Flu alert for people with asthma

The National Asthma Council Australia is urging the two million Australians with asthma to remain extremely vigilant and seek an immediate lung function check from their GP following new data from the US which confirms people with an underlying medical condition are at highest risk of complications from swine flu - with more than 40 percent of people in New York hospitalised from swine flu having asthma¹.

"Whether you are sick or not - if you have asthma and have not seen your GP in the last six months it is important you make an immediate appointment with your doctor to check the functioning and health of your lungs. Check with your GP that you are prescribed the right treatment, that you can use your inhaler correctly and that your current lung function is good. If this is all in order and you have a written asthma action plan that will guide you through any deterioration, you should be confident that you are prepared for a potentially difficult winter flu season," said Associate Professor Matthew Peters, Respiratory Physician, Head of Respiratory Medicine at Concord Hospital, Sydney.

Winter is traditionally a challenging time for people with asthma as colds and flu can exacerbate their condition resulting in worsening of symptoms and potential hospital admissions. They can be particularly susceptible to influenza as viral infections can lead to increased asthma symptoms. Older people and those with severe asthma who get the flu may be at risk of more serious complications like pneumonia. Dr Noela Whitby AM, Chairman of the National Asthma Council Australia, is concerned Australians with asthma aren't as prepared as they should be for the significant winter challenges we are facing.

"Studies continue to show a decline in asthma-related visits to GPs² and for a variety of reasons people with asthma tend to under utilise their prescribed medications," explained Dr Whitby. The National Asthma Council Australia is therefore encouraging people with asthma to visit their GP promptly for a lung function test and to ensure they are using their asthma medications effectively. It's also essential that people with asthma have an up to date written asthma action plan and that they follow it.

"We appreciate in these tough economic times that some people will be trying to contain their healthcare costs. But in the midst of this particularly difficult flu season, it's really important that people with asthma consult their doctor now to ensure their lung health is being effectively managed during winter.

"Ask your GP for a lung function test called spirometry. This measures how well your lungs are working and how asthma is affecting your breathing," she advised. Chris, 32, from Sydney has been living with asthma for over 20 years.

"I usually get some asthma symptoms in winter, but last year I had a real scare after coming down with pneumonia at the end of winter. I got really sick and one of the worst parts about it was the wheezing, feeling constantly tired and the sensation that someone was sitting on my chest. I was off work for two weeks and it took me about three weeks to fully recover.

"I know people with asthma, like me, probably think they're absolutely fine and can get by in the winter months, but after last year's experience I've made sure I think more about protecting myself and I'll be seeing my GP as soon as possible this winter."

References

1. New York City Department of Health and Mental Hygiene http://www.nyc.gov/html/doh/html/pr2009/pr039-09.shtml  accessed on 5 June 2009.

2. Australian Centre for Asthma Monitoring 2008. Asthma in Australia 2008. AIHW Asthma Series no. 3. Cat. No. ACM 14. Canberra: AIHW

Resources

Written Asthma Action Plans - http://www.nationalasthma.org.au/content/view/247/638/

Asthma Winter Checklist - http://www.nationalasthma.org.au/content/view/633/1063/

Asthma and Lung Function Tests - Measuring asthma for better control - http://www.nationalasthma.org.au/content/view/184/33/

Fighting the flu season

In this article written for GP Review (just prior to the Swine Flu outbreak), Dr Kerry Hancock Chair, GP Asthma Group, National Asthma Council Australia explains why colds and flu can be serious for children with asthma.

As winter sets in, cold and flu viruses abound. For our younger patients with asthma this is an especially difficult time of year, with respiratory viruses being a major cause of asthma exacerbations in children.

Intermittent exacerbations – particularly those due to upper respiratory viral infections – can occur in children with stable asthma despite good ongoing overall asthma control.¹   

Managing exacerbations

Exacerbations in children associated with viral infections do not necessarily indicate a failure of preventer therapy, nor do they warrant an automatic step up to higher inhaled corticosteroid (ICS) doses or a progression to combination therapy. Children taking regular preventative medicine should stay on the same dose during an exacerbation. Doubling the ICS dose is ineffective.¹

If a child is experiencing an exacerbation, reliever medications should be recommended and administered via a puffer (MDI) and spacer. This treatment is equally as effective as nebulisation in children with moderate to severe acute asthma.² Parent or practitioner initiated oral corticosteroids should be reserved for severe exacerbations.¹

As the exacerbation is brought under control, it is imperative to always review adherence and inhaler technique to ensure that the prescribed drug is actually getting to where it needs to be.

Written asthma action plans

A comprehensive written asthma action plan for recognising and managing acute episodes is vital for both children and their parents – and not only during winter but throughout the year.

Indeed, a large proportion of the serious asthma related paediatric emergencies in winter could probably be prevented if asthma action plans were adhered to. Many asthma action plan templates are available; see the National Asthma Council Australia (NAC) website for examples. In children, symptom based plans are preferred.

Remind parents that a copy of the completed action plan should also be given to their child’s grandparents, sports coaches or other regular carers.

Flu vaccination

Current Australian immunisation guidelines now recommend influenza vaccination for all children older than 6 months who are at risk of severe complications, which includes kids with asthma.³

Children 9 years of age and under who have not been previously vaccinated should receive two doses 1 month apart in the first year they get vaccinated; in subsequent years, they only require one dose. Children younger than 3 years of age need a lower dose (0.25 mL); once they reach 3 years of age, they should be given the adult dose (0.5 mL).

Reliable online resources

Finding time to provide comprehensive education for children with asthma and their families can be challenging.

With this in mind, a new child friendly website has been launched by the NAC to give children with asthma and their parents reliable information on asthma, including guidance on diagnosis, medications, triggers and management. Visit the website at http://www.kidswithasthma.com.au/.

The Kids With Asthma medical content was developed by an independent NAC expert panel led by Professor Peter van Asperen, a paediatric respiratory physician, with the support of an unrestricted educational grant from website publisher Merck Sharp & Dohme.

For information on asthma diagnosis and management, including asthma action plan templates, visit the NAC website at www.nationalasthma.org.au. The NAC’s recent panel discussion program, ‘A is for Asthma: Managing asthma in primary school kids’, is now available via the NAC website or from the Rural Health Education Foundation at www.rhef.com.au.

References

1. National Asthma Council Australia (NAC). Asthma Management Handbook 2006. Melbourne: NAC, 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.

3. National Health and Medical Research Council (NHMRC). The Australian Immunisation Handbook. 9th edn. Canberra: NHMRC, 2008. Available at www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-influenza [Accessed April 2009].

Resources

Asthma issues in focus with GP Review - http://www.nationalasthma.org.au/content/blogcategory/68/951/

'Kids With Asthma' winter update

The NAC's interactive, kid-friendly website 'Kids With Asthma' (http://www.kidswithasthma.com.au/) has seasonal information posted on the site quarterly to ensure it remains relevant and up to date. The current seasonal topic focusses on colds and viruses and is available now.

Useful information in the seasonal area incudes:

• Keeping asthma under control
• Triggers - things that cause asthma symptoms
• What is an asthma action plan
• What can I do to help my child avoid an asthma attack 

Detailed clinical information on this topic is also being made available to health professionals via a seasonal email update.  Associate Professor Adam Jaffe who is the Head of the Respiratory Department at the Sydney Children's Hospital, Randwick, discusses Viral Triggered Asthma in the latest update. 

Health professionals can register to receive Kids With Asthma seasonal update emails at: http://www.msd4gps.com.au/        

 Adults with asthma - no flu shots

 At-risk population under-vaccinated

Because of increased risk of complications from influenza, vaccination of adults and children with asthma is recommended by the Advisory Committee on Immunization Practices in the USA. The Healthy People 2010 Objectives call for annual influenza vaccination of at least 60% of adults aged 18-64 years with asthma. However, Centers for Disease Control and Prevention (CDC) investigators recently published a study determining that the vaccination levels among asthma sufferers falls well short of this guideline.

The Behavioral Risk Factor Surveillance System (BRFSS) has been in use since 1984 and collects state-specific data from random telephone surveys of US adults. This study analyzed the responses of 173,572 adults aged 18-64 years and found that 8.4% had asthma. In the 2006-2007 influenza season, vaccination estimates ranged from 26.9% in California to 53.3% in Tennessee with a median across all states of 43.1%.

Influenza vaccination coverage was 33.9% for adults aged 18-49 years with asthma compared to 54.7% for adults aged 50-64 years with asthma. Among people aged 18-64 years without asthma, vaccination coverage was 28.8%. In addition, the researchers found a race/ethnicity gap of 8 to 10 percentage points between levels among non-Hispanic whites compared to levels among non-Hispanic blacks or Hispanics, despite adjustments for a set of socio-demographic and access-to-care variables.

Lead investigator Peng-jun Lu, National Center for Immunization and Respiratory Diseases, CDC, and co-investigators advise, "The National Asthma Education and Prevention Program identified influenza vaccination as one of several 'key clinical activities that should be considered as essential for quality asthma care.' The panel included influenza vaccination among the 'core set of 10 key clinical activities' to reducing asthma morbidity and mortality…. To further improve vaccination coverage among people with asthma, providers should address barriers to delivery and acceptance of influenza vaccination among those with high-risk conditions, including asthma. Providers should also be encouraged to use evidence-based immunization strategies (such as standing orders, patient reminder/recall, provider reminder, provider assessment and feedback); screen for asthma or other high-risk conditions; and routinely offer influenza vaccination."

Reference

"Influenza Vaccination Among Adults with Asthma: Findings from the 2007 BRFSS Survey" by Peng-jun Lu, MD, PhD, Gary L. Euler, DrPH, and David B. Callahan MD. It appears in the American Journal of Preventive Medicine, Volume 37, Issue 2 (August 2009) published by Elsevier.

Current Australian immunisation guidelines

National Health and Medical Research Council (NHMRC).
The Australian Immunisation Handbook. 9th edn. Canberra: NHMRC, 2008. Available at www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-influenza [Accessed April 2009].  

Asthma Winter Checklist

If you have asthma your lungs are more susceptible to being hit hard by colds and flu. By following these important steps you can make sure your lungs are in the best possible shape for this challenging winter.

Get your lungs tested

Make an appointment with your doctor and ask for a lung function test (spirometry). It's the best way to measure the health of your lungs and identify whether you need to make any changes to your asthma management.

Know the signs of flu

Flu hits hard and fast. Most people feel like they've been hit by a brick wall. It is important to keep in mind that a runny nose or cough does not mean you have flu, however if you are unwell and experiencing an increase in asthma symptoms make sure you contact your doctor immediately and follow your written asthma action plan. If you haven't got one yet, ask your doctor to develop one with you.

Protect yourself

• Keep warm if cold air triggers your asthma
• Control germs by washing your hands
• Stay at home if you feel unwell
• If you have severe asthma, get your flu vaccination

Use your medications wisely

Tell your doctor if you have been using a reliever or rescue inhaler more than twice a week or are having asthma symptoms frequently during the day or night. These are important signs that your lungs may not be in the best condition for winter colds and flu. If you have been prescribed a preventer medication make sure you use it - even if you feel well.

Resources

Written Asthma Action Plans
First Aid Chart
Asthma and Lung Function Tests - Measuring asthma for better control
Tips to manage your asthma all year - Winter

Research Funding Opportunities

Research and Travel Grants

The Asthma Foundation of Victoria is calling for applications for Research and Travel Grants for projects to be undertaken in the 2010 Calendar Year.

The Foundation is offering two Research Grants and the Lillian Roxon Travel Grant, for Victorian based projects. Grant applications are particularly encouraged from young researchers commencing their research careers.

Further information and application forms can be found on the Asthma Foundation of Victoria website http://www.asthma.org.au/  or by contacting Garry Irving at the Asthma Foundation of Victoria on (03) 9326 7088.

Applications for the 2010 Research and Travel Grants close at 5-00pm on Friday 31 July 2009.

Submit brief conference/meeting details to the National Asthma Council Australia for possible posting in our Conference Diary by email to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

2009
	IPCRG International Scientific Conference 5 June 2009, Stansted Airport, UK http://www.theipcrg.org/sci_conf_2009/programme.php
	49th Annual Meeting of the JRS 12-14 June 2009 Tokyo, Japan http://www.jrs.or.jp/
	First World Conference of COPD Patients  14 June 2009  Rome, Italy http://www.internationalcopd.org/Conference/
	ERS Annual Congress 12-16 September 2009 Vienna, Austria http://www.ersnet.org/
	Inspiration for Life Asthma and Respiratory Educators Association 2009 Conference 15 and 16 Octopber, 2009 Sebel Albert Park, Melbourne http://www.aareaconference.com/
	Annual International Scientific Assembly of the American College of Chest Physicians 31 October - 5 November 2009 San Diego, United States http://www.chestnet.org/CHEST/
	American College of Allergy, Asthma & Immunology 6-11 November 2009 Miami Beach, United States http://www.acaai.org/
	EAACI 2009 Pediatric Allergy & Asthma Meeting 12-14 November 2009 Venice, Italy http://www.eaacipediatrics-venice2009.org
	Melbourne GPCE 13-15 November 2009 Melbourne Exhibition Centre, Southbank http://www.gpce.com.au/
	14th Congress of the APSR   14-18 November 2009 Seoul www.apsresp.org/congress/2009.php
2010
	8th Asia Pacific Congress of Allergy, Asthma and Clinical Immunology (APCAACI 2010)  7-10 November 2010  Suntec Singapore International Convention & Exhibition Centre  http://www.apcaaci2010.org/  This e-mail address is being protected from spam bots, you need JavaScript enabled to view it