September 2008

Breathlessness in the Older Adult: is it asthma?

Asthma management in general practice

The A-Team® at Advancing Asthma Where? Conference

The National Asthma Council Australia has moved

Better home heating improves childhood asthma

Farm children, asthma and allergies

Monitoring exhaled nitric oxide does not help manage asthma

Research Funding Opportunities

  Future Leaders in Healthcare

Conference Diary

Breathlessness in the Older Adult: is it asthma?

Older adults may consider their breathlessness to be a frustrating but natural consequence of ageing, unaware that respiratory disease might be the cause. Yet the prevalence of asthma and chronic obstructive pulmonary disease (COPD) both increase with age.

The risk of dying from asthma also increases with age, and acute asthma attacks are more rapidly fatal in older adults. However, up to one-third of elderly people with asthma are not identified as such by their doctors through a combination of under-reporting of symptoms and complexity of diagnosis. COPD is also under-diagnosed in the elderly.

The National Asthma Council Australia’s latest program with the Rural Health Education Foundation covers the differential diagnosis and management of asthma in older adults with breathlessness, with interrelated discussion of COPD.

The distinction between asthma and COPD is important, even when they co-exist, as there are significant differences in the optimal management of each condition. Clinical case studies are used to frame the discussion.

Speakers

• Chair: Dr Norman Swan, Presenter of the Health Report on ABC Radio National

Assoc Prof Christine McDonald, Respiratory Physician, Austin and Repatriation Medical Centre, Melbourne, VIC	Ms Toni Riley, Community Pharmacist, Bendigo, VIC
Dr Gary Kilov, General Practitioner, Clarinda Clinic, Melbourne, VIC	Ms Vanessa McDonald, Respiratory CNC, Hunter New England Health, Newcastle, NSW

Now available

The 60-minute program is available for viewing online or downloading as a podcast from the Rural Health Education Foundation website at http://www.rhef.com.au/programs/?group_id=34

For more information see NAC Asthma Programs with the Rural Health Education Foundation

Asthma management in general practice

A member of the National Asthma Council Australia's General Practitioners' Asthma Group, Dr Steven Rudolphy, has an article in the September issue of Australian Family Physician "Asthma management in general practice - A chronic disease health priority". The article provides an overview of asthma management based on the National Asthma Council’s Asthma Management Handbook 2006.

Dr Rudolphy is a Senior Lecturer, General Practice & Rural Medicine, James Cook University, Cairns Base Hospital Campus, and a general practitioner, Mt Sheridan, Queensland and has been involved with the NAC’s GP Asthma Group for many years. This important advisory group aims to co-ordinate the expertise, enthusiasm and skills of general practitioners who have a special interest in the management of asthma.

An audio podcast is also available where Dr Rudolphy discusses straight forward ways for the busy GP to improve asthma management. He also talks about tricky areas - making sure of the diagnosis, differentiating asthma from COPD and managing wheeze in infants – citing the Asthma Management Handbook 2006 as an excellent GP resource.

For the article go to: Asthma management in general practice - A chronic disease health priority

For podcast go to: AFP Audio: Interview with Dr Steven Rudolphy

Reference

Rudolphy, R. Asthma management in general practice - a chronic disease health priority.  Aust Fam Physician. 2008 Sep;37(9):710-4.

.

The A-Team^® at Advancing Asthma Where? Conference

The biennial Australian Asthma Conference will take place from 20 - 21 October 2008 at the Australian Technology Park Sydney.  NAC Project Officer, Judi Wicking, will make a presentation about  the A-Team^®, during one of the Free Paper sessions on day one of the conference.

The NAC established the A-Team Asthma Education Program in 2002 to reinforce and increase levels of awareness in best-practice asthma management. Find out more about our group of trained asthma experts who regularly run asthma education workshops across Australia for GPs, practice nurses, asthma educators and other health professionals on Monday 20 October, Free Papers Room 7 at 4.30 pm.

The conference program includes the following expert speakers:

More information

Go to www.asthmaconference2008.com

The National Asthma Council Australia has moved

The NAC team has relocated. Please update your records as follows:

National Asthma Council Australia
Suite 104, Level 1
153-161 Park Street
South Melbourne VIC 3205
Australia

Telephone: +61 (3) 9929 4333
Facsimile:   +61 (3) 9929 4300

Better home heating improves childhood asthma

Further analysis of the 'Housing, Heating and Health' study conducted by the University of Otago, Wellington, and led by Professor Philippa Howden-Chapman, shows that improved home heating reduces asthma symptoms in children in New Zealand.

The study published in the British Medical Journal, examined 409 children in five NZ communities between the ages of 6 and 12 with diagnosed asthma, both before and after more effective heating was installed in their homes. The better heating included heat pumps, flued gas heaters or pellet burners.

The results showed a positive improvement in the children's health following the installation of better heating. Specifically the children had improved health, less sleep disturbance and wheezing, less coughing at night and improved respiratory symptoms. They also had fewer sick days off school and fewer visits to the doctor and chemist.

Although there was no significant difference in lung function, asthma symptoms such as coughing and wheezing were significantly reduced.

"This study shows that sustainable heaters are good for children's health. It's possible for families to be warm inside, without polluting the air outside. The recent Emissions Trading package builds on this work and allocates a billion dollars to insulate houses and install healthy heating. We expect to see improvements in respiratory health as a result," says Professor Howden-Chapman.

The houses in the study had a mean temperature rise of 1.10C in the living room and 0.57C in the child's bedroom. They also had significantly less polluting nitrogen dioxide (NO2) from unflued gas heaters in both the living and bedrooms.

Further analysis of the health records of family members will determine other results from the heating intervention, along with a comprehensive cost-benefit analysis comparing the cost of healthy heating with the public good of ongoing savings in positive health impacts, energy use and climate change mitigation.

Asthma is one of the most prevalent chronic diseases in childhood and 25% of NZ children report asthma symptoms. It is the second most common reason for hospital admissions for children. Asthmatic children also have more days off school and caregivers have to take more time off work. It also results in higher health and pharmaceutical costs.

There is growing evidence that indoor pollutants such at NO2, cold house temperatures, damp and mould and second-hand smoke all aggravate asthma, although the exact causal relationships are unclear. However children, because of their lack of physical development inhale more air, and therefore more pollutants, than adults in the same environment.

Indoor pollutants also have a thousand-fold greater chance of being inhaled than outdoors. One third of NZ homes use unflued gas heaters which emit significant concentrations of NO2 compared to heat pumps or other flued gas appliances. Unflued gas heaters also release large amounts of water vapour which exacerbates mould and dampness.

Reference

Howden-Chapman, P et al. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial. BMJ 2008;337:a1411

Farm children, asthma and allergies

Pre-natal exposure to farm animals and plants helps protect children from asthma, allergies and eczema.

New Zealand researchers from the Centre for Public Health Research discovered farmers' children had a lower incidence of allergic diseases than children not exposed to animals, grain and hay products.

Associate Professor Jeroen Douwes says it is the first study to show a direct link between exposures in utero and a significant reduction in asthma symptoms, hay fever and eczema.

“The risk is further reduced if children are currently exposed to farm conditions and that suggests that current exposures play a role in the continued protection against disease later in life.”

The research team surveyed 1,333 farmers' children and a reference group of 566 children aged from five to 17 years for the study.

It found that children with both pre-natal and current exposure to farm animals were 50 per cent less likely to have asthma than the reference group. Similar results were found for other allergic diseases such as eczema and hay fever.

Dr Douwes says a more detailed study of infants is needed to fully understand the link between exposure and reduction of disease.

“We need more information from pregnant women and their children, so we are continuing to recruit participants to the study,” Dr Douwes says. “In future, we may be able to develop a vaccine that could mimic exposure, or outline how people could make lifestyle changes to reduce the risk of allergic disease.”

Reference

Douwes, J et al. Farm exposure in utero may protect against asthma, hay fever and eczema. Eur Respir J 2008; 32:603-611

Monitoring exhaled nitric oxide does not help manage asthma

A US study shows that monitoring levels of exhaled nitric oxide in adolescents with asthma and adjusting treatment accordingly does not improve the course of their disease.

Approximately 550 adolescents in 10 cities across the United States participated in the study. It was designed to examine whether in addition to treating asthma based on national guidelines developed at NIH, measurements of exhaled nitric oxide would allow even better control of the disease. This was the largest study to date testing exhaled nitric oxide as a biomarker for asthma management.

The causes of asthma are still unknown, but allergens, air pollution and infections can provoke its symptoms, which include wheezing, chest tightness, shortness of breath and coughing. Asthma symptoms occur when the tissues of the lungs become inflamed and the muscles in the airways contract, making breathing difficult. One measurable marker of asthma-related inflammation is high levels of nitric oxide (NO) in the breath; it is known that the higher the exhaled NO, the greater the inflammation of the lungs. Equipment is now available to easily measure exhaled NO. Widely used asthma treatments, such as inhaled corticosteroids, reduce both lung inflammation and exhaled NO. Exhaled NO would potentially be a good biomarker - a measurable feature of a disease that indicates its severity - of asthma inflammation.

"A biomarker of airway inflammation could be a useful clinical tool for gauging medical needs and clinical responses in asthma patients," says Anthony S. Fauci, MD, director of National Institute of Allergy and Infectious Diseases (NIAID). "Although this study reinforces the importance of the NIH asthma guidelines for disease control, it did not find that measuring exhaled nitric oxide provided any additional clinical benefit."

The research was led by Stanley Szefler, MD, of National Jewish Health in Denver, in conjunction with William Busse, MD, of the University of Wisconsin in Madison. Participants were randomly assigned to one of two equal-sized groups: one group received treatment based on the NIH National Asthma Education and Prevention Program (NAEPP) guidelines alone, and the other received treatment based on the guidelines plus measurement of exhaled NO. The year-long study compared participants' symptoms and asthma exacerbations.

According to Dr Szefler, "The hypothesis was that adding exhaled NO monitoring to the NIH asthma guidelines-based approach would improve asthma control over the guidelines-based approach alone." Researchers had hoped that exhaled NO would indicate if there was a need for increased treatment dosage in the participants who had few asthma symptoms but who had ongoing high levels of lung inflammation. Although measuring exhaled NO is not routine practice in asthma management, this study was aimed at determining whether it should be included in treating patients in the future.

In the end, the study found that the group whose treatment was guided by exhaled NO did not end up with fewer or less severe asthma symptoms or fewer asthma exacerbations compared with the group that received treatment based on the NAEPP guidelines alone.

Most patients in each group had marked improvement in their asthma initially and throughout the study, highlighting the importance of optimizing asthma treatment according to the NIH guidelines. According to Dr Busse, the upside of the study is that "good adherence to the current guidelines [for treating asthma patients] can mean good disease management without the need for a biomarker." This is particularly important because the study was conducted in an inner-city population, which historically has suffered from more difficult-to-treat asthma and disproportionately higher mortality from asthma due to the lack of optimal management, according to Peter Gergen, MD, the NIAID medical officer overseeing the study.

Reference

Szefler, SJ et al, Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. The Lancet 2008; 372:1065-1072

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.

Future Leaders in Healthcare

The National Health and Medical Research Council (NHMRC) is inviting early-to-mid career health professionals with a commitment to improve health care in Australia to apply for a 2009 NICS Fellowship.

The NHMRC, through its National Institute of Clinical Studies, has partnered with a number of key health organisations to offer ten Fellowships. In past years they have attracted a large number of very strong applications from people eager to develop careers in knowledge transfer.

NICS Fellows are provided with unique opportunities through mentoring, training, national and international networking and practical support. As a result, Fellows have made a significant impact in their workplace, share their knowledge and influence evidence-based policy and practice at many levels.

NICS Fellowships are offered for two years, half-time to health professionals who are future leaders in evidence-based health care and wish to address an evidence-practice gap in their area of clinical practice. Fellowships have previously been awarded across the range of health disciplines for research projects including the implementation of clinical practice guidelines in areas such as mental health, osteoporosis, stroke management and cardiovascular disease.

2009 NICS Fellowships comprise:

NICS-HCF Health and Medical Research Foundation Fellowships (3)

NICS-Cancer Australia National Centre for Gynaecological Cancers Fellowship

NICS-Gastroenterological Society of Australia Fellowship

NICS-Melbourne Health Fellowship

NICS-Multiple Sclerosis Research Australia Betty Cuthbert Fellowship

NICS-SA Health Fellowship

NICS-Victorian Department of Human Services Fellowship

NICS Fellowship

Applications close: October 27, 2008.

For information about the NICS Fellowships and the individual Fellowships: www.nhmrc.gov.au/nics

Information teleconference about the NICS Fellowship

Date: Friday 3 October 2008

Time: 1.30pm AEST, 1.00pm ACST, 11.30am AWST

To register for your toll-free dial-in PIN please email NICSFellowships@nhmrc.gov.au, indicating that you would like to attend.

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.

	WONCA 2008 Asia Pacific Regional Conference 1–5 October 2008. Melbourne, Australia http://www.wonca2008.com
	ERS Annual Congress 4-8 October 2008 Berlin, Germany http://www.ersnet.org/
	Advancing Asthma Where? Australian Asthma Conference 20 - 21 October 2008 Australian Technology Park Sydney, Australia http://www.asthmaconference2008.com/
	CHEST, Annual International Scientific Assembly of the American College of Chest Physicians 25-30 October 2008 Philadelphias United States http://www.chestnet.org/CHEST/
	American College of Allergy, Asthma & Immunology 7-12 November 2008 Seattle, United States http://www.acaai.org/
	ASCIA 19th Annual Scientific Meeting 12 - 14 November 2008 Park Hyatt Hotel, Melbourne, Australia http://www.ascia2008.com/
	13th APSR Congress 19-22 November 2008 Bangkok, Thailand http://www.apsr2008.org
	Annual Meeting of Taiwan Society of Pulmonary and Critical Care Medicine 6-7 December 2008 Taipei, Taiwan spccm@mars.seed.net.tw http://www.tspccm.org.tw/