New asthma charts ‘very useful to have at one’s fingertips’

‘Many of us in Australia, including consumers, patients and health professionals have become complacent about asthma management.’
 
That is Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, who told newsGP it is important GPs keep up to date with guidelines and the latest medications, particularly given the recent ‘explosions’ in available medications for treating the condition.
 
‘The gains we made in the 90s have plateaued despite the tsunami of medicines we have available,’ Dr Hancock said.
 
‘Disappointingly, there is complacency about achieving and maintaining good asthma control, there is overuse of SABAs [short-acting beta-agonists] and overuse of oral steroids to “rescue asthma” with significant deleterious effects for patients and our health system.’
 
Ahead of National Asthma Week, the National Asthma Council Australia has released updated versions of two widely used educational charts to help keep healthcare professionals up to date with management pathways.
 
The Asthma and COPD medications chart provides guidance on identification and explanation of different treatments, with the updated version including the latest inhalers available in Australia and the PBS reimbursement status of each medication as at August 2023. 
 
The Selecting and adjusting medication for adults and adolescents chart is a visual reference to medications for each level of the ‘Selecting and adjusting medication for adults and adolescents’ diagram in the Australian Asthma Handbook and provides a summary of the step-up/step-down approach to managing asthma together with the appropriate inhalers to be used at each step of the algorithm.
 
Professor Nick Zwar, GP and Chair of the National Asthma Council Australia Guidelines Committee, told newsGP the updates are valuable resources for GPs.
 
‘We know that good inhaler technique and adherence are critical to maintaining well-controlled asthma,’ he said.
 
‘With so many inhaler devices available now and different PBS indications, the chart provides a user-friendly visual check on medicines and strengths that can be used at each treatment level.’
 
The inhaler device wall chart has been updated to include inhaled corticosteroid/long-acting muscarinic antagonist/long-acting beta agonist (ICS/LAMA/LABA) – all four single inhaler combination devices, as well as additional brands of dual combination products. The QR code on the wall chart also allows quick access to the Asthma Council’s videos on how to use the different inhaler devices.
 
‘These are very useful clinical charts,’ Dr Hancock said.
 
‘Since the last versions in early 2022 there have been some new inhalers available via the PBS for management of both asthma and COPD [chronic obstructive pulmonary disease] for those patients with asthma who may benefit from add-on LAMAs [long-acting muscarinic antagonists] at step-4 therapy.’
 
The medications chart is helpful in indicating which inhalers and strengths are PBS-approved for asthma and COPD, according to Dr Hancock, who says although there are ‘too many’ of all the available generic brands to show all images on the chart, some names are listed, such as Pavtide for Seretide and Rilast for Symbicort. 
 
‘It’s a very useful resource to have at one’s fingertips when making decisions about treatment or for patients to show you which inhaler they are taking or previously prescribed,’ she said.
 
‘For example, “That red and grey one that the other doctor gave me”.’
 
Helping to raise greater awareness around suitable options for effective asthma management in the community is one of Dr Hancock’s missions.
 
She is also an advocate for addressing overprescribing and over-the-counter availability of SABA medications, as detailed in a recently published MJA article she co-authored, which highlights an ‘urgent need for a refocus’ and discusses how the burden of asthma for patients and doctors can be reduced through simple evidence‐based approaches to care and self‐management.
 
‘If we assisted patients to maintain good control then they would not need rescuing with SABA and steroids,’ Dr Hancock said.
 
‘Ensuring a correct diagnosis is vital, then assessing asthma control. Using a tool such as the asthma control test is helpful and quick at determining “future risk” of adverse outcomes for that patient.
 
‘For example, does this patient have comorbidities or other lifestyle factors that may impact on their asthma control and risk of exacerbations?
 
‘[It also ensures] that patients with asthma appreciate the importance of good adherence and good inhaler technique; that patients know how to recognise and manage worsening asthma symptoms by having a relevant written Asthma Action Plan; and importantly, arranging a regular review of every patient with asthma to formally assess asthma control, lung function and modify treatment accordingly.’ 
 
Professor Zwar agrees, adding that reinforcing the role of preventer therapy in the management of asthma is important, with National Asthma Week (1–7 September) an opportune time.
 
‘The week also coincides with the beginning of the peak spring asthma season, which is a great time for GPs to conduct an asthma review to help patients achieve optimal asthma and allergic rhinitis control,’ he said.
 
‘Concomitant asthma and allergic rhinitis are common, so good control of allergic rhinitis can lead to better control of asthma, and less impact on a patient’s daily activities and sleep.’
 
Dr Hancock says National Asthma Week is a sound opportunity to highlight asthma management to the community.
 
‘And to those who look after our community: their carer’s and their health professionals,’ she said.
 
All of the Asthma Council’s charts for healthcare professionals are available for download on their website, or free A2-size hardcopies can be ordered via email.
 
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