New paper discusses barriers to optimal asthma management

Evelyn Lewin

20/02/2019 3:51:29 PM

Issues relating to asthma management include poor self-management by patients and a lack of public awareness.

Contributors to the paper were concerned about gaps between evidence-based care and clinical practice.
Contributors to the paper were concerned about gaps between evidence-based care and clinical practice.

‘It’s a very informative document, I’m just not convinced it’s telling us anything new.’
That is the response of GP and Chair of the RACGP Specific Interests Respiratory Medicine network, Dr Kerry Hancock in relation to a new discussion paper released by the National Asthma Council Australia.
The paperCurrent practice and new approaches in asthma: Perspectives of asthma practitioners and patients, aims to stimulate new thinking and action to target care gaps and redress stalled progress against asthma outcomes.
It is a collective response from leading experts – including GPs and pharmacists – to Australia’s National Asthma Strategy 2018, addressing how its objectives can be realised.
Many key issues were identified.
Contributors agreed that self-management practices were critical for improving asthma outcomes. However, they expressed frustration over the suboptimal uptake of self-management practices by patients.
A common issue was that patients were not doing what their practitioners told them to do, and practitioners felt frustrated that they lacked the skills to affect changes in behaviour, especially relating to medication adherence.
The psychology of asthma was also flagged, with contributors noting many patients lacked understanding that asthma is a disease, and that it requires self-management.
Dr Hancock told newsGP she believes there’s a long-standing belief by patients with mild and moderate asthma that they don’t need to manage their disease with preventers, as even severe attacks are seen as treatable.
‘I think they do a risk-benefit analysis and say, “Well, what is the risk of it being really bad? And if it is really bad, I can be rescued”,’ Dr Hancock said.
Lack of public awareness was a further concern, with contributors feeling that quality consumer education and available resources were not always accessed as a result.
Dr Hancock says public awareness about the potential severity of asthma has waned in recent times as our mortality rate due to the disease dropped.
‘I think we had become complacent over the last decades as we had done quite well in Australia – our mortality rate had gone down from about 1000 in the late 1980s to around 400,’ she said.
However, Dr Hancock notes public awareness was recently increased following the spate of deaths from thunderstorm asthma.
‘As much as it was tragic, thunderstorm asthma brought that home – that people can die of asthma,’ she said.
The paper also called for a rethink of asthma action plans, with some contributors suggesting a range of health professionals, such as community pharmacists, could help in their creation.
While Dr Hancock believes that community pharmacists are an integral part of the allied health team, she disagrees with this call.
‘I still believe that the major focus on management should stay with general practice,’ she said.
A number of care gaps were also identified in the paper, including asthma diagnosis, medication use and adherence, and the current inequities in asthma outcomes, especially for Aboriginal and Torres Strait Islander peoples.
While many issues were noted in the paper, a sense of optimism that Australia was in a strong position to realise further improvements in asthma outcomes was also expressed.
Innovative strategies were believed to be key to taking Australia to the next stage of improvement in asthma outcomes, including the use of more sophisticated technology and emerging precision medicine approaches to asthma management.
New approaches to asthma medication were viewed as important considerations for future care, potentially through down-scheduling preventers, possibly up-scheduling relievers and addressing medication affordability.
In terms of addressing the issues discussed in the paper, Dr Hancock believes GPs play a role in increasing public awareness about asthma and the need for patients to self-manage their condition, but also feels behavioural psychologists may be needed, too.
‘I don’t think it can be a “one size fits all” [approach]. I think we all need to be working together and we need different strategies for different types of people,’ Dr Hancock said.
The National Asthma Council Australia is currently planning an initial forum on asthma action plans, to be held early this year.

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A.Prof Christopher David Hogan   21/02/2019 1:17:59 PM

Once again, this is a lesson that each generation needs to learn- Asthma can kill.
We now face a community attitude of "I know my body" & that information is available to everyone. Sadly, the symptoms of asthma can be diminished or magnified by people so asthma MUST be measured.
Now while data & opinions are easy to access on line, they are no equal of the trained GP