In this Issue March 2006

NAC Hosts Korean Visitors

TSANZ Annual Scientific Meeting

   Antioxidants and Asthma

   Over-the-counter Reliever Medication

   Pharmacists and Asthma Management

The ‘10 Tips’ Poster

Antibiotic use in infants may double asthma risk

ACRRM 4th Scientific Forum

Research Funding Opportunities 

   Asthma Targeted Intervention Grants 2006

Conference Diary 2005

NAC Hosts Korean Visitors

Presently the public recognition of asthma in Korea is not at the same level as in Australia. The nature of asthma as a chronic inflammatory disease, the need for preventer medication and for regular medical review of people with asthma is not well understood.

The GP’s role in asthma management in Korea is less well defined and is poorly recognised by respiratory specialists, so GPs are not included in regular asthma medical education. Also, a referral from a GP to see a specialist is not required, so a person seeking medical advice and treatment may choose whom they attend.

During early March the National Asthma Council had the opportunity to showcase the Australian approach to asthma management for visitors from Korea Ms Yun-Hee Yang, PR Director, GSK Korea and Mr Sean Choi, staff writer, The Chosun Daily newspaper in Seoul. With the aim of promoting greater recognition of asthma and better asthma management education and practices in Korea, the visitors gathered information on our approach to managing asthma and its successes. In particular, the delegates reviewed the NAC as a model for the development of the Korean asthma organisation.

Initiatives such as the Asthma Management Handbook, the 3+ Visit Plan, Written Asthma Action Plans were reviewed and discussed in depth. Also, Ms Yun-Hee Yang and Mr Sean Choi, along with NAC Project Manager Kathy Hope spent three days around Melbourne and environs visiting:

• A suburban family medical centre with a GP, a pharmacist /asthma educator and practice nurses to see practical application of asthma management in general practice and coordination with local pharmacy asthma education

• Assoc. Prof. Colin Robertson, paediatric respiratory specialist at the Royal Children’s Hospital

• the Asthma Advice Line, Asthma Foundation of Victoria (AFV);

• Mt Evelyn Primary School to review the Asthma Friendly Schools Program with AFV;

• NAC Chief Executive Kristine Whorlow; and

• NAC Chairman Assoc. Prof John Wilson.

The article on Australian asthma management and education has now been published in the Chosun Daily.

TSANZ Annual Scientific Meeting

The Thoracic Society of Australia and New Zealand held their Annual Scientific Meeting in Canberra at the National Convention Centre, from 24 - 29 March 2006.

Antioxidants and Asthma

Antioxidants are thought to have a protective effect on potentially harmful, unstable chemicals called free radicals that occur naturally in our bodies. These antioxidants are present in tea, fruits and vegetables and we are just beginning to understand their importance, even in the management of asthma.

Oxidative stress and impaired antioxidant defences are increasingly recognised features of asthma. Dietary antioxidants are an important component of host antioxidant defence. In a study undertaken at the John Hunter Hospital, Newcastle, Dr Lisa Wood and colleagues monitored changes in respiratory outcomes resulting from a low antioxidant diet, in people with asthma.¹

This small study of fifteen patients showed that a diet low in antioxidants worsened asthma control and lung function.

Recent UK research from the Institute of Public Health in Cambridge, had a similar result finding that the inclusion of plenty of dietary fruit and vegetables may assist in control of symptoms in people with asthma.²

The study reviewed the diets of 515 adults with asthma and 515 adult without the respiratory condition. Interestingly, people who ate more than 46.3 g of fruit each day had a lower risk of asthma than people who ate no fruit at all.

The analysis of nutrients consumed showed that higher levels of dietary vitamin C and manganese were associated with lower levels of asthma symptoms.

For people with asthma it would now seem that "an orange a day helps keep the doctor away"!

References

1. Wood LG, Garg ML, Gibson PG. A Low Antioxidant Diet Worsens Asthma Control. 2006 Annual Scientific Meeting TSANZ, Abstract.
    (www.thoracic.org.au/abs2006/084woodlg.pdf)

2. Patel BD, Welch AA, Bingham SA, Luben RN, Day NE, Khaw KT, Lomas DA, Wareham NJ. Dietary anti-oxidants and symptomatic asthma in adults. Thorax. 2006 Feb 7.
   (http://thorax.bmjjournals.com/cgi/content/abstract/thx.2004.024935v1) 

Over-the-counter Reliever Medication

Melbourne researchers compared asthma control of people purchasing reliever medication over-the-counter (OTC) with and without prescription. They recruited up to 10 consecutive people buying beta₂-agonists from 43 randomly selected Victorian urban and rural pharmacies.

The study participants had spirometry and completed  modified European Respiratory Health, Juniper Asthma Control, Marks’ Quality of Life and adherence questionnaires. There were no significant differences in results between beta₂-agonist purchasers with and without prescription.

The study concluded that in this representative state-wide sample, OTCbeta₂-agonist purchase was not a predictor for worse asthma control, quality of life or lung function.

Reference

Douglass J, Goeman D, Sawyer S, Aroni R, Stewart K, Abramson, M. Over-The-Counter (Otc) Β2-Agonist Purchase Is Not Associated With Poor Asthma Control: A Random, Community Study. 2006 Annual Scientific Meeting TSANZ, Abstract.
(www.thoracic.org.au/abs2006/119douglassj.pdf)   

Pharmacists and Asthma Management

A study measuring the impact of a specialised asthma management service, the Pharmacy Asthma Care Program, (PACP) was undertaken in 50 pharmacies (24 control and 26 intervention) across three Australian states.

Some 351 people who may have been at risk of poorly controlled asthma were identified to receive the PACP service involving a cycle of assessment, goal setting and monitoring over 6 months and followed the NAC 6-step Asthma Management plan.

Over 3-4 visits, asthma severity, spirometry, inhaler technique, medications and lifestyle issues were reviewed and interventions delivered. People were referred to their doctor for an action plan and other issues when required. T

he control group were assessed for asthma severity and spirometry measures at 0 and 6 months, but received no interventions beyond standard patient care.

Overall the results for the PACP were very promising with significant (p<0.05) changes over time in the intervention people compared to controls. With intervention, there was

• a decrease in the proportion of those with severe asthma (88% to 53%);

• an increase in those classified as adherent to preventer medications (54% to 71%);

• a decrease in salbutamol use;

• improved quality of life; asthma knowledge; perceived control; correct inhaler technique (24% to 73%) and owning an action plan (23% to 64%).

The service appears to be highly cost effective with an estimated cost per QALY of $791.

Overall, this study underscores the role for community pharmacists in identifying people in need of better asthma care and how the pharmacist contributes significantly to improving care and health outcomes for people with asthma.

Reference

Armour C, Bosnic-Anticevich S, Saini B, Krass I, Smith L, Brillant M, Burton D2, Simpson M, Wettenhall J, Emmerton L, Bond J, Johnston S, Stewart K. Pharmacists Improving Health Care for Asthma. 2006 Annual Scientific Meeting TSANZ, Abstract.
(www.thoracic.org.au/abs2006/120armourc.pdf)

The ‘10 Tips’ Poster

Encourage patient participation in their own health care

The 10 Tips for Safer Health Care: what everyone needs to know (’10 Tips’) material has been developed by the Australian Council for Safety and Quality Health Care (ACSQHC) and provided to the RACGP to promote on their behalf.

The ’10 Tips’ material assists people to become more actively involved in their own health care. It explains why things can go wrong, and how patients can work in partnership with their GPs to get the best possible care.

This material:

• gives ‘10 Tips’ to patients to help them improve their health care

• outlines what patients can expect from their GP

• lists some sources of information for finding out more about their condition and how to manage their medicines

• explains what patients can do if they have concerns about their health care

• is available in 23 languages

One A3 colour ’10 Tips’ poster is available free of charge to every general practice in Australia where a member of the RACGP is employed.

Arrange for your free poster and other materials at www.racgp.org.au/10tips

Alternatively, you may contract Rachel Pow on rachel.pow@racgp.org.au or 03 8699 0524.

Antibiotic use in infants may double asthma risk

Children exposed to at least one course of antibiotics in their first year of life may have an increased risk of developing childhood asthma. New Canadian research shows that children under age one who were treated with an antibiotic were twice as likely as untreated children to develop asthma in childhood. In addition, the use of multiple antibiotics in infants appeared to further increase the risk of developing asthma.

"Antibiotic use in children has been found to coincide with an increased incidence of childhood asthma," said lead author Carlo Marra, Pharm D, PhD, University of British Columbia, Vancouver. "Although the causal nature between antibiotics and asthma is still unclear, our overall results show that treatment with at least one antibiotic as an infant appears to be associated with the development of childhood asthma."

The research group examined the association between antibiotic exposure during infancy and the development of childhood asthma. In a meta-analysis, they reviewed seven studies (four prospective and three retrospective) that compared exposure to at least one antibiotic to no exposure in the first year of life.

Of the 12,082 children included in the analysis, 1,817 cases of childhood asthma were reported. Overall, infants who were exposed to at least one antibiotic were twice as likely as unexposed infants to develop asthma during childhood. The association between antibiotic use in the first year of life and asthma was significantly stronger in retrospective studies (odds ratio 2.82) than in prospective studies (odds ratio 1.12).

Results also showed that high-risk infants, such as those with a family history of atopy, exposed to antibiotics had a lower risk of developing asthma than children in the general population, although the results were not significant.

In a dose-response analysis, researchers analysed the reporting data from 27,167 children (3,392 asthma cases) from five studies to determine the effect that multiple courses of antibiotics in infants would have on the development of asthma. For each additional course of antibiotics taken during the first year of life, results showed a significant overall odds ratio of 1.16, suggesting that additional courses of antibiotics appeared to further increase the risk for asthma development. Again, this association was stronger for studies that were retrospective than for prospective studies.

"In children, antibiotics are commonly used to treat ear infections, upper respiratory tract infections, and bronchitis, but not every childhood infection requires an antibiotic," said the study's co-author Dr Fawziah Marra. "Current (Canadian) guidelines recommend that children under age two receive an antibiotic for diagnosed ear infection. However, the majority of upper respiratory tract infections and bronchitis is viral for which antibiotics are ineffective."

Reference

Marra F, Lynd L, Coombes M, Richardson K, Legal M, Fitzgerald JM, Marra CA. Does antibiotic exposure during infancy lead to development of asthma?: a systematic review and metaanalysis. Chest. 2006 Mar;129(3):610-8.
(www.chestjournal.org/cgi/content/abstract/129/3/610)

ACRRM 4th Scientific Forum

Practising Rural and Remote Medicine - Moving Forward ACRRM

The Australian College of Rural and Remote Medicine (ACRRM) will be holding its biennial Scientific Forum on 16-19 November 2006 at the University of Adelaide.

It is an educational conference, conducted by the world’s leading academic college for Rural and Remote Medicine, presenting research, discussions and ideas on the practical implementation of health care in rural settings.

ACRRM is calling for abstracts, from doctors, nurses, allied health professionals, and government and rural organisation representatives, that reflect the forum’s key themes:

• Rural and Remote Medicine - caring for a rural community

• Education and training for rural and remote doctors

• Supporting a skilled and sustainable rural health workforce

• Innovative service delivery in Rural and Remote Medicine

Submissions are invited for speakers, posters and workshops. Those not selected for speaking presentations may be offered poster or workshop opportunities.

Deadline for abstracts is Friday 12 May 2006.

Please submit your abstract electronically, strictly following the ‘Guidelines for Abstracts’, by visiting What’s On/Scientific Forum
(http://www.acrrm.org.au/main.asp?NodeID=26107).

Should you need to supply your abstract in hard copy, or for further assistance, please contact Jenny Laing on 1800 223 226 or email j.laing@acrrm.org.au.