A Decade of Asthma Management in Australia

Kristine Whorlow
Chief Executive Officer
National Asthma Campaign

"It is really only in the last five years that we have considered asthma as a continuous process and stopped thinking of it as an episodic disease."¹

Ten years ago, the asthma management picture in Australia was very different. Advances in asthma management were moving ahead of GP education and the crucial partnership between pharmacists and general practitioners was only just forming. An over-reliance on reliever medications by patients was compounding the situation, resulting in a general under-management of the disease, sometimes with fatal consequences.

The first breakthrough in improving the management of asthma in Australia came with the development of the Six-Step Asthma Management Plan by The Thoracic Society of Australia and New Zealand in 1989. Recognised as a pioneering document in its field, it has led to the development of similar guidelines around the world.

Thanks to the focus on increasing knowledge through sharing information and education, asthma awareness is now very high in Australia. A survey in 1996 of general practitioners and pharmacists showed that better standards of asthma management are being achieved. As a result of this increased awareness and improved understanding of how to manage the disease, Australian practitioners are now seen by many of their international peers as world leaders in terms of best practice for the management of asthma.

Major achievements by the National Asthma Campaign (NAC) over the past decade include:

• the evolution of the Asthma Management Plan into the Asthma Management Handbook- the NAC will he launching the fourth revised edition of the Asthma Management Handbook for general practitioners and pharmacists later this year;

• the development of the Report on the Cost of Asthma in Australia in 1992, which made an important contribution to our knowledge about the impact of asthma on the Australian community;

• the implementation of national epidemiological surveys in 1990 and 1993 which showed improvement in the asthma management practices of adults in that period and significant improvements in children (a third survey is currently under way);

• coordinating the development of the National Asthma Strategy, Goals and Targets in 1994, followed by the. National Asthma Strategy, Strategies and Implementation in 1996 and current work on the National Asthma Strategy Implementation Plan. All of these activities aim to significantly reduce the prevalence, severity and risk of asthma; and

• continuing the success of the first national public education campaign "Could it be asthma?" with a series of campaigns supported by information for people with asthma and their families.

Asthma management - what's coming up

The NAC recently launched the new Emergency Asthma Management Guidelines for use in both emergency departments and GPs' surgeries. The guidelines are based on the best scientific evidence available, and the consensus of a number of experts. They are presented in a practical poster which is easily understood.

According to Associate Professor Charles Mitchell, the success of the guidelines lies in their general acceptance among those who have to manage people with severe asthma, usually staff in emergency departments.

Later this year, the NAC will release the fourth edition of the Asthma Management handbook. For the first time, this combines both the GP and pharmacist versions of the handbook. Dr Chris Brown, Chairman of the NAC's Education Committee believes that the messages for both GPs and pharmacists are pretty similar.

"The emphasis is increasingly on helping the patient to self-manage the disease and give people much more control," said Dr Brown.

The NAC is also currently one year through a three year program to systematically review the Six-Step Asthma Management Plan on evidence-based principles. The aim is to examine the current consensus-based guidelines and develop a succinct set of evidence-based asthma guidelines which will make asthma management easier for GPs, pharmacists and patients.