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New asthma first aid chart for combination inhalers


Matt Woodley


19/04/2023 4:44:22 PM

A prominent GP has said it is important for clinicians to be aware of the guidance, so that everyone is on ‘the same page’.

Asthma inhaler
The chart provides guidance for the use of preventer and reliever combinations in an emergency in a community setting. (Image: AAP)

A new First Aid for Asthma (FAFA) chart has been released, outlining how to use combination inhalers with Formoterol (sold as Symbicort, Fostair, DuoResp, or BiResp).
 
Compiled by the National Asthma Council Australia, the chart provides guidance for the use of preventer and reliever combinations in an emergency in a community setting.
 
But while GPs will likely follow Australian Asthma Handbook  guidelines for managing an emergency in their clinic, Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, told newsGP it is a good idea for them to also be familiar with the new chart to ensure consistent advice is given to patients.
 
‘It’s important for GPs to know that there are first aid plans out there and what they contain, so that we’re all working from the same page,’ she said.
 
‘You don’t want GPs actually telling patients something different than what, say, a staff member has been recommended in terms of managing an asthma attack in a school environment.
 
‘It’s a bit like first aid for heart attack – what we might do in our practice or in an emergency department might be a little bit different … to what we do out in the community.’
 
The updated chart has been developed in response to the growing use of combined preventer and reliever medication, which treats the underlying cause of asthma at the same time it treats the symptoms but is administered in a different way to previous asthma medication.
 
Respiratory physician and Chair of the FAFA Working Group, Professor Peter Wark, says the new chart is for all health professionals who might need to assist people with acute asthma, including those who volunteer and provide first aid.
 
‘The FAFA charts are the backbone for the management of acute asthma by GPs and other health professionals, and the steps followed in the chart are as relevant on the sidelines of the sporting field as they are in a doctor’s surgery,’ he said.
 
He is also concerned that many people with asthma are still unaware of the combination inhaler as important treatment option, and said patients need to be reminded that a blue reliever puffer just treats the symptoms and will not stop a serious asthma attack.
 
‘Combination inhalers are now a viable alternative way of treating asthma for those with mild and moderate disease who are aged 12 and above and there is very good evidence that it is more effective and safer than using a reliever alone,’ he said.
 
‘It is also an option for those with moderate asthma using a single preventer and fast-acting reliever combination.
 
‘With the release of this new chart, the National Asthma Council is keen for all health professionals, as well as those who provide first aid for people with asthma, to reinforce with their patients that this form of acute asthma treatment is also very effective and safe.’

Dr Hancock said the combination inhalers, containing inhaled steroid and rapid onset bronchodilator, used on a “as needed” basis for mild asthma, are now part of the guidelines because too many people with asthma are relying on short-acting beta-agonist (SABA) salbutamol as the only way of managing asthma symptoms – despite the potential for long-term damage to airways and increased risk of death.

Meanwhile, those with more than mild asthma require regular daily preventer therapy, which may be regular daily inhaled steroid or a combination ICS/LABA, Dr Hancock said, adding that no one should be managing their asthma with SABA alone.
 
‘The big trials have shown us that using a medication that contains a steroid and a quick-onset beta agonist, such as formoterol is much more effective and leads to better control of asthma in the long term, fewer exacerbations, and less reliance on needing to use oral steroids,’ she said.
 
‘We know that once you accumulate 500 milligrams in total of oral steroids in a lifetime – and that’s only 10 doses of 50 milligrams, so essentially two courses – it’s associated with increased risk of diabetes, osteoporosis, and cataracts.
 
‘So having a regime where you can just take your preventive medication on an “as needed basis” … [that also] contains an inhaled steroid and a quick-onset beta agonist – an airway dilator – has been shown to be a very effective way of managing mild asthma.’
 
However, while a better treatment option, it has also led to some uncertainty in the community during emergency asthma situations.
 
‘The previous asthma action plans could accommodate these newer types of therapies, but it probably wasn’t as clear as having a specific action plan for those on combination therapies,’ Dr Hancock said.
 
‘It’s really important because not everybody carries around that asthma action plan with them. And therefore, in school environments, sporting clubs, generally out in the community … there was confusion as to how they should manage the asthma in a first aid situation.’
 
Even though the new plans will help, Dr Hancock said it is still preferable for patients to avoid those emergency situations wherever possible through effective management.
 
‘It’s vital for all our patients with asthma to have regular reviews, assess their control, and be on appropriate medication according to the guidelines, and taking it correctly, so that they can achieve good control of their asthma,’ she said.
 
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