June 2008
A-Team® scores an A+
at IPCRG
Better inhaler use improves asthma
outcomes
Montelukast new indication
New breathing exercises help manage
asthma
Road pollution blamed for higher
asthma and allergy risk in children
Research Funding Opportunities
The Asthma
Foundation of Queensland PhD Scholarship
Conference Diary
A-Team® scores an A+
at IPCRG
 The
National Asthma Council Australia’s A-Team®
asthma education program has been internationally
recognised for its innovative format and successful
outcomes at the International Primary Care
Respiratory Group (IPCRG) world conference in
Seville in May.
Judi Wicking, well-known asthma educator and
A-Team project officer, presented an abstract titled
‘The A-Team®: A national asthma education
program, the Australian way’ to a captivated
audience of health professionals from around the
world at the IPCRG conference.
“The audience was very impressed by the
participant evaluations,” says Ms Wicking. “I also
had several questions afterwards about our unique
implementation model, which is through local
Divisions of General Practice.”
The abstract was selected for publication in the
June 2008 issue of the Primary Care Respiratory
Journal.
First established in 2002, the A-Team is the
NAC’s ongoing national asthma education program that
aims to reinforce and increase awareness of the
latest best-practice asthma management guidelines
for general practitioners, practice nurses and
allied health professionals.
A preliminary evaluation of the first 9 months of
phase 3 of the program, which began mid 2007, was
presented at the IPCRG conference.
As at end March 2008, more than 1000 health
professionals had attended 45 workshops across
Australia. In post-workshop evaluations, nearly all
(97.7%) respondents reported the program ‘somewhat’
(55.0%) or ‘considerably’ (42.7%) increased their
knowledge of evidence-based asthma management
practice.
The A-Team program is part of the NAC’s
broader GP and Allied Health Professional Asthma
Education Program, which also includes the national
Spirometry Training Course and is supported by
funding from the Australian Government Department of
Health and Ageing.
Reference
Wicking J, Brophy S, Cleveland R, Fodero L,
Scuteri J, Whorlow K. The A-Team®: A
national asthma education program, the Australian
way. Prim Care Respir J. 2008; 17 (2): 119.
http://www.thepcrj.org/journ/view_article.php?article_id=568
Resources
A-Team® Asthma Education Program
(http://www.nationalasthma.org.au/html/management/prof_develop/pd030_ateam.asp)
IPCRG (http://www.theipcrg.org)
A-Team® is a registered trademark of
National Asthma Council of Australia Ltd
Better inhaler use improves
asthma outcomes
 Australian research has shown that up to 90 per
cent of people on asthma medications are using their
inhalers incorrectly leading to poor asthma control,
increased hospital visits and increased cost of
treatment.
The study then went on to show how a brief
educational chat with a pharmacist about inhaler
technique and stickers on the medication can lead to
improved asthma control in the patients.
Woolcock Institute of Medical Research
spokesperson, Associate Professor Helen Reddel said,
“Pharmacists and other health care professionals
need to effectively show patients how to use
inhalers correctly and to promote the importance of
inhaler technique on patient outcomes,” she said.
“By educating pharmacists on correct technique
and then putting in place an easy system for them to
relay this knowledge, our research was able to
demonstrate a real effect on patient behaviour.
“The inhaler technique intervention took an
average of 2.5 minutes per visit, which is short
enough to be feasible during routine dispensing
procedures,” she said.
The research carried out by Dr Iman Basheti of
the Faculty of Pharmacy is the first to report on
the effect of inhaler technique education alone on
asthma outcomes.
All pharmacists who took part in the study
attended a general workshop about asthma, inhaled
medications and peak flow meter technique. However
only pharmacists in the active group were trained to
assess and teach dry powder inhaler technique, with
the aid of a simple education tool.
The active group pharmacists then delivered
interventions to patients at four visits over six
months.
An additional component of the intervention was
the use of innovative stickers applied to the
outside of inhalers to remind patients about the
correct technique. Stickers were personalised to
highlight each patient’s most problematic steps with
their inhaler. They were updated at each visit.
At six months improvement in inhaler technique
score was significantly greater in the active group,
and asthma severity was significantly improved.
Professor Reddel explained that the findings of
the study reinforce the need for regular assessment
and education about inhaler technique.
“The inhaler labels provided a simple visual aid,
acting as both a daily reminder of correct technique
and as visit-by-visit evidence of progress.
“For people with asthma to obtain the full
benefit of medication they must not only use their
preventer inhaler regularly, which is itself a
challenge, but do so correctly.
“Pharmacist education represents an inexpensive
yet effective way of improving asthma control in the
community.
“If the results of this study are confirmed in
broader populations, this simple pharmacist
intervention should be instituted as a routine part
of the dispensing of inhaled asthma medications”,
Assoc Professor Reddel concluded.
Correct Inhaler Techniques and Common Mistakes
Commonly used inhaler devices for delivery of
controller or preventer medications include the
pressurised Metered Dose Inhaler (pMDI) and two dry
powder inhalers i.e. the Turbuhaler and the
Accuhaler.
In order to gain maximum benefit from these
inhalers, they need to be used correctly. However,
the steps involved in doing so are different for
each inhaler.
When pMDIs are used to deliver controller or
preventer medications, they should be used with a
spacer device in order to reduce side-effects and
improve delivery to the airways.
Correct Use
|
Common Mistakes
|
pMDI
- Remove cap and shake inhaler.
- Breathe out gently.
- Put mouthpiece in mouth and at
start of inspiration (which should
be slow and deep), press canister
down and continue to inhale deeply.
- Hold breath for 10 seconds, or
as long as possible then breathe out
slowly.
- If more puffs are needed, wait
for a few seconds before repeating
steps 2-4.
|
The mostly common error associated
with the use of pMDIs is that the
patient doesn’t take a slow deep breath
at the same time as pressing the
canister down |
Turbuhaler
- Unscrew and lift off white
cover. Hold Turbuhaler upright and
twist grip around and back as far as
it will go. You should hear a click
.
- Breathe out as much air as
possible gently and away from the
mouthpiece, put mouthpiece between
lips and breathe in as deeply as
possible. Even when a full dose is
taken there may be no taste.
- Remove the Turbuhaler from mouth
and hold breath for about 10
seconds.
- For a second dose, repeat these
steps.
|
The most common errors associated
with Turbuhaler misuse include:
- not keeping the device upright
while loading the dose, and
- not exhaling as much air as
possible and away from the mouth
piece.
|
Accuhaler
- Hold the outer casing of the
Accuhaler in one hand whilst pushing
the thumb grip away until a click is
heard
- Hold Accuhaler with mouthpiece
towards you, slide lever away until
it clicks. This makes the dose
available for inhalation and moves
the dose counter on
- Holding Accuhaler level, breathe
out as much air as possible, gently
away from the device, put mouthpiece
in mouth and suck in steadily and
deeply
- Remove Accuhaler from mouth and
hold breath for about 10 seconds
- To close, slide thumb grip back
towards you as far as it will go
until it clicks
- For a second dose repeat
sections 1-5
|
The most common errors associated
with Accuhaler misuse include:
- not exhaling as much air as
possible, and
- not exhaling away from the mouth
piece.
|
Reference
Original release may be found at
http://www.woolcock.org.au/PDF/PR/WIMR_Press_Release_AsthmaMeds_June2008.pdf
Montelukast new indication
The Therapeutic Goods Administration (TGA) has
approved a new indication for montelukast sodium,
Singulair, for the symptomatic treatment of
seasonal allergic rhinitis.
This new indication has been approved for use in
adults and children from the age of two years.
This means that there is now a non-steroidal,
once daily tablet for the treatment of both asthma
and seasonal allergic rhinitis symptoms in these
patients1. This is good news for asthma
patients as research shows over 80% of these
patients have seasonal or perennial allergic
rhinitis and this may complicate asthma management2,3.
"Montelukast maybe a useful single therapy that
does actually treat the allergic rhinitis component
as well as the asthmatic component in some children
and I think that has an advantage for young children
and for parents," said Associate Professor Dominic
Fitzgerald, Westmead Children's Hospital.
National Asthma Council Australia guidelines
recommend that asthma patients should be proactively
evaluated for allergic rhinitis as a trigger for
their asthma and that treatment of allergic rhinitis
can improve asthma control4.
References
1. Approved Product Information for Singulair
2. Bousquet J. J Allergy Clin Immunol Supp 2001;
108(5):S147-S334
3. Bousquet J. et al Allergy 2008: 63 (suppl. 86)
8-160
4. National Asthma Council Australia.
Asthma
Management Handbook 2006. South Melbourne; 2006
New breathing exercises help
manage asthma
A presentation that demonstrates breathing
exercises designed to help reduce the use of asthma
inhalers is now available to the general public
for free from the Cooperative Research Centre (CRC)
for Asthma and Airways website.
The 40 minute production is in response to a
research paper on the management of asthma through
the use of breathing exercises, conducted by
researchers and doctors at Sydney’s Woolcock
Institute of Medical Research and Melbourne’s Alfred
Hospital, which was published in the August 20061
edition of Thorax.
The results of this study showed that people with
asthma who undertook regular breathing exercises
reduced their preventer medication levels by up to
half and reliever use by up to 86%.
The presentation demonstrates the breathing
exercise techniques used in the study and features
Professor Christine Jenkins, Head of Asthma Research
at the Woolcock Institute and Project Leader of the
research study.
In the presentation, she outlines our current
understanding of asthma, and the potential role of
breathing techniques in helping to control asthma
symptoms. She puts this into the context of good
asthma management and review. Two different groups
of breathing techniques are demonstrated. One set is
for practicing daily and one set is for relief of
asthma symptoms.
Professor Jenkins said, “The research study was
designed to measure the effect of two very different
exercise regimes on a person’s asthma symptoms, lung
function, use of medication and quality of life”.
“However it found no evidence to favour one
breathing technique over the other. Instead, both
groups of exercises were associated with a dramatic
reduction in reliever use. Using either type of
exercise was effective in markedly reducing the use
of reliever medication. A reduction in inhaled
corticosteroid (ICS) dose was also achieved,
probably resulting from trial participation and
clinical care in the study.”
According to Professor Jenkins the results of
regularly undertaking the exercises could be
particularly beneficial to the management of
patients with mild asthma symptoms, who use a
reliever frequently.
“Our study suggests that breathing exercises as a
first-line symptom treatment can help to reinforce
the message of relaxation and self-efficacy and
provide a deferral strategy for beta-agonist use.
“The presentation advises a person to do the
exercises twice a day and also whenever they
experience asthma symptoms,” she said. “We hope that
people with asthma will avail themselves of the
information, presented in this easily understood
format, and see it as a complementary approach to
their asthma management.”
The presentation can be viewed at the Asthma
CRC’s website
www.asthmacrc.org.au.
References
1. C A Slader, H K Reddel, L M Spencer, E G
Belousova, C L Armour, S Z Bosnic-Anticevich, F C K
Thien, and C R Jenkins Double blind randomised
controlled trial of two different breathing
techniques in the management of asthma. Thorax, Aug
2006; 61: 651 - 656.
Road pollution blamed for higher asthma and allergy
risk in children
New evidence blames traffic-related pollution for
increasing the risk of allergy and atopic diseases
among children by more than fifty percent. What's
more, the closer children live to roads, the higher
their risk.
"[Children] living very close to a major road are
likely to be exposed not only to a higher amount of
traffic-derived particles and gases but also to a
more freshly emitted aerosols which may be more
toxic," wrote lead author of the research, Joachim
Heinrich, PhD, of the German Research Center for
Environment and Health at the Institute of
Epidemiology, in Munich.
"Our findings provide strong evidence for the
adverse effects of traffic-related air pollutants on
atopic diseases as well as on allergic
sensitization," wrote Dr Heinrich.
The study examined nearly 2,900 children at age
four and more than 3,000 at age six to determine
their rates of doctor-diagnosed asthma and/or
allergy with relation to long-term exposure to
traffic-related pollution.
Both the four-year-old and six-year-old groups of
children came from prospective cohort studies and
were enrolled at birth in the metropolitan Munich
area. Their exposure to traffic pollutants was
calculated as a function of the distance of their
homes from major roads at birth and at two, three
and six years of age. Parents were given
questionnaires about their child's respiratory
diagnoses and symptoms, and their children were
assessed for asthma, wheezing, sneezing and eczema.
At six years of age, the children were tested for
food allergies. Air was tested for particulate
matter (e.g. soot) and nitrogen dioxide (NO2) at
each of forty identified points near high-traffic
areas once each season between March 1999 and July
2000.
After controlling for such individual
characteristics as parental allergies, pet
ownership, and number of siblings, researchers found
significant positive associations between distance
to the nearest road and asthmatic bronchitis, hay
fever, eczema and allergic sensitizations. They also
found a distant-dependent relationship between
proximity to the road and risk of allergic
sensitization, with those living closest to major
roads having a nearly 50 percent greater risk of
allergic sensitization.
Previous studies have found that pollutants and
allergic sensitization are linked, but using
distance from major roads as a proxy for pollutant
exposure has been confused by the socioeconomic
factors that are often closely linked to such
locales. However, in Munich, as with other older
European cities, the roads and buildings are
structured so that economic advantages are not
necessarily correlated with living further from the
main thoroughfares. In this study, it was possible
to determine that economic factors were not a
confounding variable in the analysis, but there was
a clear difference in the children's allergic
development with relation to their proximity to a
road.
"We consistently found strong associations
between the distance to the nearest main road and
the allergic disease outcomes," wrote Dr Heinrich.
"Children living closer than 50 metres to a busy
street had the highest probability of getting
allergic symptoms, compared to children living
further away."
Reference
Atopic Diseases, Allergic Sensitization, and
Exposure to Traffic-related Air Pollution in
Children
(http://ajrccm.atsjournals.org/cgi/content/abstract/177/12/1331)
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. |
The Asthma Foundation of Queensland
PhD Scholarship
for Eligible Medical, Scientific, Nursing & Pharmacy
Graduates and equivalently qualified Allied Health
Practitioners Commencing 2009
Applications are invited for the Asthma
Foundation of Queensland PhD Scholarship open to
eligible medical, scientific, nursing and pharmacy
graduates and equivalently qualified allied health
practitioners (eg psychologists, physiotherapists,
asthma educators, etc) who plan to commence a PhD in
2009. The scholarship will provide financial support
for a graduate looking to build a career in research
relevant to asthma.
The research must be undertaken in Queensland.
The scholarship is open to Australian citizens or
permanent residents intending to nurture a career in
Queensland, and will be for a period of up to three
years, with the stipend and allowances based upon
NHMRC rates. Further information and application
forms are available for downloading at the
foundation’s website at
www.asthmaqld.org.au or from:
The Managing Director
The Asthma Foundation of Queensland
PO Box 394
Fortitude Valley Qld 4006
Email: info@asthmaqld.org.au
Ph:
(07) 3252 7677 or 1800 645 130 Fx: 07 3257 1080
Applications close on 30 June 2008
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.
|
