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New GP resource aims to help asthma patients’ sleep

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A new Asthma Council resource could prove a lifesaver, equipping GPs with the critical advice needed to treat patients who present with poor asthma control and sleep disturbance.
 
Released to coincide with World Sleep Day on Friday, the Sleep and asthma information for health professionals paper is designed to be a quick guide for doctors to provide best practice asthma care.
 
The three basic practice points outlined for GPs treating asthma patients are:

• ask about sleep, nocturnal waking, and early morning symptoms
• do not accept nocturnal asthma symptoms as normal
• minimise oral corticosteroid use, which often cause sleep disturbance.

It also notes that the need for oral corticosteroids is reduced by treatment with inhaled corticosteroids, and when oral corticosteroids are necessary, they should be taken early in the morning.
 
The new resource defines healthy sleep as having a regular sleep–wake cycle, getting enough sleep each day, and enjoying good-quality sleep.
 
It associates poor asthma control with sleep disturbance, saying frequent nocturnal symptoms indicate increased risk of acute asthma exacerbations.
 
Sleep disturbance is a common adverse effect of short courses of prednisone or prednisolone, the resources states, as well as montelukast being associated with insomnia and disturbed sleep.
 
It advises GPs that, when assessing asthma in adults and children, they should ask about nocturnal waking and early morning symptoms of chest tightness, wheeze, and breathlessness.
 
Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, told newsGP the resource is a reminder to GPs that common symptoms can be indicators of poor asthma control and should not be ignored or ‘accepted as normal’.
 
‘These symptoms necessitate action by the patient by implementing their asthma action plan if they have one, and if not improving within 24 to 72 hours, then a review with their GP is recommended,’ she said.
 
‘Poor asthma control increases the risk of an asthma exacerbation, hospitalisation, worsening lung function and even increased risk of death.’
 
The resource says conditions such as allergic rhinitis have an estimated prevalence of up to 80% for people with asthma and can cause significant sleep disturbance.
 
While chronic rhinosinusitis is prevalent in up to 42% in people with asthma, and anxiety symptoms impact one third of patients.
 
Australian Asthma Handbook Committee member, Associate Professor Greg Katsoulotos, said a nocturnal cough can occur with or without wheeze and must be addressed with the patient.
 
‘Airway inflammation occurs in asthma, so treatment of airway inflammation is just as important as treatment of airway infection,’ he said.
 
‘If one or two courses of antibiotics do not help, consider that there may be unstable asthma or an alternative diagnosis.
 
‘Inhaled anti-inflammatory therapy is the cornerstone of asthma treatment, not antibiotics or SABA alone.’
 
The advice comes at the same time as asthma-related deaths jumped by 32% in just one year, with 467 deaths recorded in Australia in 2022, up from 355 in 2021.
 
Dr Hancock said the resource is a crucial reminder of the relationship between asthma and common comorbidities, such as obstructive sleep apnoea, obesity, or allergic rhinitis.
 
She said there are also several checks GPs can do to ensure patients are correctly utilising their treatments.
 
‘Do an asthma control test, check adherence, check and correct inhaler technique and then step-up preventer therapy, don’t just use short acting bet agonist or reliever therapy alone,’ she said.
 
‘Review within a few weeks, check for other conditions that may be contributing to the symptoms causing the sleep disturbance, and investigate appropriately.’
 
The sleep resource also encourages GPs to use an asthma symptom tool, such as the Asthma Control Test.
 
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