Asthma triggers thrive this autumn

Warning as conditions create a storm for asthma and allergy sufferers.

Australians with asthma are being warned to be extra vigilant this autumn, as the season delivers a trifecta of asthma triggers - mould, more dust mites and increased exposure to pet allergens.

According to National Asthma Council Australia Chief Executive Officer, Kristine Whorlow, these three nasties are the leading triggers of asthma in Australia.

"Many areas of Australia are experiencing mould problems following an unseasonal wet start to the year; there is an annual autumn indoor dust mite population spike; and, some people face increased exposure to pet allergens as soft-hearted pet owners allow their four legged friends more household access as temperatures plunge," Kristine Whorlow explained.

"This can all add up to make autumn pretty miserable for many people."

Kristine Whorlow points the finger at house dust mites as the biggest problem.

"Around 45 per cent of the population have an allergy and of those people, almost 80 per cent react to dust mites.

"In fact, dust mites are the number one trigger for asthma in Australia and research from Sydney's Woolcock Institute of Medical Research has shown that dust mite levels can increase two to three fold during late autumn, compared with summer levels ¹," she said.

House dust mites are microscopic creatures that feed off human skin scales. They are mostly found in the home and live in soft furnishing such as beds, bedding, carpets, upholstered furniture, soft toys and clothing.

Kristine Whorlow said the bedroom is the site of greatest exposure to the pesky mite, however, there are a number of avoidance measures and tips to reduce exposure to allergen triggers.

Typical control measures include:

• washing sheets and pillow cases weekly in water hotter than 55oC.
• covering mattress, pillow and quilt with dust mite resistant covers, which must be washed every two months.
• removing soft toys or hot washing them weekly or freezing them overnight.
• dusting hard floors and surfaces with a damp or electrostatic cloth.
• cleaning carpets weekly using a vacuum cleaner with a HEPA filter.

"It's important to remember that dust mite allergy is a perennial problem and dust mite control measures need to be adhered to year round - not just in autumn," Kristine Whorlow warned.

Comprehensive dust mite control advice can be found on the National Asthma Council Australia website.

Reference

1. Crisafulli D, Almqvist C, Marks G, Tovey E. Seasonal trends in house dust mite allergen in children's beds over a 7-year period. Allergy 2007; 62 (12): 1394-1400.

 

New 'Asthma & COPD Medications' chart available

The National Asthma Council Australia has released an updated version of its popular asthma medications wall chart, which is designed to assist health professionals discuss respiratory medications and inhalers with patients.

The revamped chart, which is the Council's second most-requested resource (after the Asthma Management Handbook), has been retitled: ‘Asthma & COPD Medications' to reflect the inclusion of the latest COPD medications. 

Featuring up-to-date products and packaging imagery, the chart provides a practical guide to the main types of medications prescribed in Australia. Relievers, non-steroidal preventers, corticosteroid preventers, symptom controllers, combination medications and COPD medications are all highlighted.

National Asthma Council Australia spokesperson and asthma educator, Judi Wicking, said: "The asthma medications chart is a popular education tool for health professionals and patients due to its simplicity and relevance.

"More than 20,000 copies of the previous version of the chart were distributed and it continues to be one of the most popular downloads on the National Asthma Council Australia website."

Thanks to an unrestricted education grant from MSD, the National Asthma Council Australia has been able to update and reissue the chart, making it available nationally, at no cost.

Distribution of the new ‘Asthma & COPD Medications' chart is occurring nationally via MSD representatives and a PDF download is available on our website.

 

TSANZ and NAC asthma prize

The winner of the 2011 Thoracic Society of Australia and New Zealand (TSANZ) and National Asthma Council Australia (NAC) Asthma Prize was Dr Jay Horvat from the University of Newcastle.

The TSANZ and NAC Asthma Prize is one of four annual awards funded by the NAC to encourage research into asthma. It is given for the best oral or poster presentation on asthma at the TSANZ Annual Scientific Meeting.

Dr Horvat and colleagues used experimental models of Chlamydia and Haemophilus influenzae lung infection and asthma to show how infection may be linked to steroid-resistant, neutrophilic asthma.

The winning presentation was: "Investigation of infection-induced, steroid-resistant asthma." JC Horvat, A-T Essilfie, RY Kim, JL Simpson, ML Dunkley, KW Beagley, PG Gibson, PS Foster, PM Hansbro.

More information: NAC Asthma Research Awards

 

General Practitioner Conference & Exhibition May 2011

Childhood Asthma Update - Assessment and Management

Sydney GPCE: 20-22 May 2011

Dr Andrew Tai, paediatric respiratory physician, will present a Childhood Asthma Update seminar at Sydney GPCE on Saturday 21 May, on behalf of the National Asthma Council Australia with support from MSD Australia.

The update will review asthma assessment in primary school-aged kids, including patterns, triggers and commonly confused diagnoses. The seminar will also cover the latest in childhood asthma management, including the role of combination therapy, risks and benefits of corticosteroids, and non-steroidal alternatives.

For all the details and registration visit the Sydney GPCE website. 

 

Adult allergic asthma associated with childhood eczema and hay fever

Children who have eczema, particularly when occurring with hay fever, are nine times more likely to develop allergic asthma in their 40s, a new study has revealed.

The study was conducted by the University of Melbourne, the Murdoch Childrens Research Institute, Menzies Research Institute and Monash University. 

Published online in the Journal of Allergy and Clinical Immunology, the study reported on evidence from a clinical study of around 1400 grown up participants in the fifth decade follow-up of the Tasmanian Longitudinal Health Study (TAHS) which is the largest of its kind in the world.
 
In the TAHS, participants were assessed about their allergies and childhood environment in 1968, at 7 years of age, and were followed up in 2004, at the age of 44.

Lead author Pamela Martin, a University of Melbourne PhD student based at the Murdoch Children Research Institute, analysed the survey and skin prick testing data collected in the clinical study for the evidence of childhood eczema and hay fever leading to adult asthma.

She said "In this study we see that childhood eczema, particularly when hay fever also occurs, is a very strong predictor of who will suffer from allergic asthma in adult life."
 
"The implications of this study are that prevention and rigorous treatment of childhood eczema and hay fever may prevent the persistence and development of asthma."

She also said this is the first study to distinguish between allergic and non-allergic asthma and their occurrence after childhood eczema and hay fever, as part of a sequence of allergic illnesses dubbed the ‘atopic march'
 
Associate Professor Shyamali Dharmage, principal investigator of the TAHS and from the University of Melbourne's School of Population Health said currently few interventions are trialled to halt this march from childhood allergies to asthma.
 
"If successful strategies to stop the ‘atopic march' are identified, this could ultimately save lives and health care costs related to asthma management and treatment."

The researchers estimate that up to 30 per cent of current allergic asthma within the larger population sample could be attributed to a history of childhood eczema and hay fever.

Reference

Martin PE, Matheson MC, Gurrin L et al. Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: A prospective cohort study over 4 decades. J Allergy Clin Immunol 04 April 2011 (10.1016/j.jaci.2011.02.041)

 

Flu helps spread pneumonia

Bacteria that cause pneumonia and meningitis are only able to spread when individuals are infected with flu, says a scientist reporting at the Society for General Microbiology's Spring Conference in Harrogate. The work could have implications for the management of influenza pandemics and could help reduce incidence of pneumococcal infections in very young children, who are more susceptible to disease.

Streptococcus pneumoniae normally lives harmlessly in the nasal passage. Up to 80% of young children carry the bacterium in their nose. It is already known that if a colonized individual is infected with influenza virus, the bacterium is more likely to spread to other parts of the body and may cause potentially life-threatening infections such as pneumonia, sepsis or meningitis. Young children, the elderly and the immunocompromised are most vulnerable to these secondary bacterial infections. S. pneumoniae kills more than one million children under the age of five each year.

Dr Dimitri Diavatopoulos from the Radboud University Nijmegen Medical Centre in The Netherlands explained how infection with the flu virus is also necessary for transmitting S. pneumoniae between individuals. His work has shown that in infant mice, all mice had to be infected with flu for pneumococcal bacteria to efficiently spread between them. Blocking influenza infection in these mice effectively prevented the spread of the bacterium.

Viral infection is likely to encourage the spread of pneumonia through a combination of factors, suggested Dr Diavatopoulos. "We think that the flu virus increases the bacterial load in the nose of colonized individuals but also makes uncolonized individuals more susceptible to pneumococcal infection by altering host immunity."

Dr Diavatopoulos believes that learning how viral infections affect not only the development but also the spread of bacterial pathogens will be clinically beneficial. "If we know that the flu virus - and potentially other respiratory viruses - allows the transmission of S. pneumoniae, then targeting these viruses may represent a novel therapeutic strategy to reduce pneumococcal diseases," he said. "During influenza pandemic planning, when a high proportion of the population is infected with the virus, this is important. The findings are particularly relevant to childcare centres as up to 80% of children are asymptomatic carriers of S. pneumonia and are more vulnerable to developing serious infections such as pneumonia or meningitis.

 

COPD not just a smoker's disease

Although chronic obstructive pulmonary disease (COPD) is most often caused by smoking, new research confirms that a substantial proportion of individuals with COPD have never smoked.

As part of the Burden of Obstructive Lung Disease (BOLD) study, researchers from several international medical institutions analyzed data from 4,291 never-smokers aged 40 years or older from 14 countries.

Of the never-smokers, 6.6 percent met criteria for mild (GOLD Stage I) COPD, and 5.6 percent met criteria for moderate to very severe (GOLD Stage II+) COPD. Although never-smokers were less likely to have COPD and had less severe COPD than ever-smokers, never-smokers comprised 23.3 percent of those classified with GOLD Stage II+ COPD.

Predictors of COPD in never-smokers include age, education, occupational exposure, childhood respiratory diseases, and alterations in BMI.

Researchers conclude that never smokers comprise a substantial proportion of individuals with COPD. Their data suggest that, in addition to increased age, a prior diagnosis of asthma and, among women, lower education levels are associated with an increased risk for COPD among never smokers.  

Overall increased awareness about other COPD factors is needed and symptomatic never-smokers should be included in COPD screening efforts.

Reference

Lamprecht B, McBurnie MA, Vollmer WM et al. COPD in never smokers: Results from the population-based Burden of Obstructive Lung Disease study. Chest 2011; 139: 752-63.