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Asthma and current treatment available in Australia Paper

Abstract

Asthma has a high prevalence in Australia but education and appropriate medications are availed to manage this condition and improve health outcomes.  The purpose of this report is to discuss and avail the current available treatment methods for Asthma in Australia. The report examines the prevalence of Asthma in the 1980s and 1990s when the disease became highly prevalent in Australia, and compares it to the prevalence, treatment and management practices today, through a critical review of literatures. The research strategy used is a case study which highlights asthma management practices of a healthy 30 year old male (patient X). Data is collected from a variety of scholarly literatures that discuss asthma management and current treatment available in Australia.

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 This dissertation provides a critical look on whether the General Practitioners (GPs) and asthma patients are applying effective treatment and management practices for control of asthma and whether these practices improve the health out come.  After analysis of the available treatments, the report recommends an appropriate treatment for patient X who was diagnosed with adult onset asthma and was under treatment using Ventolin inhaler prn but the patient later shifts to Ventolin puffer where he puffs thrice, four times a day on a regular basis. Despite availability of effective medication and management practices, healthy patients who otherwise face persistent asthma attacks, risk using inappropriate management practices for asthma and therefore under manages the condition which later leads to poor health outcomes.

Introduction

Asthma is a respiratory illness characterized by chronic inflammation of the airways that affects people of all ages and sexes (1). Asthma patients experience difficulty in breathing due to airflow obstruction. Chest tightness, bronchospasm and wheezing sound are some of the uncomfortable symptoms in asthma sufferers (2) and causes absenteeism in work places and schools. Asthma is one of the major public health burdens in Australia (1) affecting about 2 million Australians and about 1.2 percent of the national’s health budget targets asthma control. Although asthma is life threatening, it is not the leading cause of death. Asthma prevalence in Australia is high as compared to most countries and the increase was notably high in the 1980s and 1990s. Currently, the prevalence seems to reduce among the children and remains stable with the rest of the population but it is believed that better management practices would further improve health outcomes and reduce hospital admissions (1,5). Public health campaigns are carried out in Australia with the purpose of creating awareness and increasing effective management of asthma for better health outcomes.

Literature review and argument

            Asthma is incurable but can be well managed for better health outcomes with appropriate medication and lifestyle. Asthma management has be come a national priority and many studies have been carried out to determine the effectiveness of Asthma management for better health outcomes. A lot of studies have been carried out in Australia concerning Asthma and its management and findings published in scholarly journals. Research strategies used include telephone surveys where patients are conducted or filling of questionnaires on management practices. A process to improve the integration of health care for asthma patients in primary care and rural settings is required (4). This is because higher asthmatic exacerbation risks occur in people with little knowledge about asthma management, or lack regular GP attendance. Asthma medication falls into two categories; the beta 2 agonists that provide quick relief from asthmatic symptoms, for instance Ventolin puffs; and Glucorcorticoids/inhaled corticosteroids (ICS) and Long Term Beta Agonists (LABA) that are medication for long term use (5). The therapy for asthma can be preventive, reliever or symptom controller (9). Preventive therapy where the corticosteroids fall is regarded as a first line therapy for asthma that is moderate to persistent in both children and adults (9).  Several studies indicate that the available strategies to manage asthma are enhanced but Australia continues to face high morbidity rates caused by asthma (1, 4, 5,). This is attributed to factors like inadequate self-management education and inappropriately used optimal therapies among other factors. Low ICS dosage administration is crucial in determining health outcomes, and sometimes a combination therapy of ICS and LABA achieves better outcome in mild to severe asthma (5). However, another study reveals that long term use of ICS risky and leads to poor health outcomes (7). The high prevalence rate of Asthma in Australia is suspected to come from adherence to beta 2 agonists and low or no usage of prescribed ICS (8). Frequent use of short term inhalers like Ventolin can lead to risky side effects as well as non responsiveness in the longer run. Moreover excessive use of beta 2 agonists is an indication of deteriorating control of asthma. A visit to the GP is required to reassess the therapy plan, and usually, it is an indication that the patient needs to be put under ICS therapy. Chlorofluoro-carbon (CFCs) inhalers have been phased out as treatment for Asthma in Australia and replaced with hydrofluoroalkane (HFA) propellant and other asthma inhalers which are CFC-free (1).Ventolin is an example of HFA. CFCs have been associated to ozone layer destruction.  HFA perform as effectively as CFC but without the ozone layer damaging effect.  Asthma management is a task for both the GPs and patients as there are both incidences of under prescribing and under usage of medication (6). A survey (6) reveals that one in five asthma patients neither visits a regular GP nor sees an asthma specialist.  Regular visits are required of asthma patients whether with mild or severe asthmatic attacks because medication has to be regulated depending on surrounding factors (7, 10). Questionnaire and telephone surveys were used to collect data from patients under asthmatic treatment (8). Findings reveal that significant use of ICS on patients with current attacks, similar to patient X, has better outcomes. Asthma is manageable and treatable due to medication, management strategies and education which improve with time. Improved medication and management practices will lead to a reduction in mortality and morbidity rates of asthma (1, 2, 10).

Discussion

Currently, asthmatic prevalence stabilization is attributed to the increase use of ICS as compared to the earlier decades of 1980s and 1990s when the population preferred the short term beta2 agonists and hence increased morbidity rates (3). However, there still needs to be education on proper therapy education. Patients with mild asthmatic attacks or those with adult onset attacks tend to overlook the importance of adhering to prescribed medication or frequent GP visits for regular checkups (8). Beta2 agonists are known to provide faster relief but are for short term use, and their overuse should be avoided. ICS and LABA are proved to provide better health outcomes and their consistent use should be encouraged. Regular visits to GPs and Asthma specialists need to be carried out disease assessment and therapy evaluation.

Conclusion and Recommendations

Asthma management can be effectively achieved if both the patients and healthcare providers are well educated and willing to corporate on the use of current therapy. Corticosteroids and Long Term Beta Agonists are available drugs that have high efficacy for asthma treatment as seen from several studies. Ventolin and other beta 2 agonists for quick relief should only be used as combinational therapy with either ICS (a preventive thrapy) or LABA (a symptom controller).. Adherence to quick relief medication should be discouraged through the ongoing asthma campaigns and education because they risk the life of the patient afterwards (3).

I recommend corticosteroid inhaler (ICS) therapy for patient X, and even though he can puff Ventolin for short term symptomatic relief, ICS should be the underlying therapy.  ICS is one of the current treatments for Asthma prevention, available in Australia today. ICS does not provide immediate relief on the symptoms but it works on the airway linings to heal the inflammation, and is known to have less adverse effects as compared to symptom relievers like beta 2 agonists. I chose this treatment for patient X because his situation is current and his asthma falls between moderate and persistent. Patient X has just been diagnosed with asthma at 30 years. This is an indication that the asthma is not hereditary but could have been caused from environmental factors. If he begins ICS therapy early enough chances are that his condition can be reversed or will become less severe. Other than using ICS patient X needs to work closely with his GP and verify allergens that trigger his condition, then determine ways to avoid them. Proper dosage of ICS and appropriate usage as well as leading a risk free life style will enable patient X to have a better health outcome.

References

1.      Kandane R, Matheson M, Simpson J, et al.  Medication use between asymptomatic and       symptomatic asthma patients. Asian Pacific society of Respirology. 2008; 13(2)

2.      Jenkins C. Expert view. Health Insite: An Austarlian Government initiative.Available at      http://www.healthinsite.gov.au/expert/Asthma___Expert_View

3.      Marks GB, Abramson MJ, Jenkins CR, Kenny P et al. Asthma management and       outcomes in Australia: A nationwide telephone interview survey. Respirology, 2007; 12: 212-219.

4.      Laurence M, Beilby J, Campbell S, et al. Processes for improving the integration of care       across the primary and acute care settings in rural South Australia: Asthma as a ca se     study. Blackwell Publishing Limited: Australian Journal of Rural Health. 2004; 12; 264-268.

5.      Jenkins C. Clinical perspectives: An update on asthma management. Internal Medicine         Journal.2003; 33: 365-371

6.      Sawyer SM and Fardy JH.  Bridging the gap between doctors’ and patients’ expectations    of asthma management. Journal of  Asthma, 2003; 40(2): 131-138

7.      Lancsar EJ, Hall JP, King M. et al. Using discrete choice experiments to investigate subject preferences for preventive asthma medication. Respirology. 2007;12: 127-136

8.      Reid D, Azbramson M, Raven J and Walters H. Management and treatment perceptions      among young adults with asthma in Melbourne: The Australian experience from the             European community respiratory health survey.   Respirology, 2000; 5: 281-387.

9.      Comino E and Henry R. Changing approaches to asthma management in Australia:   Effects on Asthma morbidity. Therapy in Practice, 2001; 61(9): 1289-1300

10.  Simonella L, Marks G, Sanderson K, and Andrews G. Cost effectiveness of current and optimal treatment for adult asthma.  Internal Medicine Journal, 2006; 36:244-250

 

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