Asthma Management Handbook development update

Work is well under way on developing the new edition of the Asthma Management Handbook, the Australian national asthma treatment guidelines. This new edition, the seventh, is due for publication in late 2012.

A collaborative, multi-disciplinary effort, development of the Handbook involves more than 70 leading health professionals dedicated to asthma. Most of these clinical contributors joined us in kicking off the latest stage of development at our recent contributor workshop.

First published in 1989 and now in its sixth edition, the National Asthma Council Australia's Asthma Management Handbook continues to set the standard for best-practice asthma management in primary care.

The current edition of the Handbook is still available online in full and for free.

 

ASCIA 2011 Annual Scientific Meeting 

The Australasian Society of Clinical Immunology and Allergy (ASCIA) 2011 Annual Scientific Meeting will run for three days, from Wednesday 7th to Friday 9th September.

The meeting will be held in conjunction with:

• ASCIA 2011 Allergy & Immunology Update for health professionals – Tuesday 6th September
• ASCIA 2011 Postgraduate Immunology Course - Saturday 10th September

International speakers presenting at ASCIA 2011 include:

• Professor Abul Abbas (USA)
• Professor Pascal Demoly (France) 
• Dr George Du Toit (UK)
• Dr Montserrat Fernández-Rivas (Spain) 
• Dr Steven Holland (USA) 
• Professor Yehuda Shoenfeld (Israel)

ASCIA 2011 will also feature more than 40 other speakers and chairs contributing to the meeting.

Abstracts submitted to the meeting include:

• The association between onset and persistence of eczema and the risk of other allergic diseases
• The association between maternal obesity and childhood asthma – an analysis based on Swedish sib-pairs
• Aspirin allergy: the first successful desensitization to aspirin in Vietnam
• Does vitamin D intake during pregnancy influence allergic outcomes in children at one year of age?
• Characteristics of Churg-Strauss syndrome in South Australia

More information

 

WONCA Europe Conference

The World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) will hold the 17th WONCA Europe Conference from 8 - 11 September 2011 in Warsaw, Poland.

The theme of the conference is ‘Family Medicine – Practice, Science and Art’.

In family medicine and other medical disciplines, the decision-making process is generally supported by science that provides evidence coming from randomised controlled trials or observational studies. Doctors apply this scientific knowledge in a rational manner during their everyday consultation with patients. However, they also need to take into account psychological, social, ideological and even political factors. They need to use their skills and judgments carefully to consider costs, patient values, prejudices and emotions that may influence their care. All these aspects make Family Medicine more an art than just a science.

The conference program includes two International Primary Care Respiratory Group (IPCRG) symposiums on Wheezing and asthma in children and Poorly controlled asthma.

The National Asthma Council is the member organisation representing Australia within IPCRG.

More information

 

New edition of Johns' Pocket Guide to Spirometry

Popular resource Pocket Guide to Spirometry, written by leading respiratory scientist Assoc. Prof. David P. Johns, is now in its third edition.

The textbook explains everything a practitioner needs to know about spirometry, including what a spirometer is, how to use one, how to interpret test results and the different types of spirometers. Information is presented in a practical, systematic manner and is an essential aid for all health professionals involved in the management of patients with respiratory conditions.

For more information, visit the McGraw-Hill website

 

Breathing in America aims to increase public awareness of lung disease

The American Thoracic Society (ATS) recently published a comprehensive book on lung disease, titled Breathing in America: Diseases, Progress, and Hope.

The book is aimed at patients and their advocates. It is written for the nonmedical layperson, but contains considerable medical information on the latest research and clinical advances. Each disease is treated in a separate chapter and each chapter contains sections that define and explain the disease, current research and future directions. Each chapter also has a case study which is designed to convey to the reader, “What is it like to have this disease?”

Included also is the progress being made toward the ultimate goal of curing and eliminating major lung diseases. It sets the background for the diseases and indicates where breakthroughs have been made, how far off we are from controlling the disease and what needs to be done. It also advocates for better awareness of these conditions and the importance of investing in research and applying its findings.

The online version is available for free on the ATS website

 

Sensitivity to house dust mites and the risk of developing asthma

A new study has found that children aged 1–2 years with a family history of allergy, who had a positive skin prick test to house dust mites, had a higher risk of developing asthma later in life. Results showed 75% of these children had asthma at aged 12 compared to 36% of children without a positive skin prick test.
 
Lead author Dr Caroline Lodge from the University of Melbourne’s School of Population Health said the identification of house dust mites as a predictor for asthma in high risk children, is a significant step forward in identifying high risk groups on whom we can trial interventions.
 
“Our findings provide researchers with a more targeted group of at risk children, for investigating strategies to prevent asthma later in life,” she said.
 
“House dust mite sensitivity amongst wheezy toddlers could be used as a clinical tool to assist parents in understanding the risk of asthma in their children.

“Although currently there is no known intervention to stop asthma developing, identifying children at higher risk may lead to more tailored treatments of wheeze in this high risk group.”
 
The study followed 620 children, with a family history of allergies, from birth to 12 years old.  Researchers tested the children at the ages of one and two years, for single and multiple sensitivity to milk, egg, peanut, rye grass, cat and house hold dust mites and then again at the age of 12 for having asthma.
 
“We found in the children aged 1–2 years, that whatever the mix of sensitivity, if their skin reacted to house dust mites they had a higher chance of developing asthma later in life,” Dr Lodge said.
 
“Our study did not show house dust mite caused asthma but it highlighted a strong correlation between sensitivity and more severe wheeze and asthma.

“House dust mites are common in our environment. They are something we have to live with everyday. Previous studies have revealed that efforts to eradicate house dust mites have been ineffective.”
 
The study was published in the Journal of Allergy and Clinical Immunology. Collaborators involved in the study are the Murdoch Childrens Research Institute, Monash University and the Royal Children’s Hospital.

The study is part of a broader project to investigate sensitivity and allergy and their link to asthma.

Reference

Lodge CJ, Lowe AJ, Gurrin LC et al. House dust mite sensitization in toddlers predicts current wheeze at age 12 years. J Allergy Clin Immunol 2011; doi:10.1016/j.jaci.2011.06.038

 

Risk of misdiagnosis for obese patients  

The prevalence of physician-diagnosed asthma is increasing partly because of a link between asthma and obesity. Several factors lead to asthma-like symptoms in obese patients, including the mechanical effect of increased body mass index on lung volumes, which increases the work required for breathing.

Researchers from the Countess of Chester Hospital and the University of Liverpool in the United Kingdom recently found that obese patients may be more at risk for asthma misdiagnosis due to the similarity of symptoms experienced, such as breathlessness.

Out of 91 subjects, 33 (36.3%) experienced a possible misclassification of an asthma diagnosis.

Reference

Scott S, Currie J, Albert P, Calverley P, Wilding JPH. Risk of mis-diagnosis, health related quality of life and body mass index in overweight patients with doctor diagnosed asthma. Chest 2011; doi:10.1378/chest.11-0948

 

Molecular pathway that leads to inflammation in asthma found 

Researchers from the University of Pittsburgh School of Medicine in the USA have identified a molecular pathway that helps explain how an enzyme elevated in asthma patients can lead to increased mucus production and inflammation that is characteristic of the lung condition. Their findings, reported online in the Proceedings of the National Academy of Sciences, reveal unique interactions between biological molecules that could be targeted to develop new asthma treatments.

An enzyme called epithelial 15-lipoxygenase 1 (15LO1) metabolizes fatty acids to produce an eicosanoid known as 15 hydroxyeicosaetetranoic acid (15 HETE) and is elevated in the cells that line the lungs of asthma patients, explained Sally E. Wenzel, MD, professor of medicine, Pitt School of Medicine, and director of the Asthma Institute at UPMC and Pitt School of Medicine. Her team showed in 2009 that the enzyme plays a role in mucus production.

"In this project, we found out 15 HETE is conjugated to a common phospholipid," she said. "That complex, called 15HETE-PE, and 15LO1 behave as signaling molecules that appear to have a powerful influence on airway inflammation."

By examining lung cells obtained by bronchoscopy from 65 people with asthma, the researchers found that both 15LO1 and 15HETE-PE displace an inhibitory protein called PEBP1 from its bond with another protein called Raf-1, which when freed can lead to activation of extracellular signal-regulated kinase(ERK). Activated ERK is commonly observed in the epithelial, or lung lining, cells in asthma, but until now the reason for that was not understood.

"This is an important study as it directly explores the important role of 15-lipoxygenase 1 in the airway epithelial cells of patients with asthma, which immediately establishes the relevance to human disease," said Mark T. Gladwin, MD, chief, Division of Pulmonary, Allergy and Critical Care Medicine, UPSOM.

Other experiments showed that knocking down 15LO1 decreased the dissociation of Raf-1 from PEBP1, which in turn reduced ERK activation. The pathway ultimately influences the production of factors involved in inflammation and mucus production.

"These results show us on both a molecular and mechanistic level and as mirrored by fresh cells from the patients themselves that the epithelial cells of people with asthma are very different from those that don't have it," Dr Wenzel said. "It also gives us a potential treatment strategy: If we can prevent Raf-1 displacement, we might have a way of stopping the downstream consequences that lead to asthma."

Reference

Zhao J, O'Donnell VB, Balzar S et al. 15-Lipoxygenase 1 interacts with phosphatidylethanolamine-binding protein to regulate MAPK signaling in human airway epithelial cells PNAS 2011; 108 (34): 14246-51; doi:10.1073/pnas.1018075108