Academic literature on the topic 'Asthma Treatment Australia'

Insufficient use of anti-inflammatory drugs, such as inhaled corticosteroids and cromoglycate, may contribute to the disease burden associated with asthma. Conversely, aggressive treatment of mild disease may result in avoidable costs and/or adverse drug effects. The aim of this study was to determine the relationship between asthma severity and inhaled corticosteroid/cromoglycate use in a large (n=4,909) random sample of children, aged 8-11 yrs, in NSW, Australia. Asthma and its treatment were assessed by questionnaire responses. Asthma, defined as diagnosis plus current wheeze, was present in 901 children (18% of the sample), of whom 225 (5%) had moderate asthma, defined as asthma plus additional symptoms (sleep disturbance), utilization (hospital, casualty), or disability (reduced activity, school absence). Use of inhaled corticosteroid/cromoglycate was reported by 636 children (13% of the sample). Determinants of use included: asthma diagnosis, current wheeze, and troublesome dry nocturnal cough. There was also a strong relationship between anti-inflammatory treatment and a multicomponent asthma severity score constructed for each child. Inhaled corticosteroids and/or cromoglycate were used by 56% of the children with asthma (24% daily) and by 76% of children with moderate asthma (42% daily). Undertreatment, defined as less than daily inhaled corticosteroids/cromoglycate in moderate asthma, was identified in 130 children (14% of those with asthma or 3% of the sample). Conversely, apparently aggressive treatment, defined as inhaled corticosteroid/cromoglycate use in children with persistent minimal symptoms (asthma severity score of less than 3) was identified in 101 children (2% of the sample). Although there were significant differences between regions in the choice of anti-inflammatory drugs and in the prevalence both of undertreatment and apparently aggressive treatment, there was no clear relationship to regional utilization of emergency and hospital services for asthma. Nevertheless, the frequency of undertreatment suggests an opportunity to reduce asthma morbidity by more consistent application of current therapeutic guidelines.

Wildfires are increasing and cause health effects. The immediate and ongoing health impacts of prolonged wildfire smoke exposure in severe asthma are unknown. This longitudinal study examined the experiences and health impacts of prolonged wildfire (bushfire) smoke exposure in adults with severe asthma during the 2019/2020 Australian bushfire period. Participants from Eastern/Southern Australia who had previously enrolled in an asthma registry completed a questionnaire survey regarding symptoms, asthma attacks, quality of life and smoke exposure mitigation during the bushfires and in the months following exposure. Daily individualized exposure to bushfire particulate matter (PM2.5) was estimated by geolocation and validated modelling. Respondents (n = 240) had a median age of 63 years, 60% were female and 92% had severe asthma. They experienced prolonged intense PM2.5 exposure (mean PM2.5 32.5 μg/m3 on 55 bushfire days). Most (83%) of the participants experienced symptoms during the bushfire period, including: breathlessness (57%); wheeze/whistling chest (53%); and cough (50%). A total of 44% required oral corticosteroid treatment for an asthma attack and 65% reported reduced capacity to participate in usual activities. About half of the participants received information/advice regarding asthma management (45%) and smoke exposure minimization strategies (52%). Most of the participants stayed indoors (88%) and kept the windows/doors shut when inside (93%), but this did not clearly mitigate the symptoms. Following the bushfire period, 65% of the participants reported persistent asthma symptoms. Monoclonal antibody use for asthma was associated with a reduced risk of persistent symptoms. Intense and prolonged PM2.5 exposure during the 2019/2020 bushfires was associated with acute and persistent symptoms among people with severe asthma. There are opportunities to improve the exposure mitigation strategies and communicate these to people with severe asthma.

Australia has one of the highest asthma prevalence rates in the world, with this chronic and debilitating condition affecting one in nine people. The health and mental wellbeing of young people with asthma are worse than not only their peers without asthma but also worse than that of people with asthma at other ages. Psychological interventions could be beneficial in treating symptoms of elevated psychological distress in patients with asthma. However, evidence suggests that engagement with mental health services is low in this population. Technology-based solutions that engage youth may overcome barriers to service uptake for both mental health and asthma management. To fast-track the successful translation of evidence-based treatment into practice, interactive, mixed-reality technologies such as augmented reality (AR), virtual reality (VR) and holographic technology may provide a novel, low-cost solution, yet to date, methodological rigor in the evaluation of mixed reality for this purpose is lacking. To evaluate the perceived usability and acceptability of these technologies, mixed reality tools will be developed by the author team to deliver a component of a psychological intervention for treatment of elevated psychological distress among young people with asthma. Qualitative research will be conducted through one-on-one interviews with young people with asthma, parents/caregivers of young people with asthma, and with health professionals, during which participants will have time to interact with the resources. Moderator guides will be used to direct interviews, and will be supplemented with a questionnaire, including Likert-type measures of usability and acceptability to facilitate triangulation of data. Understanding and data obtained through this study will be used to develop version 2.0 mixed reality tools, which will be tested for feasibility in a RCT. Improving access to and uptake of evidence-based treatments for elevated psychological distress in young people with asthma may reduce the burden of this highly prevalent disease.

We investigated the time course of change of type-2 asthma biomarkers after a severe asthma exacerbation. Blood eosinophils were lowest immediately after treatment was initiated (0.07 vs 0.33×109/L, p<0.001) while serum IgE levels were at their highest (339 vs 249 U/L, p<0.001). Fractional exhaled Nitric Oxide levels were lowest 2 weeks after treatment (23 vs 33 ppb, p=0.06) and serum periostin levels were lowest 1 week after treatment (45·9 vs 50·9 ng/mL, p<0.001). A delay of 4–8 weeks following a severe exacerbation is required if these biomarkers are used to guide the ongoing management of patients with asthma.Trial registration numberPost-results; The Australia New Zealand Trial Registry, >ACTRN12614000443695.

Significant gaps remain between recommendations of evidence-based guidelines and primary health care practice in Australia. This paper aims to evaluate factors associated with the use of guidelines reported by Australian GPs. Secondary analysis was performed on a survey of primary care practitioners which was conducted by the Commonwealth Fund in 2009: 1016 general practitioners responded in Australia (response rate 52%). Two-thirds of Australian GPs reported that they routinely used evidence-based treatment guidelines for the management of four conditions: diabetes, depression, asthma or chronic obstructive pulmonary disease and hypertension – a higher proportion than in most other countries. Having non-medical staff educating patients about self-management, and a system of GP reminders to provide patients with test results or guideline-based intervention or screening tests, were associated with a higher probability of guidelines use. Older GP age was associated with lower probability of guideline usage. The negative association with age of the doctor may reflect a tendency to rely on experience rather than evidence-based guidelines. The association with greater use of reminders and self-management is consistent with the chronic illness model.

BackgroundChange in the prevalence of asthma-like symptoms in populations of ageing adults is likely to be influenced by smoking, asthma treatment and atopy.MethodsThe European Community Respiratory Health Survey collected information on prevalent asthma-like symptoms from representative samples of adults aged 20–44 years (29 centres in 13 European countries and Australia) at baseline and 10 and 20 years later (n=7844). Net changes in symptom prevalence were determined using generalised estimating equations (accounting for non-response through inverse probability weighting), followed by meta-analysis of centre level estimates.FindingsOver 20 years the prevalence of ‘wheeze’ and ‘wheeze in the absence of a cold’ decreased (−2.4%, 95% CI −3.5 to −1.3%; −1.5%, 95% CI −2.4 to −0.6%, respectively) but the prevalence of asthma attacks, use of asthma medication and hay fever/nasal allergies increased (0.6%, 95% CI 0.1 to 1.11; 3.6%, 95% CI 3.0 to 4.2; 2.7%, 95% CI 1.7 to 3.7). Changes were similar in the first 10 years compared with the second 10 years, except for hay fever/nasal allergies (increase seen in the first 10 years only). Decreases in these wheeze-related symptoms were largely seen in the group who gave up smoking, and were seen in those who reported hay fever/nasal allergies at baseline.InterpretationEuropean adults born between 1946 and 1970 have, over the last 20 years, experienced less wheeze, although they were more likely to report asthma attacks, use of asthma medication and hay fever. Decrease in wheeze is largely attributable to smoking cessation, rather than improved treatment of asthma. It may also be influenced by reductions in atopy with ageing.

Asthma affects over 330 million people worldwide, with relatively higher disease burdens in Australia, New Zealand, Africa, the Middle East, and South America. The symptoms associated with asthma were reported to be prevalent in children from the period of 1993 to 2013, in many low- and middle-income countries, due to changes in environmental conditions, such as domestic lifestyle, and urban and industrial developments. (1) Background: Several studies have also shown that children are prone to a severe type of asthma, because of their narrow respiratory airways and susceptibility to irritation from environmental agents. This study aimed to assess the association between environmental exposure and asthma among children in King Williams Town, South Africa. (2) Methodology: This study adopted a cross-sectional design method, with an estimated sample size of 262 participants. The eligible study participants were enrolled while attending Grey hospital in King Williams Town, for asthma management. Information will be collected from eligible, stable participants, on asthma treatment, through in-person interviewing in 2021. A semi-structured questionnaire will be administered to the participants. However, as a result of the prevailing COVID-19 pandemic, data may be abstracted from the asthma medical record of the eligible participants. Multivariate regression will be utilized, to describe the correlation between the variables, and the odds ratio will be calculated as well. (3) Discussion and conclusion: The study will objectively identify the local environmental agents that are associated with asthma among children in King Williams Town, in order to reprioritize treatment and preventative strategies. Ethical approval was obtained from the Research Ethics Committee, Faculty of Health Sciences at the University of Johannesburg.

Objective Out-of-pocket costs strongly affect patient adherence with medicines. For asthma, guidelines recommend that most patients should be prescribed regular low-dose inhaled corticosteroids (ICS) alone, but in Australia most are prescribed combination ICS–long-acting β2-agonists (LABA), which cost more to patients and government. The present qualitative study among general practitioners (GPs) explored the acceptability, and likely effect on prescribing, of lower patient copayments for ICS alone. Methods Semistructured telephone interviews were conducted with 15 GPs from the greater Sydney area; the interviews were transcribed and thematically analysed. Results GPs reported that their main criteria for selecting medicines were appropriateness and effectiveness. They did not usually discuss costs with patients, had low awareness of out-of-pocket costs and considered that these were seldom prohibitive for asthma patients. GPs strongly believed that patient care should not be compromised to reduce cost to government. They favoured ICS–LABA combinations over ICS alone because they perceived that ICS–LABA combinations enhanced adherence and reduced costs for patients. GPs did not consider that lower patient copayments for ICS alone would affect their prescribing. Conclusion The results suggest that financial incentives, such as lower patient copayments, would be unlikely to encourage GPs to preferentially prescribe ICS alone, unless accompanied by other strategies, including evidence for clinical effectiveness. GPs should be encouraged to discuss cost barriers to treatment with patients when considering treatment choices. What is known about the topic? Australian guidelines recommend that most patients with asthma should be treated with low-dose ICS alone to minimise symptom burden and risk of flare ups. However, most patients in Australian general practice are instead prescribed combination ICS–LABA preventers, which are indicated if asthma remains uncontrolled despite treatment with ICS alone. It is not known whether GPs are aware that the combination preventers have a higher patient copayment and a higher cost to government. What does this paper add? This qualitative study found that GPs favoured combination ICS–LABA inhalers over ICS alone because they perceived ICS–LABA combinations to have greater effectiveness and promote patient adherence. This aligned with GPs’ views that their primary responsibility was patient care rather than generating cost savings for government. However, it emerged that GPs rarely discussed medicine costs with patients, had low knowledge of medicine costs to patients and the health system and reported that patients rarely volunteered cost concerns. GPs believed that lower patient copayments for asthma preventer medicines would have little effect on their prescribing practices. What are the implications for practitioners? This study suggests that, when considering asthma treatment choices, GPs should empathically explore with the patient whether cost-related medication underuse is an issue, and should be aware of the option of lower out-of-pocket costs with guideline-recommended ICS alone treatment. Policy makers must be aware that differential patient copayments for ICS preventer medicines are unlikely to act as an incentive for GPs to preferentially prescribe ICS alone preventers, unless the position of these preventers in guidelines and evidence for their clinical effectiveness are also reiterated.

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50–193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33–187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13–14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30–11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia.

Justicia procumbens L. is usually known as water willow which belongs to family Acanthaceae growing widely in southern regions of China, Japan, Vietnam, India and Australia. It is one of the important herbal being used in Ayurvedic system of medicine. The plant contains various active compounds like arylnaphthalide and diarylbutane lignans, glycosides, flavonoids. Few pharmacological properties including anti-inflammatory, anti-arthritic, anti-arrhythmic, anti-asthmatic, anti-proliferative, anti-allergic, antibacterial, cytotoxic and anti-HIV activities activity have been reported for this plant. Conventionally, it is used for the treatment of fever, inflammation, cold, cough, asthma, cancer, snake bites etc. The current review is created with an intended to focus on the numerous ethnobotanical and traditional uses as well as the phytochemical and pharmacological report on Justicia procumbens.

[Truncated abstract] This thesis describes the epidemiology and outcome of acute asthma managed by ambulance paramedics, in the metropolitan area of Perth, Western Australia, for the period of 1990 to 2001. The primary aim of this thesis was to determine demographic, socio-economic and clinical trends for ambulance transported patients with asthma, their outcomes and how they have changed over time. The Perth metropolitan area, located in the south-western corner of Western Australia (WA), accounts for 72% of the state’s population, which was approximately 1.3 million people at Census 2001. This thesis was structured around the analysis of twelve years of St John Ambulance (WA) data. Ambulance data was linked using probabilistic matching techniques to the Western Australian Data Linkage System, custodian of links to thirty five years of morbidity and mortality data of the state’s population . . . Unique geography, a monopolistic ambulance service and access to extensive linked data provided ideal conditions for this population-based epidemiological study of patients with asthma who were transported by ambulance. Observed trends in age and gender characteristics of patients, ambulance codes and temporal variables appear to be consistent over time. Monitoring trends in the use of ventilation procedures recorded in hospital data provided useful indicators for describing the epidemiology of severe, lifethreatening asthma in the prehospital setting. Findings from this study were found to be consistent with published literature.