The National Asthma Council Australia has launched new resources to educate health professionals about treatment options.
According to National Asthma Council Australia director and pulmonologist Professor Peter Wark, there has been a recent ‘explosion’ in the medicines available for people with asthma.
But while the choice is welcome, it has made it more difficult for time-poor clinicians to stay current on the latest drugs and their indications. That’s why the council has released a new set of resources to help doctors determine the best treatment option.
The first source is a graphic which provides a visual reference of the drugs for each level of the diagram of the Australian Asthma Handbookwhich is designed to assist healthcare providers in selecting and adapting medications for adults and adolescents.
‘The card is popular with general practitioners and pharmacists because there are … [are] there are so many different inhalers and devices on the market,” said Professor Wark.
“This is a real challenge and can cause confusion for both patients and healthcare providers.
“This chart now brings all the information together in a visual format of drugs and when to use them, in one place for a quick reference.
“We hope that GPs and pharmacists will use this visual aid to help patients understand the place of their therapy and to reinforce the important place of preventive therapy in the treatment of almost everyone with asthma.”
The second source is an updated version of the table Asthma and Chronic Obstructive Pulmonary Disease (COPD) Medicationswhich provides a guide to the main types of asthma and COPD medications available in Australia.
The updated version also specifies the reimbursement status of the Pharmaceutical Benefits (PBS) of each drug as of April 2022.
The table provides a quick reference guide that describes the best approach to asthma and COPD and when to use the right inhalers at the right time, explained Professor Wark.
“It’s a useful learning tool for health professionals to help identify and explain different treatments,” he said.
‘This is such a changing environment and staying up-to-date is a big challenge, so it’s important for GPs and pharmacists to keep abreast of new medicines as well as existing medicines that have changed packaging or branding. ‘
According to Professor Nick Zwar, chair of the National Asthma Council Australia Guidelines Committee, the number of long-acting muscarinic antagonists (LAMAs) has also risen recently and there is a need for a clear overview of the range of treatment options on one page. document.
“It used to be just tiotropium and now there’s umeclidinium, aclidinium and glycopyrronium,” he said. newsGP†
“That’s three additional LAMAs that have only recently become available for the treatment of more difficult-to-control asthma.”
According to Professor Wark, the importance of visually presenting the information should also not be underestimated.
“Even if patients don’t remember the name of their inhaler, they will recognize it,” he said.
“They can see where to put it in therapy and it’s also an important tool for people when English isn’t their first language.
The problem with the rapid growth in the number of LAMAs, inhaled corticosteroids (ICS), long-acting beta agonists (LABAs), and combinations of these drugs is that the same drug often comes in different devices.
Professor Wark said choosing the most suitable device should be ‘a concerted effort’ between the patient and their GP.
‘It is very important that the patient uses a device that he or she feels comfortable with and loves. This has been shown to very markedly affect their loyalty to that device,” he said.
“Using the devices themselves is complex and requires patient training, initiation and support – and that support often has to be an ongoing thing.
“If someone is on a certain type of device and shown how to use it, changing that device can be quite disruptive. That is a challenge in the breathing space.’
In addition, diagnosing asthma has always been challenging because it usually requires lung function testing and spirometry to demonstrate reversible airflow obstruction.
‘This research takes a lot of time, is not properly reimbursed and GPs are often not familiar with its interpretation,’ says Professor Wark.
‘There has been an under-utilization of the tests and as a result, that has led to both under- and over-diagnosis of asthma. And sometimes inappropriate drug use.’
These challenges have been compounded by the pandemic as there is a risk that these procedures generate aerosols.
‘There was a very long period in which there was virtually no lung function’ [testing] happened,” said Professor Wark.
“There has been a shift towards redoing, but in many cases there is still a reluctance in primary care to reintroduce spirometry, based in part on these [COVID-related risks]†
“While there are alternative diagnostic tests, such as exhaled nitric oxide, these are less well known and the equipment is less available in Australia.”
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