Australian Asthma Research Articles

Aggregatibacter is inversely associated with inflammatory mediators in sputa of patients with chronic airway diseases and reduces inflammation in vitro

BackgroundChronic airway disease (CAD) is characterized by chronic airway inflammation and colonization of the lungs by pro-inflammatory pathogens. However, while various other bacterial species are present in the lower airways, it is not fully understood how they influence inflammation. We aimed to identify novel anti-inflammatory species present in lower airway samples of patients with CAD.MethodsPaired sputum microbiome and inflammatory marker data of adults with CAD across three separate cohorts (Australian asthma and bronchiectasis, Scottish bronchiectasis) was analyzed using Linear discriminant analysis Effect Size (LEfSE) and Spearman correlation analysis to identify species associated with a low inflammatory profile in patients.ResultsWe identified the genus Aggregatibacter as more abundant in patients with lower levels of airway inflammatory markers in two CAD cohorts (Australian asthma and bronchiectasis). In addition, the relative abundance of Aggregatibacter was inversely correlated with sputum IL-8 (Australian bronchiectasis) and IL-1β levels (Australian asthma and bronchiectasis). Subsequent in vitro testing, using a physiologically relevant three-dimensional lung epithelial cell model, revealed that Aggregatibacter spp. (i.e. A. actinomycetemcomitans, A. aphrophilus) and their cell-free supernatant exerted anti-inflammatory activity without influencing host cell viability.ConclusionsThese findings suggest that Aggregatibacter spp. might act to reduce airway inflammation in CAD patients.

Renewing the Australian asthma agenda: lessons from the Finnish 10-year Asthma Program

The Finnish Asthma Program, which ran between 1994 and 2004, has long been heralded as a benchmark of success in how to improve management and reduce asthma-related health service utilization. In Australia, there were 38,792 asthma hospitalizations in 2017–18, and 80% of these were considered avoidable (J Asthma Allergy. 2021;14:797–808. doi: 10.2147/JAA.S311721). To address this issue, Asthma Australia has set a strategic objective of halving avoidable asthma presentations to hospital by 2030. This article provides an overview of the Finnish Asthma Program, including an evaluation of critical success factors, outputs, and outcomes, followed by a synthesis of these findings for relevance and applicability to the contemporary Australian context that will inform policy and practice recommendations. Early diagnosis, effective anti-inflammatory medication, guided self-management, and monitoring disease control are still the keys to mitigating asthma burden. In the spirit of the Finnish Program, the digital transformation of healthcare and social media is enabling a new kind of systematic approach, both for patients and professionals.

Updated Australian guidelines for mild asthma: what's changed and why?

SUMMARYThe Australian asthma guidelines have recently been updated and include additional treatment options for adults and adolescents with mild asthmaMild asthma is not necessarily a benign condition and patients are still at risk of severe flare-ups, particularly if they overuse short-acting beta2 agonists such as a salbutamol inhalerFor adults and adolescents with mild asthma, the updated guidelines include as-needed inhaled low-dose budesonide–formoterol as an alternative to daily low-dose inhaled corticosteroid plus as-needed short-acting beta2 agonistThe budesonide–formoterol combination should be taken as needed to provide symptom relief and reduce the risk of severe exacerbations

Are young children with asthma more likely to be less physically active?

Previous research suggests that children who experience asthma may be less physically active; however, results have been inconclusive. This study aimed to investigate whether the presence of asthma or wheeze is associated with lower physical activity levels in children, and whether sex, body mass index or earlier asthma or wheeze status modifies the association. This study was conducted in 391 HealthNuts participants in Melbourne, Australia. Asthma and wheeze data were collected via questionnaire at age 4 and 6, and physical activity was measured through accelerometry. Using adjusted linear regression models, the cross-sectional and longitudinal associations were investigated. There was no evidence of a difference in time spent in moderate-to-vigorous physical activity (MVPA) at age 6years between children with and without asthma at age 4; children with asthma spent 8.3minutes more time physically active per day (95% CI: -5.6, 22.1, P=.24) than children without asthma. Similar results were seen for children with current wheeze (5.8minutes per day more, 95% CI: -5.9, 17.5, P=.33) or ever wheeze or asthma (7.7minutes per day more, 95% CI: -4.8, 20.2, P=.23) at age 4years. Comparable null results were observed in the cross-sectional analyses. Interaction with BMI could not be assessed; however, previous asthma or wheeze status and sex were not found to modify these associations. This analysis found no evidence of asthma hindering physical activity in these young children. These results are encouraging, as they indicate that the Australian asthma and physical activity public health campaigns are being effectively communicated and adopted by the public.

Dispensing Practices of Fixed Dose Combination Controller Therapy for Asthma in Australian Children and Adolescents.

The Australian Asthma Handbook does not recommend use of fixed dose combination (FDC) controller medicines for asthma in children aged ≤5 years. FDCs are only recommended in children and adolescents (aged 6–18 years) not responding to initial inhaled corticosteroid (ICS) therapy. Using Pharmaceutical Benefits Scheme dispensing claims from 2013–2018, we examined the annual incident FDC dispensing and the incident FDC dispensing without prior ICS up to 365 days. We also determined cost of FDCs to government and patients. During 2013–2018, there were 35,635 FDC initiations and 31,368 (88%) did not have a preceding ICS dispensing. The annual incidence of FDC dispensing declined from 14.7 to 7.2/1000 children. Incidence of FDC dispensing/1000 children without a preceding ICS declined from 2.1 to 0.5 in children aged 1–2 years, 7.2 to 1.7 in 3–5 years, 14.8 to 5.1 in 6–11 years, and 18.6 to 11.9 in ≥12years. The cost of FDCs was 7.8 million Australian dollars (AUD); of which 4.4 million AUD was to government and 3.3 million AUD was to patient. Despite inappropriate dispensing of FDCs in children aged ≤5 years, incidence of FDC dispensing and more importantly incidence without a preceding ICS is declining in Australia.

Easing the wheeze.

Easing the wheeze.

Ann Janet Woolcock 1937–2001

Ann Woolcock graduated in medicine from the University of Adelaide and pursued postgraduate studies in respiratory medicine with Professor John Read at the University of Sydney. Her MD thesis, awarded in 1967, was on the mechanical behaviour of the lungs in asthma. From 1966 to 1968 she worked with Professor Peter Macklem at McGill University in Canada, then returned to the University of Sydney to continue researching asthma. Her work in asthma and epidemiology showed that asthma was caused by allergens but that there is a genetic component. Her clinical research was a major contribution to better outcomes in asthma, in particular, the demonstration and practical measurement of airway hyperresponsiveness and her subsequent research that examined its contribution to asthma severity and the ways in which treatments were able to reduce it. In 1989 she wrote, with others, the world's first national guidelines for asthma management, the Australian Asthma Management Plan. In 1984, she was appointed to a personal chair of Respiratory Medicine at the University of Sydney. She founded the Institute of Respiratory Medicine in 1985, based at Sydney's Royal Prince Alfred Hospital. After her death, the Institute was renamed the Woolcock Institute of Medical Research in her honour.

Feasibility study of a communication and education asthma intervention for general practitioners in Australia

The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor-patient communication. The impact ofthe modified PACE Australia program on the processes and outcomes ofGP care ofchildren with asthma is now being measured in a randomised controlled trial.

Management of childhood asthma in Western Australia

The study aimed to determine how childhood asthma is managed in Western Australia by general practitioners (GPs) and specialist paediatricians. A questionnaire survey was sent to 992 GPs and specialist paediatricians, asking about practice and preferences regarding maintenance management of childhood asthma and treatment of acute asthma. Questions about asthma in infants, pre-school and school-aged children were asked separately. The overall response rate was 24.7%, with 188/878 (21.4%) of GPs and 44/62 (71.0%) of paediatricians returning the questionnaire. The decision to start maintenance therapy was generally based on symptom frequency and severity. The first choice for maintenance treatment in all age groups was inhaled corticosteroids (ICS). The second most common treatment varied according to age group, with short-acting beta(2)-agonist (SBA) preferred for infants, montelukast or short-acting beta(2)-agonist for pre-schoolers and combination therapy (ICS + long action beta(2)-agonist) for school-aged children. Objective monitoring of lung function with peak flow or spirometry, was used by 40% of GPs and 59% of paediatricians. Acute asthma was primarily managed with inhaled salbutamol and oral corticosteroids. There were few differences in treatment choice between GPs and paediatricians. Many GPs indicated that they did not treat asthma in infants without specialist consultation. These data show good compliance by the minority of GPs responding to the survey and by paediatricians practising in Western Australia with current Australian asthma management guidelines. Major differences in treatment preferences between the groups were not detected.

Australian Asthma Conference 2008: Advancing Asthma Where?

The Australian Asthma Conference provided a timely forum for rethinking research priorities and strategies at a time when the Australian government is undertaking major national health policy reviews. Until now, asthma has been a national health priority in Australia, and at the conclusion of the conference, delegates issued a strong statement in support of asthma continuing to be a national health priority in Australia.

What Affects Asthma Medicine Use in Children? Australian Asthma Educator Perspectives

The global burden of childhood asthma is significant. Health care systems are faced with increasing financial costs, while children with asthma and their caretakers are faced with poorer physical health, emotional health, and quality of life. Despite the availability of effective treatment, the quality use of asthma medicines in children remains suboptimal. An investigation was conducted to explore issues related to children's asthma medicine usage from the perspective of the health care professional. Although current literature has elicited the views of caretakers and children, the health care professional viewpoint has been relatively unexplored. Semi-structured qualitative interviews were conducted with a convenience sample of 21 Australian asthma educators. Interviews were audiotaped and transcribed, and transcripts were thematically analyzed with the assistance of NVivo 7. Emergent themes associated with health care professionals, parents, medicines, children, and educational resources were found. Major issues included a lack of information provided to parents, poor parental understanding of medicines, the high cost of medicines and devices, child self-image, the need for more child responsibility over asthma management, and the lack of standardization, access to, and funding for educational resources on childhood asthma. There are multitudes of key issues that may affect asthma medicines usage in children. This research will help inform the development of educational tools on the use of medicines in childhood asthma that can be evaluated for their effectiveness in getting key messages to target audiences such as children, caretakers, and teachers.

Genetic variation in immune signaling genes differentially expressed in asthmatic lung tissues

Eight genes in the immune signaling pathway shown to be differentially expressed in asthmatic lung biopsy specimens in a previous microarray experiment were selected as candidate genes for asthma susceptibility. We sought to perform an association study with these genes and asthma-related phenotypes in 3 independent Canadian familial asthma collections and 1 Australian asthma case-control study. Tagging single nucleotide polymorphisms were selected by using the HapMap public database (r(2) > 0.8; minor allele frequency >0.10) and genotyped with the Illumina platform. Family-based association and trend tests for asthma, atopy, airway hyperresponsiveness, and allergic asthma phenotypes were done in each sample, correcting for multiple testing. Uncorrected associations with polymorphisms within 7 genes were detected with 1 or more of the phenotypes in 1 or more of the 4 populations (.001 <P < .05). After correction, the 15-lipoxygenase (15-LO) associations with airway hyperresponsiveness and allergic asthma remained significant in 2 Canadian samples (corrected P = .022 and .049, respectively), and the association of the CD14 antigen with asthma remained significant in 1 Canadian sample (corrected P = .042). In both cases a protective effect of the minor alleles was observed. Expression profiling studies are a useful way to identify candidate genes for asthma because this approach has led to the first report of an association with 15-LO in 2 independent populations. Because 15-LO is involved in anti-inflammatory processes, further functional and clinical investigation of the role of this biologic pathway in asthma is warranted.

An interactive workshop plus locally adapted guidelines can improve general practitioners asthma management and knowledge: a cluster randomised trial in the Australian setting.

BackgroundA cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops.MethodsTwenty-nine practices were randomly allocated to one of three study arms. Australian asthma management guidelines were adapted to accommodate characteristics of the local area. GPs in the intervention arm (Group 1, n = 18 GPs) participated in a small group based education program and were provided with the adapted guidelines. One control arm (Group 2, n = 18 GPs) received only the adapted guidelines, while the other control arm (Group 3, n = 15 GPs) received an unrelated education intervention. GPs' knowledge, attitudes and management of paediatric asthma was assessed.ResultsPost intervention, intervention arm GPs were no more likely to provide a written asthma action plan, but were better able to assess the severity of asthma attack (Group 1vs Group 2 p = 0.05 and Group 1 vs Group 3 p = 0.01), better able to identify patients at high risk of severe attack (Group 1vs Group 3 p = 0.06), and tended to score higher on the asthma knowledge questionnaire (Group 1 vs Group 2 p = 0.06 and Group 1 vs Group 3 p = 0.2). Most intervention arm GPs felt more confident than control GPs to manage acute asthma attack and ongoing management of infrequent episodic asthma.ConclusionUsing interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in GP's knowledge and confidence to manage asthma, but did not change GP's self-reported provision of written action plans.

ABS78: A pilot study of Physician Asthma Care Education program in Australia

Introduction:The Physician Asthma Care Education (PACE) program was developed by the Universities of Michigan and Columbia, as an educational intervention to enhance the care of children with asthma in primary care. PACE has had a significant impact on the prescribing and communication behaviours of primary care paediatricians in US, leading to improved patient outcomes.Aims:The study aims were to adapt the program material to the Australian context and to test its acceptability and feasibility with General Practitioners.Methods:PACE materials were modified to meet the Australian asthma management guidelines. 25 Doctors in Sydney were recruited to attend two 2½ hour workshops that included interactive sessions on asthma management and a communication and education video. Before and again four weeks after the intervention, participants completed a questionnaire about the use of 10 key teaching and communication strategies. They were asked about their confidence in using these strategies, how helpful they perceived them to be and the frequency of use during asthma consultations.Results:Following the PACE Australia workshops, participants reported greater confidence in using the 10 key strategies, perceived them as more helpful, and reported using them more often. The doctors gave very positive written and oral feedback about the program content and strategies. The most useful aspects of the workshops were the sessions on communication strategies, patterns of asthma and the use of devices. The recommendations included extending the duration of the workshops and modifying the video for Australian audiences.Conclusion:The results demonstrate that PACE Australia program can improve the way in which doctors manage asthma consultations and the communication strategies would be equally relevant for other chronic illness consultations. The impact of the revised PACE program on the processes, costs and outcomes of general practitioners' care of children with asthma is currently being studied as a randomized controlled trial. Conflict of interest and funding Nil.

General practitioner views on barriers and facilitators to implementation of the Asthma 3+ Visit Plan

The Asthma 3+ Visit Plan is an initiative to promote organised asthma care in general practice. This study aimed to identify factors associated with uptake of the plan by general practitioners, and their views on barriers and facilitators to implementation of the plan. Postal survey sent to a random sample of GPs. 315 GPs in five Divisions of General Practice in metropolitan Sydney, surveyed sequentially between 1 October 2002 and 31 May 2003. Awareness and use of the Asthma 3+ Visit Plan; GP and practice factors associated with use of the plan; and GP views on barriers and facilitators to implementing the plan. The response rate was 55.7%, and 72.1% of participants were male; participants' mean age was 50.5 years. Most GPs (91.2%) were aware of the plan and and 44.9% had used it. GP and practice factors associated with use of the plan were use of the six-step Australian Asthma Management Plan, confidence in aspects of asthma care, practice accreditation, sign-up for asthma incentives, and computerisation. Major barriers to implementing the plan were workload/paperwork and administrative complexities. Patient factors that influenced completion of the plan were their concept of the severity of their asthma, compliance with follow-up, and patient attitudes towards asthma care. The perceived workload and administrative complexity of the asthma incentives are barriers to uptake. Factors relating to the illness rather than social factors are seen as the most important influences on completion of the plan by patients.

How well do doctors know their patients with severe asthma?

Rates of asthma mortality have fallen in Australia since the commencement of the National Asthma Campaign and promotion of the Australian asthma management plan. New strategies are now needed to further reduce mortality. To examine agreement about key features between asthma patients and their general practitioners (GPs). We interviewed: (i) the next of kin of 56 asthma deaths, (ii) 91 asthma patients presenting to emergency departments with acute severe asthma and (iii) 147 of their GPs. Agreement was substantial for usage of oral symptomatic medication, but poor for inhaled symptomatic and preventive medications. There was moderate agreement regarding hospital admissions within the last 12 months among the cases, but little about other markers of severity. There was moderate agreement where the presenting or fatal attack was triggered by an upper respiratory-tract infection or aspirin. The next of kin and GPs agreed about family problems, but not about other psychosocial issues. They also agreed about which cases had been given action plans or verbal instructions, but few other aspects of asthma management. There was also moderate agreement regarding the use of peak flow meters by the controls. Doctors often have relatively poor insights into self-management practices, social background or trigger factors, even in high-risk patients. This should be considered when planning future campaigns to improve asthma management and further reduce mortality.

Australian Asthma Conference - 2004 “A Fresh Breath – Looking to the Future”

The Australian Asthma Conference held this year in Melbourne, was hosted by the Asthma Foundation of Victoria. The conference attracted over 300 participants from all states and internationally, and was headed by a range of keynote speakers representing national and international leaders in the various aspects of asthma management from prevention through to clinical care. Participants included the full spectrum of health professionals, with a large number of asthma educators represented.

Self-management education and regular practitioner review for adults with asthma.

A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health outcomes is less well established. This review was conducted to examine the strength of evidence supporting Step 6 of the Australian Asthma Management Plan: "Educate and Review Regularly"; to test whether health outcomes are influenced by education and self-management programmes. The objective of this review was to assess the effects of asthma self-management programmes, when coupled with regular health practitioner review, on health outcomes in adults with asthma. We searched the Cochrane Airways Group trials register and reference lists of articles. Randomised trials of self-management education in adults over 16 years of age with asthma. Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation. Twenty-five trials were included. Self-management education was compared with usual care in 22 studies. Self-management education reduced hospitalisations (odds ratio 0.57, 95% confidence interval 0.38 to 0.88); emergency room visits (odds ratio 0.71, 95% confidence interval (0.57 to 0.90); unscheduled visits to the doctor (odds ratio 0.57, 95% confidence interval 0.40 to 0.82); days off work or school (odds ratio 0.55, 95% confidence interval 0.38 to 0. 79); and nocturnal asthma (odds ratio 0.53, 95% confidence interval 0.39 to 0.72). Measures of lung function were little changed. Self-management programmes that involved a written action plan showed a greater reduction in hospitalisation than those that did not (odds ratio 0.35, 95% confidence interval 0.18 to 0.68). People who managed their asthma by self-adjustment of their medications using an individualised written plan had better lung function than those whose medications were adjusted by a doctor. Training in asthma self-management which involves self-monitoring by either peak expiratory flow or symptoms, coupled with regular medical review and a written action plan appears to improve health outcomes for adults with asthma. Training programmes which enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management.

Evaluation of a randomised controlled trial of adult asthma education in a hospital setting

BACKGROUNDAlthough patient education is a key step in the Australian Asthma Management Plan, its impact has not been assessed in a hospital outpatient asthma clinic.METHODSA controlled trial was undertaken in...

Attendance at an asthma educational intervention: characteristics of participants and non-participants

As part of an evaluation of the patient education component of the Australian Asthma Management plan, a randomized, controlled trial of asthma education was conducted in 1994/95 at the outpatient asthma and allergy clinic of The Alfred Hospital, a tertiary referral hospital in Melbourne, Australia. The objective of the study was to investigate which demographic and clinical characteristics were associated with attendance at asthma educational session. A total of 125 asthmatics aged over 16 years agreed to participate in the programme, and full compliance with the programme was 43·2%. Allocation to immediate, rather than delayed, education and age were the only significant predictors of attendance. Subjects randomized to the intervention were approximately three times more likely to attend than control subjects (OR = 3·3, 95% CI 1·5–7·3). Asthmatics over 60 years old were approximately six times more likely to attend (OR = 6·6, 95% CI 2·2–19·8) than the age group 16–30 years. The increasing trend in attendance across age categories was highly significant ( P<0·001). There was no relationship between attendance and gender, medication, atopy, smoking status or the physical accessibility of the hospital. Despite offering incentives and conducting the education sessions at subjects' preferred times, their compliance in attending sessions was poor. Over half of the asthmatics, who had expressed interest, failed to attend for their educational sessions. An alternative strategy is required to improve participation by young and employed asthmatics at hospital-based asthma education programmes.