
Alvesco has been available on prescription
for adults and adolescents older than 12 years in
Australia since 2005.
References
1. Alvesco Consumer Medicine
Information.
2. Cochrane GM. Compliance and
outcomes in patients with asthma. Drugs 1996;
52:12–9
Asthma Management Handbook
2006
 The latest edition of the National Asthma Council's
leading publication is still the Asthma Management Handbook
2006.
The Handbook aims to be both comprehensive and
user-friendly. While written primarily for general
practitioners and community pharmacists, the
Handbook emphasises a team approach to asthma care
and is intended for use by general practitioners,
pharmacists, asthma educators, nurses and other
health professionals and healthcare students. It
contains:
- updated diagnostic, management and
prescribing guidelines
- expanded material on asthma and allergy,
exercise-induced asthma, occupational asthma,
asthma in pregnancy and in older people, and
comorbidities
- more detail on diet and complementary
medicine
- chapters on smoking cessation and asthma
prevention
- practical advice on providing structured
asthma care in the primary care setting.
The Asthma Management Handbook 2006is
available online from the National Asthma Council
website in full and for free.
The top accessed pages from the Handbook are
The online
Asthma Management Handbook 2006
carries the full references and levels of evidence
supporting the content.
Throughout the chapters there are relevant
internal and external links and a Handbook-only
search function to assist you in finding specific
information.
Reference
National Asthma Council Australia. Asthma
Management Handbook 2006. Melbourne, 2006
Spirometry Workshop at WONCA
The National Asthma Council Australia is holding
its popular Spirometry Training Course as a
preconference workshop at the WONCA 2008 Asia
Pacific Regional Conference which is being combined with The
Royal Australian College of General Practitioners
51st Annual Scientific Convention 2–5 October 2008.
Open to conference registrants only, the workshop
will be held on Thursday 2 October 2008 at Melbourne
Convention & Exhibition Centre.
The NAC thanks Medical Developments International
(MDI) for supporting the workshop lunch.
Due to unprecedented demand a second, concurrent
workshop is now available but places are filling
quickly.
Online registration and required pre-reading
material are available at
http://www.wonca2008.com/gpra.php
About the NAC Spirometry Training Course
 This
6-hour interactive course provides participants
with comprehensive training in the application,
measurement and interpretation of expiratory
spirometry in general practice. Experienced general
practitioner and respiratory scientist presenters
will lead a hands-on workshop covering:
- spirometry overview;
- indications and contraindications;
- spirometer specifications; choosing a
spirometer;
- performing spirometry (theory and
application);
- quality assurance; interpretation;
- case discussions; and
- practical spirometry sessions.
The course was developed by the National Asthma
Council Australia with the Australian and New
Zealand Society of Respiratory Science. It is
coordinated by the NAC with funding from the
Australian Government Department of Health and
Ageing
This activity has been approved by the RACGP QA&CPD
Program. Total CPD points: 40 (Category 1).
More Information
Spirometry training course
NAC Asthma Research Awards
As the national communicating authority on asthma
the National Asthma Council's role is to gather,
refine and disseminate information on asthma aimed
at improving health professionals quality of asthma
care and management. As part of this commitment the
National Asthma Council funds annual awards to
encourage research into asthma.
The awards are offered via the National Asthma
Council’s member bodies: the Thoracic Society of
Australia and New Zealand, The Royal Australian
College of General Practitioners, the Australasian
Society of Clinical Immunology and Allergy, and
Asthma Foundations Australia.
Past award winners have conducted research in a
wide range of asthma-related areas.
Winning presentations have covered such diverse
topics as the association between asthma and
obesity, gene polymorphism in the development of
asthma, new blood vessel growth in asthmatic airways
and cytokine involvement in airway inflammation.
Applications are now open for:
Royal
Australian College of General Practitioners (RACGP)
and NAC Asthma Research Award
Australasian
Society of Clinical Immunology and Allergy (ASCIA)
and NAC Asthma Research Award
Asthma
Foundations Australia (AFA) and NAC Asthma Research
Award
More information
Asthma
Research Awards
Advancing
Asthma Where? Conference
 The biennial Australian Asthma Conference will
take place from 20 - 21 October 2008 at the
Australian Technology Park Sydney.
Building on the theme Advancing Asthma Where?
the conference program will review the changing
world of asthma in Australia and how the nation can
work together to develop ideas and actions which
will influence and inform future asthma agendas.
The program seeks to involve a wide cross section
of people connected with asthma including:
- consumers,
- health professionals,
- scientists and researchers,
- policy makers from State and Federal
Governments
- Asthma Foundations of Australia staff and
- National Asthma Council Australia
representatives.
Expert speakers include:
- Professor Matthew Peters (NSW)
combination
therapies.
- Dr Helen Reddel (NSW)
consumer research
insights.
- Professor Peter Sly (WA)
the future of
paediatric asthma research.
- Dr Ken Fitch (WA)
the elite athlete and
asthma, considering experience of the Beijing
Olympics.
|
- Mr Martin Stewart-Weeks (NSW)
the next
generation of information technologies and their
impact on individuals and society.
- Dr Cheryl Salome (NSW)
obesity and
asthma.
- Professor Stephen Leeder AO
the
future of health policy in Australia
- Professor Peter Gibson
future
directions of adult asthma research
|
More information
Go to
www.asthmaconference2008.com
How gastric reflux may trigger asthma
Researchers at Duke University Medical Center in
the US
appear to have solved at least a piece of a puzzle
that has mystified physicians for years: why so many
patients with asthma also suffer from GERD, or
gastroesophageal reflux disease.
Clinicians first noted a relationship between the
two diseases in the mid-1970s. Since then, studies
have shown that anywhere from 50 to 90 percent of
patients with asthma experience some aspect of GERD.
But can GERD cause asthma, or, is it the other way
around? Perhaps there is some shared mechanism at
the root of both disorders causing them to arise
together. Physicians could make a case for each
scenario, but until now, the exact nature of the
relationship was not clear.
Working in laboratory experiments with mice, Dr
Shu Lin, an assistant professor of surgery and
immunology at Duke, discovered that inhaling tiny
amounts of stomach fluid that back up into the
esophagus – a hallmark of GERD – produces changes in
the immune system that can drive the development of
asthma.
In the experiments, researchers inserted
miniscule amounts of gastric fluid into the lungs of
mice (mimicking the human process of
micro-aspiration, or breathing in tiny amounts) over
a period of eight weeks. They compared these
animals' immune systems with those of mice that were
exposed to allergens but not the gastric fluid.
The immune systems of the two sets of mice
responded very differently. Those that had the
gastric fluid in their lungs developed what
researchers call a T-helper type 2 response, a type
of immune system reaction characteristic of asthma.
The other mice responded in a more balanced manner,
mounting an immune reaction consisting of both
T-helper type 1 and T-helper type 2 responses.
"This is the first experimental evidence in a
controlled, laboratory setting linking these two
very common conditions in humans," says Lin, the
senior author of the study published online in the
European Journal of Clinical Investigation. "These
data suggest that chronic micro-aspiration of
gastric fluid can drive the immune system toward an
asthmatic response."
"This does not mean that everyone with GERD is
going to develop asthma, by any means," says William
Parker, an assistant professor of surgery at Duke
and a co-author of the study. "But it may mean that
people with GERD may be more likely to develop
asthma. If there is an upside to this, it is that
developing GERD is something we can pretty much
treat and control."
Parker says poor diet, a lack of exercise and
obesity all contribute to the development of GERD,
and that rising rates of reflux disease are part of
a "perfect storm" of environmental and behavioral
factors driving escalating rates of asthma,
particularly in Western cultures. "People should
avoid the risk factors for GERD. We strongly believe
that the rise in asthma, particularly among adults
in the country, is in large measure due to lifestyle
choices that can be changed."
Lin and Parker agree that much more work needs to
be done to fully understand the cellular and
molecular mechanisms involved in the relationship
between reflux disease and asthma, but both feel
their study offers new directions for developing
additional treatment options for both problems.
Lin says patients who already have GERD can
minimize gastric reflux – and thereby lessen their
chances of developing asthma – by following a few
simple guidelines: Eat smaller meals and eat several
hours before going to bed; raise the head of the bed
a few inches; maintain a healthy weight; and limit
fatty goods, coffee, tea, caffeine and alcohol –
they can relax the esophageal sphincter and make
reflux more likely.
Reference
Duke University Medical Center. "How Gastric Reflux
May Trigger Asthma." Accessed 21 July 2008
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
nac@nationalasthma.org.au. |
Conference Diary
Submit brief conference/meeting details to the National Asthma Council Australia for possible posting in our Conference Diary by email to
nac@nationalasthma.org.au.
|
