Complementary complexities
COMPLEMENTARY medicine figures prominently in the healthcare regimen of many Australians.
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asthma
The following articles have the tag asthma
Asthma InfoLine has real benefits
AN INNOVATIVE health management initiative that links patients to support and education from asthma experts is showing real benefits, according to GPs.
Modern medicine meets jungle life
FORMER Ecuadorian political refugee, now Cairns GP, Patricio Gordillo returns to his homeland.
Laryngopharyngeal reflux
This Update looks at current concepts in the diagnosis and management of laryngopharyngeal reflux.
Bariatric surgery saves on drug costs
SAVINGS on pharmaceuticals are greatest for diabetes medications after bariatric surgery, Australian data shows.
Call for national flu and pneumococcal vaccination register
LOW flu and pneumococcal vaccination rates among at-risk populations have incited a call for the establishment of a national vaccination register.
Cleaning linked to asthma
CLEANERS and other people who work with cleaning products are at an elevated risk of developing adult onset asthma, according to a large longitudinal study.
Fast food linked to higher risk of asthma in children
CHILDREN and teenagers who eat more than three servings of fast food a week are at increased risk of severe asthma, eczema and rhinoconjunctivitis, according to a large international study.
Nine-fold increased risk of PE for patients with severe asthma
SEVERE asthma poses a nine-fold increased risk of suffering a pulmonary embolism (PE), European research suggests.
Inhaled steroids suppress HPA axis
ALMOST two-thirds of children being treated with corticosteroids may have a degree of hypothalamic-pituitary-adrenal (HPA) axis dysfunction, researchers suggest.
Botox trial for treatment of allergic rhinitis and asthma
BOTOX could be a new weapon against allergic rhinitis and asthma, researchers say.
Symptom based ICS effective for asthma
PATIENTS with mild to moderate persistent asthma may not need inhaled corticosteroids (ICS) daily according to trial findings, which may herald a future method of management, experts say.
Fast Forward - 11 September 2012
MO looks back 10 years, casting a fresh eye over what made news in 2002. Then we hit the fast forward button to see what’s changed.
Nurse consults benefit asthmatics
DEVELOPING a guide for young people to help them participate more in their own consultation with primary care nurses is beneficial, UK researchers say.
Patients miss asthma meds due to high cost
PATIENTS with asthma are skipping vital preventer medication, and even relievers, due to cost, the Asthma Foundation of NSW warns.
Asthma deaths in children double
ASTHMA deaths among children have more than doubled since 2006, raising concerns that parents may have become complacent about monitoring their child’s illness.
Inhaled corticosteroids may be overprescribed
ONE in six patients prescribed corticosteroid inhalers probably do not need them, Australian research suggests.
Pregnant women neglect asthma meds
MANY Australian women opt to not take their asthma medication during pregnancy despite a worsening of their symptoms, a study has found.
Treating asthma in pregnancy can be daunting
THERE is a good understanding by GPs of asthma medication safety in pregnancy but some lack confidence in managing patients whose symptom control deteriorates, an Australian study suggests.
Asthma now more strongly linked to poverty
ASTHMA rates among children and young adults are falling but a gap is opening up between the rich and poor. The latest report card on asthma in Australia, released today, found the prevalence of the condition among five- to 34-year-olds dropped by a quarter between 2001 and 2007–08 and remained stable among older adults. However, people from poorer backgrounds were increasingly more likely to have the illness than those in wealthier areas. The Australian Institute of Health and Welfare (AIHW) report, Asthma in Australia 2011 , said the finding ...
Prenatal pets protective for allergies
PRENATAL pet-exposure may protect children against developing asthma and allergies, a study suggests. In what is believed to be the first study of its kind, researchers found levels of IgE antibodies were 28% lower in babies whose mothers kept a cat or dog in the house while pregnant in comparison to those born into pet-free homes. The research, carried out by the Public Health Sciences Department at Henry Ford Health System, in Michigan, US, also found that this protective effect was even stronger statistically when comparing children born vaginally to those born through ...
Influenza vaccination in kids
Should we routinely immunise preschoolers against influenza?
Bushfire smoke toxicity rivals urban air pollution: survey
BUSHFIRE smoke is at least as toxic as urban air pollution and increases the risk of respiratory morbidity, Australian research suggests. Analysis of 27 Australian and international studies investigating the health impact of bushfire seasons found tiny particulate matter (PM10) from bushfire smoke moderately increased the number of hospital presentations for respiratory diseases, including asthma, compared with non-bushfire periods. One Australian study revealed an increase in hospital admissions for respiratory problems of 1.2% for each 10 µg/m3 increase in PM10 from bushfire smoke. “Bushfires are expected to increase in the future as a result of climate ...
Paracetamol link to asthma in kids remains controversial
AUSTRALIAN experts have challenged findings from a New Zealand birth cohort study linking paracetamol use with the development of asthma and atopy. In the study, children administered paracetamol before the age of 15 months were more than three times more likely to be sensitised to allergens as children who had no paracetamol, said Professor Julian Crane and colleagues from the University of Otago. Data from the study of 1400 children also showed those who took paracetamol more than 10 times between five and six years of age had double the risk of asthma compared to those not ...
Paracetamol linked to asthma and atopy in kids
NEW evidence backs a link between frequent paracetamol use in early childhood and development of asthma and atopy, researchers say. A New Zealand research group says findings from a birth cohort study of 500 children suggested paracetamol exposure before the age of 15 months is associated with atopy at six years. And among a further 900 children aged five to six years, paracetamol exposure was linked to wheeze, but not atopy, in a dose-dependent way. The children had double the risk of asthma if they had taken paracetamol more than 10 times in their life, the ...
Study clarifies effective inhalation via spacer
TWO or three tidal breaths are sufficient to deliver asthma medication to young children using a spacer, research suggests. Working with children aged two to seven, respiratory physicians from Princess Margaret Hospital for Children in Perth have discovered youngsters tend to take much larger breaths than normal when using a spacer or valved holding chamber device. Experimenting with two small-volume devices – Funhaler and AeroChamber Plus – the researchers found no significant difference in drug delivery between two tidal breaths and nine tidal breaths (39% vs 38%). With larger-volume devices, a Volumatic and a modified 500 ...
Asthmatics warned to be vigilant as thunderstorm season begins
THUNDERSTORM season has begun, kicking off with a spike in hospital attendances for acute asthma across NSW. The state’s health department recently issued a warning after recording 126 emergency department visits for asthma on one day, compared to the usual 68 or so. Doctors are urged to ensure all asthma patients have a personalised action plan and awareness of what to do if their condition worsens. Patients are also advised to carry their prescribed medications at all times and to stay indoors during thunderstorms. The phenomenon is caused by a downdraft from the thunderstorm, disturbing pollen ...
Respiratory diseases linked to diabetes
COPD and asthma may be independently associated with an increased risk of type 2 diabetes, new research indicates. From a US prospective cohort study of 38,570 women aged 45 years or older without diabetes at baseline, those who had asthma alone had a 37% greater risk of developing type 2 diabetes after 12 years’ follow-up. Those who had COPD had a 38% increased risk. These associations were not significantly modified by age, smoking status, BMI, menopausal status or other confounders. The authors said the findings supported a hypothesis that chronic airway inflammation might increase diabetes ...
Paracetamol link with teen asthma
DESPITE growing evidence of a possible association between adolescent use of paracetamol and prevalence of asthma, an expert believes it is too early to advise against use of paracetamol by this age group. An international research team found that among 322,959 adolescents aged 13 to 14, high self-reported paracetamol use was associated with a 2.5 times greater risk of current asthma symptoms compared to no use. It was also associated with an exposure-dependent increased risk of symptoms of rhinoconjunctivitis and eczema. However, Associate Professor Frank Thien, of the department of Allergy, Immunology and Respiratory Medicine at ...
Probiotic supplement in pregnancy halves eczema in children
THE prevalence of eczema can be almost halved if women drink milk with a probiotic supplement during and after pregnancy, a study suggests. Norwegian researchers randomised 415 women to receive either probiotic milk or placebo from 36 weeks’ gestation to three months postnatally during breastfeeding. Children whose mothers were in the probiotic group had a 49% lower rate of eczema than the placebo group at two years of age. However, probiotic supplementation had no significant effect on the incidence of asthma or atopic sensitisation in children. The study was “the first to show that certain ...
Doubts raised over spirometry benefits
REGULAR use of spirometry in general practice fails to improve quality of life, symptoms or emergency medical visits in patients with asthma and COPD. Australian researchers saidthe findings of their study of 305 patients from 31 Melbourne general practices made it difficult to recommend more widespread spirometry use in primary care. Patients were randomised to three-monthly spirometry and regular medical review, spirometry at baseline and trial’s end only, or a control group receiving usual medical care with no spirometry. The primary outcome, quality of life, did not improve significantly in the intervention group and there was no ...
Doubts raised over spirometry benefits
REGULAR use of spirometry in general practice fails to improve quality of life, symptoms or emergency medical visits in patients with asthma and COPD. Australian researchers saidthe findings of their study of 305 patients from 31 Melbourne general practices made it difficult to recommend more widespread spirometry use in primary care. Patients were randomised to three-monthly spirometry and regular medical review, spirometry at baseline and trial’s end only, or a control group receiving usual medical care with no spirometry. The primary outcome, quality of life, did not improve significantly in the intervention group and there was no ...
Recent rise in asthma deaths remains unexplained
AN unexpected spike in asthma deaths, revealed in recent figures, has prompted calls for extra vigilance for signs of exacerbation in elderly patients. The Australian Institute of Health and Welfare (AIHW) found the number of deaths due to asthma in 2006 was unusually high, with signs the trend continued in 2007. More than 92% of the 402 asthma deaths in 2006 were aged 45 years and older, with many associated with co-morbidities such as COPD or acute respiratory infections. “The recent rise in deaths due to asthma after a sustained drop from 1995-2005 needs further study, ...
Hospital-in-the-home teams benefit from GP involvement
CLEAR and ongoing communication between GPs and other care providers is the key to successful shared care and hospital-in-the-home programs, medico-legal experts have argued. Addressing the 19th Annual Medico-Legal Congress in Sydney, Avant medical adviser Dr Penny Browne said it was important to have GPs involved in such care programs whenever possible. “Hospital-in-the-home teams may or may not have full awareness of all the patient issues. Communication with GPs may or may not occur, and this could lead to parallel or conflicting treatment,” she told delegates. “There can also be issues around clinical guidelines and how ...
Study rejects paracetamol-asthma link in children
AUSTRALIAN evidence has cast doubt on concerns that paracetamol use in childhood is linked to the development of asthma. The issue attracted attention 18 months ago when data from studies involving thousands of children worldwide linked paracetamol in the first year of life to an increased risk of asthma by age six ( MO , 26 September 2008). But Melbourne researchers say that analysis, published in The Lancet , failed to account for paracetamol use in respiratory infections, which may independently increase the risk of asthma. Allergy epidemiologist Dr Adrian Lowe (PhD) said his team ...
Asthma management program leads to better outcomes in kids
AUSTRALIAN research shows a new GP asthma management program can improve patient outcomes and doctor-patient communication skills. Sydney thoracic physician Professor Christine Jenkins said a randomised controlled trial of the Physician Asthma Communication and Education (PACE) program showed it produced real benefits for patients. Professor Jenkins, from the Woolcock Institute of Medical Research, said the trial, which involved 100 GPs and 200 families, boosted GP confidence in using specific communication strategies in consultations. The PACE program incorporates paediatric asthma management consistent with Australian guidelines and includes developing communication skills, case studies, device demonstrations and provision of ...
GP nurses help to drive care plan rise
A RISE in the number of diabetes and asthma care plans completed for patients has been linked to the efforts of practice nurses. The latest Productivity Commission report found patients with diabetes who received an annual cycle of care plan increased from 17% in 2004/5 to 19.8% in 2008/9. Written asthma care plans also went up from 17% in 2001 to 21% in 2007/8 and the proportion of children aged 0-14 years with asthma that had a plan rose from 24.7% in 2001 to 47.8% in 2007/8. Referring to the report, Professor Mark Harris, professor of ...
Asthma link to risk of preterm birth disputed
THE risk of preterm delivery is not increased in asthmatic mothers according to new Australian research that contrasts with previous study findings. However, male and female babies born to mothers with asthma responded differently in-utero, with differences in fetal growth identified in the study. Researchers analysed the outcomes of 17,440 singleton pregnancies over four years in the Newcastle region of NSW. Asthma was a complicating factor in 12% of pregnancies. The incidence of preterm delivery, which earlier studies had identified as a risk to mothers with asthma was not significantly higher in the cohort studied (13% ...
Folate supplements in late pregnancy up child asthma risk
WOMEN should be cautioned against excess folate supplementation during pregnancy, Australian experts say. In particular, they warn that supplemental folate should not be taken during late pregnancy. The comments follow the publication of Australian research finding an increased risk of asthma in the offspring of mothers who take folic acid in late pregnancy. The researchers said it was an important reminder that women should adhere to recommendations on timing and dosage of folate supplementation. The prospective study found use of folic acid supplements in late pregnancy (from 30 to 34 weeks) was associated with a ...
Younger maternal age a risk for infantile asthma
BABIES born to younger mothers are at increased risk of developing asthma during infancy, according to Australian research. Professor Guy Marks, from the Australian Centre for Asthma Monitoring, said for the first time researchers had been able to disentangle the effect of maternal age from other asthma predictors such as low birth weight and premature delivery. “We found that younger maternal age was an independent predictor of the development of wheezing illness (in children) but only in the first three years of life,” he said. A European Community survey had found that mothers aged 13 to ...
Better monitoring of adherence in mild asthma vital
CLINICIANS will need to redouble their monitoring of patients with mild asthma after new Australian research outlined the potentially serious adverse health outcomes of non-adherence to preventer medications. A longitudinal study of 702 patients with asthma in Tasmania found only 26% were using even suboptimal preventer medications. Use was lowest among those with adult onset asthma or without a family history. “While the majority of patients with current asthma had persistent asthma, few were taking even minimally adequate preventer medication,” the authors said. “Importantly, their lung function measurements declined statistically significantly with increasing severity, while those ...
Adolescents, asthma and adherence
Teenagers are notoriously bad with their asthma management. ADOLESCENTS with asthma remain a highly vulnerable group due to the impact of living with a chronic illness during a time of rapid physical, psychological and cognitive change. Adherence to an asthma management plan – in particular, regular use of a preventer – is often very difficult for teens. A recent article in the Journal of Allergy and Clinical Immunology outlines the reasons why this occurs. 1 The authors investigated adherence to preventive asthma therapy and explored beliefs and attitudes to asthma in older urban ...
Long-term safety of inhaled steroids in kids unclear
FEW studies are available to establish the long-term safety and efficacy of inhaled corticosteroids (ICS) in children with asthma, say UK researchers. Most studies of these drugs focussed on short-term disease activity, and failed to address quality of life and long-term consequences of asthma, they said after reviewing 159 randomised controlled trials of ICS in children. This was largely due to pharmaceutical industry-funded trials being designed to meet the demands of regulatory authorities, they said. They found that none of the trials measured long-term disease outcomes or progression although two used FEV 1 to assess ...
Babies in daycare no less likely to develop childhood asthma
DAYCARE attendance in infancy is not protective against asthma in later childhood, research shows. Despite suggestions that childcare could reduce later development of allergic diseases, a Dutch study of 4000 children found no decrease in airway hyperresponsiveness, allergies or asthma among those attending childcare. The study, which followed the children prospectively until age eight, was the first to look at the links between childcare and airway hyperresponsiveness. It found that children in daycare younger than two years developed wheezing earlier than children never in daycare. The wheezing resolved by the age of four so there was ...
Managing asthma in general practice
This Clinical Update outlines the practice nurse’s roles in asthma management, including device use, spirometry and models of care. Earn CPD by completing a quiz on this Update Introduction ASTHMA is predominantly managed in general practice 1 and practice nurses are in an excellent position to complement the medical management of asthma by GPs. Practice nurses can be vital members of the asthma management team, providing aspects of patient care including self-management education, spirometry and instructions on inhaler use. Asthma in Australia More than ...
Chronically ill hit hardest by swine flu
PEOPLE who are asthmatic or obese are at especially high risk of developing complications from swine flu, a leading virologist warns. Professor John Mackenzie, a pandemic adviser to the World Health Organization and professorial fellow in infectious and emerging diseases at Curtin University, WA, said most hospitalised cases worldwide involved people aged 20 to 40 years who had an underlying medical vulnerability. “Most of the serious cases are in people with asthma, the morbidly obese, and those with diabetes,” he said. Professor Mackenzie said others at risk were young to middle-aged people with COPD or underlying cardiac disease, and ...
Exercise prevents asthma attacks
REGULAR physical activity can benefit older asthma patients, a longitudinal study has found. Among 2800 women aged 63 years with asthma from the US Nurses’ Health Study, those who reported regular leisure activities, such as walking, swimming, cycling or playing tennis, were less likely to have a self-reported emergency doctor or hospital visit. More than one in five of the women suffered at least one exacerbation in the follow-up period. The researchers found the higher the overall level of physical activity, the lower the risk of having an exacerbation. However, they noted that fear of exercise-induced ...
Plan for parents to initiate steroids in severe asthma
GUIDELINES on managing acute asthma in school-age children may be revised in light of Australian research showing benefit from the use of parent-initiated oral prednisolone. National Asthma Council guidelines reviewer Professor Colin Robertson said the results of a new study in children aged 5-12 years would be assessed by an expert committee meeting next week. The randomised controlled trial of 230 Victorian children found that symptoms improved and visits to GPs reduced when parents initiated oral steroids in children with severe episodes of asthma. “I would anticipate rewriting the guidelines... but this will be discussed at ...
Inhaled plus oral steroids a cataract concern
ASTHMA patients who have used both inhaled and oral corticosteroids are at increased long-term risk of developing cataracts. While the association between corticosteroid use and development of cataracts was known, Australian researchers found that long-term use of inhaled corticosteroids increased the chance of posterior subcapsular or nuclear cataract development among those who had previously used oral corticosteroids. After 10 years’ follow-up of 3654 patients from the Blue Mountains Eye Study, researchers found users of both forms of corticosteroid had a four-fold greater risk of developing posterior subcapsular cataracts compared to never users. Co-author Professor Paul Mitchell, ...
Suckling improves lung volume, may protect against asthma
BREASTFEEDING may be protective against asthma not just because of protective factors in the milk but because suckling improves lung volume, researchers say. A study of the Isle of Wight birth cohort of 1400 children found that those breastfed for at least four months had lung function (FVC) 54 ml larger at the age of 10 years compared to children who were not breastfed. The researchers found no effect modification of breastfeeding by maternal history of asthma or allergy. Breastfeeding required about three times the sucking power of bottle-feeding, and on average sucking went for twice ...
Asthma risk higher after caesarean birth
THE risk of developing asthma by the age of eight years appears to be dramatically higher among children born by caesarean section. A population-based study of nearly 3000 Dutch mothers and their offspring found children born via caesarean had a 79% higher risk of asthma than those born by vaginal delivery. While the mechanism was unclear, the researchers said it might fit with the hygiene hypothesis, as caesarean delivery delays the immune system’s exposure to micro-organisms. Thorax , online 3 December.
Warning on inhaler misuse
HOLDING asthma devices incorrectly when loading or inhaling may limit the amount of medication delivered, the National Asthma Council Australia warns. Launching the Prevent Puffer Problems campaign, the Council last week urged GPs to counsel patients on correct inhaler technique. Council asthma educator Judi Wicking said a common problem with the Turbuhaler was failing to hold it completely vertical, and some patients did not know to hold the Accuhaler so the mouthpiece was “tipping upright”. Other misuses included failing to shake the puffer between each dose and putting multiple doses into a spacer. Elderly people ...
Patient compliance queried in poor asthma symptom control
MORE than a quarter of general practice patients with asthma have poor disease control despite being prescribed high-dose inhaled corticosteroids, Australian research has found. Associate Professor Frank Thien, director of respiratory medicine at Victoria’s Box Hill Hospital, said the surprising baseline data from the ongoing SPIRO-GP study raised issues about correct diagnosis and patient compliance. The data “gives us a handle on what is going on with regard to level of control, but the cause… needs further investigation”, he said. Professor Thien told last week’s Australasian Society of Clinical Immunology and Allergy scientific meeting in Melbourne ...
Rebate push to curb asthma overdiagnosis
A RENEWED bid for higher Medicare rebates for GP spirometry is to be launched as concern mounts that asthma may be overdiagnosed. A Canadian longitudinal study of 496 adults found that about one-third of patients diagnosed with asthma were shown not to have the disease after spirometry testing. Professor Christine Jenkins (pictured), president of the Thoracic Society of Australia and New Zealand (TSANZ), said spirometry was crucial for asthma diagnosis but it was unlikely to be more widely used while reimbursement was inadequate for a test which took at least 20 minutes. Professor Jenkins said the ...
Asthma improves but low action plan uptake
CONTROVERSIAL asthma action plans are again in the spotlight after a report revealed asthma mortality and hospitalisation rates had declined despite poor use of action plans. A new Australian Institute of Health and Welfare report highlighted that only one in five (22.5%) people with asthma currently had a written action plan. The Asthma in Australia 2008 report revealed mortality rates fell by 69% between 1989 and 2006. It also found hospital admissions for asthma dropped by 42% among children, and by almost half among adults between 1993-94 and 2006-07. However, despite the ...
Call to limit paracetamol in kids after asthma link found
PARENTS should be advised to avoid using paracetamol in infants and young children, except in high fever, after a study found it raised the risk of asthma, rhino-conjunctivitis and eczema. A multivariate analysis of 205,487 children from 31 countries found use of paracetamol for fever in the first year of life was associated with a 46% increased risk of asthma symptoms at age 6-7 years. Current use of paracetamol was associated with a dose-dependent increased risk of asthma symptoms in this age group – 61% for medium use (once or more in the past 12 months), and ...
Global warming to cause rise in skin conditions
GLOBAL warming may lead to an increase in dermatological conditions, experts warn. Italian dermatologists say increasing temperature and humidity could extend the range and frequency of tropical and subtropical parasites that cause skin conditions such as cutaneous larva migrans. “Climate tropicalisation can be hypothesised to be at least one of the causes in the increase of human [dermatophytes and moulds] and plant mycoses,” the authors said. Climate change would potentially also shorten the incubation period of pathogens, they said. Dr Graeme Horton, NSW GP and member of Doctors for the Environment Australia, said the increase ...
Emergency education for acute asthma
Q: Does providing education to patients who present with exacerbations prevent future admissions for asthma? A: Asthma action plans can improve health outcomes for patients with asthma, but the Cochrane Collaboration has also looked at the effect of education on patients who have presented acutely to emergency departments. There were 12 randomised studies in this analysis. All 1954 patients were older than 17 years. Within a week of their acute presentation, the patients received a variety of educational interventions. Most of the interventions were given by nurses and included a written management ...
Kids’ asthma-adult anxiety link
RESPIRATORY disease in childhood can substantially increase the risk of anxiety in adulthood, research has confirmed. And the longer a child has respiratory disease, the greater the risk. A US study of 720 participants found those with a higher respiratory rate at four months of age were more than twice as likely to have received treatment for anxiety by 34 years of age. There was no such association with treatment for depression. Those who had respiratory disease (including asthma, croup, pneumonia and bronchiolitis) at both one and seven years of age had 19 times the risk ...
Inhaled steroids offer cardioprotection
INHALED corticosteroid therapy may confer benefits beyond asthma control by reducing all-cause and cardiovascular mortality among women with persistent asthma. A US observational study found that inhaled corticosteroid use over five years was associated with a 42% lower risk of all-cause mortality and a 65% reduced risk of cardiovascular mortality among 2671 women aged 30 to 55 years. “These observational data suggest that ICS may indeed have anti-inflammatory benefits beyond the airway, a possibility that merits further study,” the authors said. The researchers adjusted for confounders including age, asthma severity, smoking, cardiovascular risk factors, aspirin use ...
Obesity blunts prednisone
OVERWEIGHT and obese adults with asthma may not respond as well to prednisone therapy as those of normal weight, a small US study has found. A trial of 45 non-smoking adults found those with asthma and higher body mass index showed less improvement in lung function and spirometric response to treatment. “These data indicate that in vitro biomarkers of glucocorticoid insensitivity increase in both the lung and peripheral blood as body mass increases in individuals with asthma, but not in non-asthmatic controls,” the authors said. Studies had shown the tumour necrosis factor-alpha receptor etanercept ...