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Asthma

Update Issue 47 Winter 2013

Inside this issue... Asthma Conference Tackling Asthma the next 5 years Conference Report Changing the healthcare system

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Contents 2013 Tackling Asthma Conference CommuniquÊ......... 3 Asthma Conference Tackling Asthma the next 5 years ................................. 4 Conference opening and welcoming............................ 7 From the CEO................................................................. 10 Asthma medicine in the news...................................... 11 Social snapshot - Canberra............................................ 12 Asthma Australia film and poster competition for young people..................................... 14 Conference report what is happening in the asthma world..................... 15 Asthma Update PO Box 394 Fortitude Valley QLD 4006 P: 0404 690 552 E: editor@asthmaaustralia.org.au asthmaaustralia.org.au Published by Asthma Australia Š May 2013 Asthma Australia Design Jo Weismann

Disclaimer All Asthma Australia information is endorsed by our Medical and Scientific Advisory Committee and is consistent with the National Asthma Council Australia clinical guidelines. Asthma Australia information does not replace professional medical advice. People should ask their doctor any questions about diagnosis and treatment. This magazine can be copied for education purposes.

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Do you ever wish that you could change the healthcare system?.................................... 22 Conference sponsors..................................................... 23 Facebook and Twitter competition.............................. 23

2013 Tackling Asthma Conference CommuniquĂŠ

Introduction There is a perception in the community, including government, medical professionals and people with asthma themselves believing asthma in under control. Current evidence highlights that asthma management and control are far from optimal. This is particularly an issue for communities that are more difficult to reach through mainstream channels. The economic impact for over 2 million Australians living with asthma, their carers and the broader community is significant. A proactive approach towards asthma management is required. Many people experience daily symptoms, struggling with medication routines and feeling illinformed and disempowered. Given these trends, it is not surprising that each year across the country, too many people are visiting emergency departments and avoidable hospital admissions attributable to asthma remain an issue.

Asthma Australia Asthma Australia is the nation’s peak asthma body. For over 50 years Asthma Australia and member Foundations have been delivering high quality support to people with asthma and their carers. As one of the country’s largest and most respected respiratory organisations, with offices and staff in every State and Territory of Australia, Asthma Australia continues to deliver evidence based, consumer focused, accessible and appropriate services to over 200,000 Australians with asthma every year. Asthma Australia also proudly takes the role of acting as the voice of people for asthma, advocating on a range of issues including air quality, tobacco legislation and the cost of medications. Winter 2013 I Asthma Update

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Asthma Conference – Tackling Asthma the next 5 years Asthma Australia held their bi-annual national conference in Canberra on 19 & 20 March 2013 as a contributing event of the Centenary of our Nation’s Capital. The event was highly successful and firmly established a focus on working with a diverse range of consumers as the key goal for Asthma Australia. Over 220 delegates from every state and territory of Australia as well as from New Zealand and the United Kingdom heard from forty speakers and presenters on a range of research, clinical practice and health care project asthma topics. In keeping with Asthma Australia’s commitment to engaging with and partnering people with asthma we actively sought and included the experiences of people living with asthma from across the life cycle. Further to this Asthma Australia and Asthma Foundations acknowledged and paid their respects to the traditional owners, the Nun-awaal people, and their elders past and present.

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The issues – a summary — T he majority of people with asthma underestimate the severity of their condition and are unclear about how to manage their illness  any people with asthma are not using the correct medication — M i.e. they are relying on reliever medicine to fix symptoms, rather than regular preventative treatment. Alternately they have been prescribed medication in excess of what is required for the severity of their condition due to issues with compliance and device technique — M  any people with asthma are not using their medication devices correctly resulting in the medicine not getting into their lungs where it is needed, resulting in minimal improvement in symptoms. — T he majority of people with asthma do not have an Asthma Plan despite best practice guidelines recommending their use — T here is a lack of continuity between the providers of patient advice and patient care leading to people falling between the cracks and not receiving any follow up support between asthma attacks leading them to require further health service engagement — A  dvice from health professionals is not consistent with the clinical guidelines  ospital readmission rates for people with asthma are high and — H many could be avoided — T he costs that asthma places on the health system are substantial and could be significantly reduced through interventions such as increased community education and support

Key Messages There is a lot more that can be done to help people with asthma take control of their condition and Asthma Australia and Asthma Foundations are well placed to deliver accessible, appropriate and affordable services to both people with asthma, the wider community and the primary health care sector. Key recommendations from a range of national and internationally acclaimed researchers and asthma care specialists included:

Government investment in people living with asthma must continue — A  ustralia’s ‘National Asthma Strategy’ is a signed compact between Commonwealth, State and Territory governments. It remains unclear how this document is being progressed and the activities and outcomes should be publically and transparently reported to the Australian community. — M  any delegates felt that the National Asthma Strategy had ‘fallen off the radar’ and required critical review to ensure it remained consistent with:

- t he experiences of people living with asthma;

- c urrent national and international research findings; and

- w  as relevant in the context of current health and hospital reform, particularly the ongoing debate over the responsibilities for primary health care and chronic diseases management.

— F urther investment of resources by Government at

Asthma Australia@AsthmaAUS Know the community before you start providing education, i.e migration history, literacy, communication styles. Clara Tait #TacklingAsthma both Commonwealth and State levels is necessary to provide effective ‘joined up’ care of people with asthma or their care giver, with the patient at the centre, not as a bystander.

the past decade. This is disappointing as considerable evidence shows that these two activities substantially improve health and wellbeing of people living with asthma over the longer term. An Asthma Management Plan that is portable throughout a patient’s daily life – school, workplace, and recreation - is integral to ensuring people with asthma have the capacity to adhere to their care plan.

— F urther research around the cost of medications is vital given its potential to improve adherence as, when financial restraints are removed, patients and care givers will no longer have to ‘go without’. This will also address the issue of people with asthma on a cycle of poor outcomes through an over-reliance on reliever medications.

— H  ealth Literacy remains a major stumbling block for many in particular those for whom English is a second language.

Support for the primary care sector is urgently required

Embracing systems wide reform to support people with asthma is necessary

— P harmacological guidelines and ‘The Asthma Handbook’ need to be re-thought to have a greater patient centred focus. The partnership between primary care (GPs and Pharmacists) is absolutely critical to supporting people with asthma; however the primary care sector needs more patient focused professional development and resources to assist people with asthma to self manage their condition.

A consumer focussed approach is not the only avenue for improving health outcomes for people with asthma.

— T he use of Asthma Management Plans and the coaching and checking of inhaler technique in primary care remains underutilized. There also has been no progress made to increase the percentage of people possessing these Plans over

There are potentially powerful interventions that can be adopted within primary, sub-acute and acute health care systems that will provide improved support for people with asthma and linked conditions. There needs to be a collaborative and coordinated effort between patients, carers, health professionals, community groups and the health care system. Evidence suggests that when these participants work together in concert, positive health outcomes will result. Funding of pilot projects, consistent with the National Asthma Strategy, should be implemented in Medicare Local Winter 2013 I Asthma Update

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Asthma Australia@AsthmaAUS Important to listen to the needs of consumers at the national and local level. Carol Bennett #TacklingAsthma communities that have identified asthma as a critical issue of concern. These pilot projects should have strong consumer representation and focus on primary care deliverables. These include hospitals, community health services, general practice, community pharmacy, Medicare Locals and consumer organisations such as Asthma Australia and its affiliate Asthma Foundations.

Our response Asthma Australia is now preparing its new strategic directions document for the next five years. Over 70 leaders and practitioners have met to discuss key messages and emerging asthma priorities to be tackled. You are invited to take part of this conversation and you are welcome to make further contributions to Asthma Australia’s priorities by sharing your feedback via Facebook and Twitter. Three key initiatives for the next 5 years include: — Improving the consistency of information provided to patients and health

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professionals, using best available evidence and research, through the establishment of a Centre of Excellence to deliver Asthma Assist – a patient centric, evidence based and freely available service of information and support for people with asthma. Critically, Asthma Assist must expand with funding to include a process of follow up and support to ensure adherence and compliance and must have a strong and rigorous outcomes focused evaluation over the longer term. — D  eveloping and introducing a patient centric quality assured professional development program for general practitioners and pharmacists to be delivered in partnership with Medicare Locals and other local Divisions of General Practice. — S ecuring additional funding from government, philanthropic and/or corporate sources to grow Asthma Australia’s research corpus so that our investment in research and evaluation can be strengthened.

Summary Significant improvements in the treatment and support of people with asthma have been made over the past 30 years, with Asthma Australia and Asthma Foundations considered leaders in the field. The Tackling Asthma – the next 5 years Conference clearly demonstrated the significant depth of research and practitioner talent in Australia and as a nation and asthma community we can hold our heads high on the global stage. Our commitment to people with asthma as our first priority is a cornerstone of our work. As charities, Asthma Australia and Asthma Foundations remain reliant on community and corporate goodwill and donations to deliver our services to over 2 million Australians living with asthma. This support is greatly appreciated. You can support this work by making a donation via asthmaaustralia.org.au Mark Brooke Conference Co-Chair

‘Welcome to the future’ by Hayley and Eddie

Conference opening and welcome Aunty Agnes Shea provided a ‘Welcome to Country’, paying respect to the Ngunnawal people as traditional owners of the land on which we meet, and to their elders past and present.

Opening Keynote presentation - An overview of Asthma in Australia

Asthma Australia Patron, Mr Michael Bryce, was introduced by Mr Terry Evans, President Asthma Australia, and opened the conference with his address during which he observed, “This conference will address issues such as current asthma research, innovation in community care, self-management and global partnerships, and will highlight the best practice in the treatment of this insidious disease.”

The conference presentations commenced with Asthma in Australia from Professor Guy Marks. Professor Marks is a respiratory physician and epidemiologist based at Liverpool Hospital and the Woolcock Institute in Sydney. He has been the Director of the Australian Centre for Asthma Monitoring since 2002.

Two local young people gave a ‘welcome to the future’, Hayley a student at St Francis Xavier College and Eddie, an active sportsperson. Both told the audience about their asthma and how they manage this. Eddie was involved in the Asthma Australia filming at the Australian Institute of Sport in February and introduced a promotional film clip (view at http://asthmaaustralia.org.au/assist/yourasthma/asthma-sport/ on the Asthma Australia website via Asthma Assist / Your Asthma / Asthma and Sport). Here is an overview of the Keynote presentations from the Opening Day of the National Tackling Asthma Conference. Further, detailed information regarding these studies, can be found on Asthma Australia’s website – asthmaaustralia.org.au Thank you to all Keynote presenters, whose time, research and insights enable Asthma Australia to deliver evidence based, quality education and information to our communities.

Summary Professor Guy Marks spoke about the improvement in asthma during the 1990’s, and how key asthma indicators have now stabilized, for example, asthma deaths. However, asthma still presents a substantial burden across people all ages. It is a major contributor to the burden of disease in children 5-14 years,

Please note that the following articles discuss research or medication that might be from overseas, or have not been formally put into clinical practice in Australia.

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while 68% of asthma related deaths occur in Australians aged 65 years and over.

— Few people follow up with doctor – although could access their GP if wanted

Unfortunately, despite the development of a range of quality medicines which contributed to the earlier decline in asthma deaths, many people are not using their medicines regularly.

— Medication costs are an issue

Professor Marks highlighted the key areas his research shows we need to focus on: — Improving access to effective medications by addressing the cost. Cost of asthma medications is known to be a barrier to regular use.

— Most people attending emergency departments report long term asthma difficulties — Not using asthma medicines is the number one issue — Not using asthma medicines properly very common

Recommendations — Focus on helping people to use their medicine properly

— Addressing inappropriate use of asthma medications by improving prescribing practices (supporting doctors to work with people with asthma to use medicines effectively)

— Support people to improve how they use their puffers/ inhalers

— Improve asthma management during pregnancy as this not only protects the health of the mother, but improves health outcomes for her unborn child

Understanding immunity to viruses in asthma

— Find better ways to manage severe asthma with targeted, affordable therapies that have minimal adverse effects

Community asthma management: overview of the issues, opportunities and challenges Dr Simon Bowler is the Chair of Asthma Australia Medical and Scientific Advisory Committee, Director of Medicine at the Mater Hospital, Brisbane.

— Ensure that doctors and care providers take thorough health history

Professor John Upham is a respiratory physician and clinical scientist with research interests in asthma and chronic lung disease.

Summary The common cold occurs in similar frequency in people with asthma and people without, however viruses have a greater effect on people with asthma.

— People not recognizing poorly controlled asthma – this leads to asthma attacks

People with asthma are more vulnerable to cold viruses, due to potentially having decreased lung capacity. Exposure to a trigger whilst having a virus can lead to an asthma attack as the virus infection activates allergic mechanisms. This means that your body is already working hard to fight off the trigger of a cold for example, and coming into contact with another trigger may mean your asthma symptoms get worse, and you find breathing difficult.

— People accepting asthma symptoms

The vulnerability to viruses may only affect those whose asthma

Dr Bowler has been conducting a study looking at people who present at emergency departments with asthma attacks.

Some of the key issues highlighted in this study:

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is poorly controlled. This means people who frequently have asthma symptoms, may rely on their reliever medicine and not use preventative treatment. Some simple measures to minimize the risk include building one’s own resilience (keeping in good health, being active and eating healthy food), maintaining good asthma management especially between asthma episodes, basic hand washing and isolating yourself from those people who have a virus, where possible. Professor Upham recommended people speak to their doctors regarding vaccination as a possible preventative approach.

Carol Bennett – CEO Consumers Health Forum Summary Carol Bennett provided an overview of the current health system from a national consumer perspective. She stated that consumers wanted quality, accessibility and affordability in health care. However there was an emerging two tier health system in Australia between those who can afford to pay for health care and those who cannot. This issue is a consumer advocacy priority. The demand for health care is growing due to the rise in chronic disease however access to appropriate services is a major barrier in rural and remote areas. First aid treatment for asthma and information for culturally and linguistically diverse populations that includes interpreters and other resources should be readily available. The health system has to meet services required or expected by the community. People want to be active participants in their health care rather than passive recipients. They also want to be treated holistically not as a person with asthma. It is important to listen

to the needs of consumers when planning programs and implementing policies at the national and local level.

Asthma Phenotypes - what asthma looks like for different people Professor Gibson is a NHMRC Practioner Research Fellow and holds a variety of positions at John Hunter Hospital, Universities of Newcastle, Sydney and Jilin University in China.

Summary Professor Gibson’s study has been looking at asthma phenotypes as the next step in determining asthma treatment. A phenotype is an observable quality of an individual. This direction of research is a tool that will help in identifying the most appropriate treatment specific to a type of asthma. Professor Gibson has been looking, in particular at clinical studies of asthma in pregnancy, and the interaction of asthma and obesity. In the future, this may mean that treatments can be customised to the individual – for a better response to medicines.

Neil Churchill@neilgchurchill @AsthmaAUS Thanks for being so welcoming. I left feeling we have much in common and I loved your strength as patient-centred organisations — Recommendations — Support practitioners to support their patients better — Ensure appropriate prescribing based on proper diagnosis — Education to ensure children use medicine and devices properly

Asthma Self-management, what works, what’s working and challenges Associate Professor Helen Reddel Research Leader at Woolcock Institute of Medical Research Sydney, Chair of Science Committee for Global Initiative for Asthma (GINA)

Key points — High death rate in 80’s something had to be done — Development of clinical practice guidelines — This led to Cochrane review

Key elements identified

Asthma and Children

— Asthma education

Professor Peter van Asperen MacIntosh Professor of Paediatric Respiratory Medicine at University of Sydney

— Regular review

— Need for understanding of viral interactions as part of proper diagnosis — Ensuring correct treatment is prescribed following guidelines particularly relating to increased dosage and the use of long acting relievers, as initial treatment – lack of evidence to support practice — Look for other reasons – cough v wheeze, poor fitness, hyperventilation or vocal cord dysfunction

— Adherence — Use of asthma plans

Recommendations — Education alone is not enough

Neil Churchill CEO Asthma UK Summary Neil provided an overview of the picture of asthma in the UK, which has similar rates as Australia. The UK has a Respiratory Outcomes Framework focussed on the following: — Mortality — Hospital admissions — Quality of life This framework is being implemented by the following: — National improvement with support tools — Clinical research with local priorities — Asthma improvement projects The UK has a National Review of Asthma Deaths. Doctors are asked to notify of asthma deaths that occurred in a one year time frame. This aims to: — Improve understanding of why people die in order that deaths in future be prevented Neil described one of Asthma UK’s programs - Triple A Test for people aged over twelve – Avoid Asthma Attacks – helping people understand risk for their current and future asthma

— Target efforts to those who need the most support

Neil also provided an overview of Asthma UK’s strategy

— Greater focus on inhaler technique

— Research

— We need to reduce the cost of treatment

— Social media for awareness and engagement

— Practitioners need to demonstrate correct technique — How can we support people to take medicines – technology?

— Focussing on self-management

We appreciated hearing how another country manages asthma issues, and hope to learn from the programs and research occurring in the UK, to help to improve outcomes for people in Australia. Winter 2013 I Asthma Update

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CEO From the

CEO

Tackling Asthma – Five Years – Five Priorities Asthma remains a serious chronic disease effecting over 2 million Australians. Asthma Australia, as the nation’s peak asthma body, is leading the way in supporting people with asthma and their care givers to improve their wellbeing. Our unity and commitment to people with asthma was clearly on display at our recent national conference which attracted over 200 health professional, policy makers, researchers and people with asthma themselves. In March, Asthma Australia and Asthma Foundations nationwide united to stage the 2013 Tackling Asthma Conference held in national capital Canberra. As the largest conference of its type one of the key messages repeated by many speakers and presenters was the significant majority of people with asthma underestimate the severity of asthma. Recent research commissioned by Asthma Australia of patients seen in two Brisbane metropolitan hospital emergency departments again highlighted the complexity of asthma and the serious burden of disease. A majority of those interviewed during their emergency department visit had visited hospital more than 3 times in the previous 12 months, many did not understand their treatment or medications but surprisingly many indicated they had regular contact with their GP.

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Similarly feedback from people with asthma participating in panels during the conference and those asthma specialists and educators highlighted confusion about treatments, triggers and how to access support. The importance of General Practitioners and Pharmacists was again reiterated and the importance of these health professionals working with people asthma so to improve adherence cannot be underestimated. Supporting health practitioners to be successful in understanding the patient journey is a key priority of Asthma Australia into the future. As Asthma Australia’s new Chief Executive Officer I couldn’t think of a better way to commence in my role than to Co-Chair the Conference with Nathalie Maconachie the ACT Foundation CEO. The Tackling Asthma Conference was the start of a six month conversation about the priorities for Asthma Australia over the next five years. In doing so, we build on the considerable achievements of Asthma Australia’s Strategic Directions of the last three years. It would be remiss if I did not publically

acknowledge the considerable contribution of outgoing CEO, Debra Kay, who in four years has transitioned Asthma Australia into a highly effective, patient centric and mission focused peak body. Deb will be sorely missed and on behalf of the National Leadership Team I wish Deb well in the future. You can join the conversation about Asthma priorities over the next five years by leaving your feedback on Asthma Australia’s Facebook page or by emailing as below. Can I offer my thanks to our conference sponsors the Department of Health and Ageing, GSK, AstraZeneca and Bird Health Care as well as the 50+ key note speakers and presenters for their time and contribution. To the Asthma Foundation ACT thank you for the magnificent coordination and for the welcome to our beautiful national capital. Thank you for your continued interest in our work. Mark Brooke Chief Executive Officer Asthma Australia mark.brooke@asthmaaustralia.org.au

Asthma Australia@AsthmaAUS Big issues we face: Access to effective #asthma medications by addressing cost, a barrier to making meds more accessible. #TacklingAsthma

Asthma Australia@AsthmaAUS Misdiagnosis of #asthma is an issue in #Australia. GPs and care providers need to take a good history. Dr Simon Bowler #TacklingAsthma

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Register for Asthma Assist – and let us help you – Live well with asthma!

Recently, you may have seen the media attention given to the use of the asthma medication Singulair. Asthma Australia posted the following information on it’s website. Monteleukast (Singulair) is a highly effective and usually very safe preventer medication for children with asthma.

Registration details: asthmaaustralia.org. au/assist/

The Therapeutic Drugs Administration – the Commonwealth body responsible for regulating medicines in Australia – has reminded doctors prescribing this medication that a very small percentage of children taking this tablet may become emotionally unstable sometimes with depression and thoughts of suicide. Other uncommon side effects which are rarely noted include sleep disturbance, hallucinations and tremor (shaking). These effects are reversible once the medication is ceased.

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Again it is important to stress that the vast majority of children taking this drug will have no issues. Asthma medication in appropriate doses is generally very safe and and small risks are outweighed by the improvement in quality of life that occurs with control of the child’s asthma.

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Social Snapshot – Canberra Asthma Foundation ACT host the Conference Social Events It was with great pride that Asthma Foundation ACT welcomed delegates to one of Australia’s ‘best kept secrets’, our national capital Canberra, during its centenary year. The Foundation was delighted to invite delegates to take part in an exciting social program where we heard from some of Canberra’s most passionate citizens over the course of the two conference days.

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Day one Cocktail welcome function at the National Arboretum Canberra Taking the opportunity to show delegates from across Australia and overseas some of Canberra’s finest views, the welcome cocktail function was held in the Village Centre at the heart of the Arboretum. Featuring a soaring high ceiling inspired by the fronds of the adjoining Chilean wine palm forest, the Village Centre is filled with natural light from windows and glass doors that overlook panoramic views of Lake Burley Griffin and Canberra. The welcome function was hosted by Asthma Foundation ACT Patron and 666 ABC Canberra Mornings presenter Genevieve Jacob (she has asthma!) and delegates heard from the Arboretum Chair, John Mackay AM, who talked passionately about how the Arboretum came about and shared stories of the special forests and the saving of rare trees, now safely installed at the Arboretum.

Day two Conference breakfast function in the Skyline Room at Rydges Lakeside Once again delegates were treated to a stunning panoramic view at the conference breakfast at the start of day two. Hosted by Asthma Foundation ACT Board member and past 666 ABC Canberra morning presenter Mark Giffard, the function commenced with a tribute to the work of Senator Trish Crossin. Asthma Australia President, Terry Evans, presented Senator Crossin with an award to acknowledge the dedication and hard work she has put in to the establishment and growth of the Parliamentary Friends of Asthma group.

Delegates then heard from Robyn Archer AO, Creative Director of the Centenary of Canberra and renowned singer, writer, actor and director. Robyn shared her passion for our wonderful national capital and her vision for the celebration of its 100 year birthday and spoke to delegates about what the Centenary of Canberra means.

renowned Canberra band, Annie and the Armadillos with a supporting act by Tony Haley. Dinner guests then heard from Senator Stephen Conroy, Minister for Broadband, Communications and the Digital Economy, Leader of the Government in the Senate and Minister Assisting the Prime Minister on Digital Productivity.

Asthma Australia@AsthmaAUS Prof Helen Reddel today led a standing ovation of delegates at #TacklingAsthma in honour of outgoing CEO of Asthma Australia, Debra Kay. ‘The Centenary of Canberra can be a platform on which we reinstate respect not only for the capital, but for all that it symbolises. If celebrating Canberra still feels risky to some, then this is the best opportunity we will have to overcome that risk—to use the sense of risk brilliantly to ensure that one need not be apologetic about our capital. This place is not going to go away and we would do well to respect that. In fact, I have seen how people from all over the country, from cities to the remotest parts of Australia, have a genuine sense of pilgrimage and occasion when they are asked to bring their work and their ideas to the capital. People do feel that their work and their passion have meaning when they bring it here—whether they raise their voices in a spirit of collaboration or a spirit of anger. Canberra does have that significance.’

Conference Gala Dinner at the National Press Club of Australia The final social event took place at the National Press Club, Australia’s leading forum for discussion and debate and for major statements on politics and public policy. The evening opened with an energetic performance by

Senator Conroy spoke of his vision for the National Broadband Network and how it will support people living in remote and rural communities to access health support to manage their chronic disease. In addition to hearing from one of the Government’s most senior Ministers, we were thrilled to see the Prime Minister, Julia Gillard, dinning upstairs at the National Press Club. We were delighted when the Prime Minister agreed to sign our bottle of 2005 Penfolds Grange – a dinner prize generously donated to Asthma Australia by Bird Healthcare. A great way to complete the Canberra experience! A huge thanks must also go to our dinner sponsors because without their generous support it would not have been possible to host an event in such a prestigious and significant national venue. Thank you to: — Dyson — Telstra — Calvary eHealth The team at Asthma Foundation ACT were proud to show delegates a taste of some of our city’s finest venues, speakers and entertainment – we hope it will entice you to come back for a longer stay in the not too distant future. Winter 2013 I Asthma Update

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Asthma Australia film and poster competition for young people

Best school based poster (above) Best individual poster (right)

Young people around Australia were invited to submit short films and posters in a competition run at the end of last year. Around 70 entries were received and staff in Foundations associated with the Asthma Child and Adolescent Program judged these. Prizes of i-pad minis were awarded to the best poster from an individual and from a school, and the best film from an individual and a school. Incentive prizes of iTunes vouchers were given to a further 10 entries. Our thanks are extended to Next Byte who supported the competition. Asthma Australia looks forward to using the films and posters to enhance our capacity to provide relevant asthma messages to young people with asthma. Best school based poster by Maire from Woodleigh School, Victoria (Maire’s poster was duplicated and framed as a gift for all the presenters at the Tackling Asthma conference) Best individual poster by Max from Eltham, Victoria Best school based film was ‘Asthma First Aid’ by Lloyd from Ramingining School in East Arnhem Land, Northern Territory Best individual film was ‘Asthma Awareness’ by Lydea from Elizabeth, South Australia These 2 films can be view through the Asthma Australia website link: http://asthmaaustralia.org.au/news/filmposter-competition-winner-announcement/ (see under News / News archive)

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Conference report – what is happening in the asthma world? The second day of the conference showcased a range of work, research and interventions occurring across the country, both from Asthma Foundation staff and external organisations. As you will see, there is a wide range of people doing interesting work – all focussed on helping people with asthma. Please note: this is a selection only

Education and Training What education leaders need to know about asthma - weighing up the risks and benefits? Tony Healy, Asthma Australia National Program Manager, Schools Program; Peter Curtis (UK parent) and Margy WyldeBrowne, Principals Australia Institute

Key learning Peter Curtis talked to the session direct from the UK by teleconference (it was 4am in the morning for him!). Peter lost his son to an as asthma attack in a UK school at the age of 17, and has since dedicated his time to working with local schools in Hertfordshire, addressing staff and students about asthma and its management. He has established volunteers in other parts of the UK to do the same, with limited success. Peter shared the issues and successes of his

activity under the Alex Curtis Trust established in his son’s name. He has also been an active advocate for UK schools holding asthma medications for emergency use, which is currently against policy. Peter contacted Tony regarding the (then titled) Asthma Friendly Schools program and has since adapted Asthma Australia resources for use in a small but growing number of UK schools. Tony and Margy informed the group of a new Asthma Australia and Principals Australia Institute resource in development for school principals and leaders that addresses the risk factors around asthma management in schools. This also provides a risk

assessment model for schools to address other chronic conditions, which includes connectivity with peak health organisations. This could help overcome the barrier of getting the message to Principals, an issue Peter has been grappling with. Margy cited the Melbourne Declaration – Education Goals for Young Australians (2008) as a useful guiding document.

Recommendations Discussion recommended: asthma training for school staff (various formats); online format for the School Leaders package; Identification of ‘champion’ Asthma Friendly schools to influence others.

Neil Churchill@neilgchurchill Highest prevalence of asthma in most disadvantaged areas of Australia. Same pattern in UK. Asthma as health inequality Winter 2013 I Asthma Update

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Through Asthma Australia’s Community Support Program education sessions are delivered to people all around Australia. Through delivering these sessions, it became clear that attendees learn in a variety of ways, and particularly as we deliver many sessions to people with English as a second language, we needed to develop a simple, visual education tool to help people understand asthma, and its symptoms, and key information. Claire Miller from Asthma Foundation ACT presented – The Lung Story – fondly known as George.

Community information and resources Asthma Australia released three new brochures at the conference. These are now available from your local Asthma Foundation.

Asthma Triggers – What are they and what can be done about them?

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Asthma Austra

There has always been a lot of information available about asthma triggers, what you should do, avoid, and how to get rid of them – all to improve your asthma. Unfortunately, many of these suggestions do not have the evidence to back claims. This means that a great deal of time, effort and often money is expended, and the asthma symptoms are still a problem. This brochure points you in the right direction for reducing asthma symptoms and letting you get on with the things you enjoy in life.

Things to ask/tell your pharmacist Asthma

sk Things to A & Tell your Pharmacist

In the same style as our very popular 10 Things to ask/tell your doctor Recognising the importance of the pharmacist, this brochure provides key tips and questions to ask your pharmacist when you are picking up your medicine – pharmacists know a great deal about medicines, including asthma and can help with technique, device checks and can explain your medicine regime to you. Pick up the brochure – it will help you start the conversation.

The brochure is endorsed and supported by The Pharmacy Guild of Australia.

Emergency Wallet Card Time to see a doctor? My name

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Asthma Update I Winter 2013

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The Lung Story uses a range of visual and hands on tools to tell the story of asthma. This image shows what you might see at the end of this type of session, creating a storyboard of the most important things you need to know about living well with asthma.

Your Asthma Emergency Card Be prepared

...

This credit card sized resource is handy – it contains the Asthma First Aid steps, will easily fit in your wallet and has room for you to write down your emergency contacts – and if you are ever having an asthma attack, you can show it to people to explain what is happening and how they can help you. People often tell us - they can’t ask for help when they have an asthma attack, because they can’t talk!

Let us know what you think of the new resources – your feedback matters – feel free to get in touch! Email us at: info@asthmaaustralia.org.au To order these and get further information about asthma Contact your local Asthma Foundation 1800 ASTHMA (1800 278 462) asthmaaustralia.org.au

Social Inclusion One of Asthma Australia’s key goals has been to support the people who need assistance the most. People with limited access to information, language barriers or support and guidance can find it difficult to look after their health, particularly if there are other major issues going on in their life. A vital aspect of our work with people with asthma, has been providing respectful, useful information to people to support them to look after their asthma.

Towards Cultural Competency in Asthma Health Promotion Clara Tait, Community Support Program Coordinator, Asthma Foundation SA

Key Learning — Tailoring education to suit the cultural and linguistic needs of each individual is fundamental — Effective communication with interpreters will facilitate understanding — The first step towards cultural competency is overcoming

ethnocentrism and engaging in respectful inquiry and not stereotyping.

Recommendations — Research and data from a range of cultural perspectives needed to inform all aspects of organisational practice — A multifaceted approach towards cultural competency includes training for staff, effective use of interpreters, community engagement, data collection, translated resources and the best way to reach different groups and addressing health literacy levels and social determinant of health.

Asthma Education through the 8 ways: Aboriginal and Torres Strait Islander Health Practitioners project Tonia Crawford, Education and Training Coordinator, Asthma Foundation Queensland

Summary Tonia has worked as an asthma educator for over 10 years with Asthma Foundation Queensland and she has a strong interest in educational design and

development. This prompted her to explore various education strategies based upon learning and teaching through Aboriginal perspectives and culture. After attempting to engage Aboriginal and Torres Strait Islander people with standard education methods that were not successful she learnt that it was important to use Aboriginal processes to impart learnings. Asthma Foundation Queensland developed a culturally appropriate asthma training program for Aboriginal and Torres Strait Islanders based on an Aboriginal pedagogies framework called the “8 Aboriginal Ways of Learning”. The framework is built upon the principle of teaching through Aboriginal perspectives and Indigenous processes of learning, a novel approach to asthma education. This is an ongoing learning process for both the education providers and Aboriginal people and requires a significant cultural shift on behalf of the provider. It could also be adapted to engage with other cultures as well as Aboriginal people.

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Talking Books and Educational Flip charts Anne Bastian, Community Support Coordinator Asthma Foundation NT

Summary Ann showcased a range of Talking Books; these are quality, culturally appropriate, pictorial information books used to provide information to people about their condition. These are useful tools available to Indigenous health workers. The Talking posters raised much interest especially due to their flexibility of language exchange.

As part of Asthma Australia’s School Program, there has been a great deal of work done toward understanding adolescents and how they view asthma. These years see dependent children grow into young adults and the transition from parental care to young people making independent health choices. These reports demonstrate what we found out when we asked young people what they think about asthma:

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Asthma Update I Winter 2013

Young people’s views about how best to target asthma messages for adolescents Claire Miller, Education and Training Manager Asthma Foundation ACT

What was learnt? — Students don’t want to stand out as being different — Students embarrassed about their asthma — They wanted their peers to know about asthma — They wanted information to come from an external source – not teachers — They wanted other students to be able to respond to an asthma attack

Recommendations — Use this information to develop pilot asthma education program for year 7 students — The importance of talking to the target group about their needs and expectations in relation to the content and delivery of asthma education — Different population sub groups may require education and programs that is

specifically developed for their characteristics

A plan for engaging young people to better manage their asthma Sarah Cole, Youth Engagement coordinator Asthma Foundation NSW and Claire Dollard, Marketing and Communication Manager Asthma Foundation NSW

What was learnt? — Stability and level of support in the home has a big impact upon asthma management — Young people need programs and messages that specifically target their issues and barriers to management — Don’t use scare tactics to promote behaviour change — Games can be useful to help students think about selfmanagement related issues

Recommendations — Use this information to develop asthma education programs and services for young people — Young people require education and programs that are specifically developed for their needs

Research

Key learning’s

There are a range of research projects occurring around the country, all working toward developing programs or interventions to assist our understanding of, and supporting people to live well with their asthma. Here is a rundown on some of the presentations.

— People with asthma engaged in unintentional nonadherence of preventer medicine use as well as intentional non-adherence. This engagement in preventer use is influenced by their beliefs about asthma and medications

This initial piece of research is of great interest, consumers often tell us that they feel they want better relationships with their doctors, so that they can make informed choices in how they manage their asthma

Can brief training change GPs’ opinions on using communication skills for discussing adherence in asthma? Dr Juliet Foster, Research Psychologist Woolcock Institute Dr Foster’s research looked at the effect of the use of motivational interviewing (MI) techniques by doctors on their patients with asthma, and whilst not yet fully reviewed to date, the initial results showed a positive change in patient’s interactions with their doctor regarding their asthma, its (MI) ability to elicit greater two way communication between the two, and from there a better pathway to adherence and understanding

— People with asthma who received the SMSs:

- Had increased use of preventer

- Improved adherence

- Improved sense of control of their asthma

- Increased perception that asthma is a chronic condition not acute episodes

— Non adherence rates of preventer use for people with asthma vary between 1050%. Non adherence can be very costly financially for the government (subsidised medications, GP/ED presentations, missed days of work) and to the overall health/wellbeing and quality of life for the individual

Recommendations — Engagement with health professionals to determine reasons for non-adherence of patients (intentional vs unintentional) to assist with improving self-management and medication adherence

A text message program designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication

— Advocacy regarding cost of asthma medications

Dr. Antonia Rich, Lead Health Psychology Specialist, Atlantis Healthcare

Our work with the community frequently highlights some of the

— Consideration of a text messaging program as a part of Asthma Assist targeting hard to reach population groups

barriers to using asthma medicines; cost is always near the top of the list: The Impact of the Cost of Medications on Adherence Michele Goldman, CEO Asthma Foundation NSW

Key points and Survey Results — 85% had issues with the cost of medication (survey results) — 49% admitted to take less medication because of the cost — 49% spending more than $100 a month in the household on asthma medications — Free for all prescription medication in Wales, Northern Ireland, Scotland yet increase in scripts filled by only 4-6% (discussion held around the cost of medication being much cheaper in UK as compared to Australia)

One of the key focus areas in improving asthma outcomes is to look at the beginning of life care – pregnancy: A Multidisciplinary Approach to Management of Maternal Asthma (MAMMA©) – How can we help? Dr Angelina Lim, PhD candidate at Centre for Medicine Use and Safety, Monash University Key Learning One in every eight pregnant women has asthma; poorly controlled asthma during pregnancy is hazardous for both the mother and child. This can result in pre-term births, low birth weight babies, preWinter 2013 I Asthma Update

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eclampsia, impaired foetal brain development and other problems; pregnant women need to be managed the same way as non-pregnant women with asthma; women should have their asthma monitored at least monthly due to possible changes that can arise from pregnancy; all of which means that optimal asthma control during pregnancy is vital. The study conducted by Dr Lim aimed to determine whether a multidisciplinary approach involving asthma education and regular monitoring during pregnancy would decrease asthma exacerbations. This was done by comparing asthma education and regular monitoring during pregnancy to standard maternal care.

Recommendations This approach can contribute to improving asthma outcomes during pregnancy; empower pregnant women to enhance asthma self-management and monitoring; promote more awareness and support for these women; and justify the need for implementing asthma antenatal clinics in routine care.

Recently, you may have noticed that after thunderstorms, the newspapers carry stories about Emergency Departments having a rush of people having asthma attacks, and requiring urgent medical care. This is called Thunderstorm Asthma Dr Bruce Graham, Postgraduate Respiratory Science Course Coordinator, Charles Sturt University

Key Learnings — There is evidence between the

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Asthma Update I Winter 2013

relationship of thunderstorm activity and the increase in pollen count that causes asthma events — A lot of patients have allergies, including hay fever, but have never had an asthma experience before — During a thunderstorm pollen counts can be 4 times higher than normal levels. Then we also have the fraction amounts of pollen grains and these can be 7 times higher at this time — Studies include that airborne fungi can increase up to 1.5 – 2.2 times higher during thunderstorm activity as well as just pollens — Sometimes there has been a tenfold increase in asthma presentations to the Hospital Emergency Departments — Pollens contain starch granules and when they rupture they become much smaller and they can now penetrate deeper into the lungs which is why we see presentations of asthma – not hayfever

(with complete pre- and post-intervention data being gathered from 51 people). Both components were aimed at people aged over 55 who had asthma. The social marketing campaign showed that positive messaging was more effective than negative (or ‘scare’) messages. The online component struggled to achieve significant numbers (in itself an outcome indicating that online learning was not appropriate for this age group), but did report positive outcomes around effective self-management of asthma for participants.

Using Rx for change: An overview of evidencebased quality use of medicines interventions targeting consumers with asthma Dianne Lowe, PhD Candidate, La Trobe University

Key learning — The importance of systematic reviews in being able to identify the best evidence

Breathing better: A multicomponent intervention to improve asthma awareness and outcomes in the elderly

— Overviews (of systematic reviews) bring systematic reviews together

Kelly Andrews, Project Leader (Research) at the University of Wollongong’s Centre for Health Initiatives

Recommendations

Summary Kelly reported on the outcomes of the research project run by AFNSW and University of Wollongong. There were two components of the project: one being a social marketing campaign (with evaluation data collected from 710 people), and the other being an online education program

— Saves time in finding the best evidence on a particular topic

Interventions that support selfmanagement need to be: — Culturally specific — Include symptom monitoring — Provide general education about the illness along with self-management education/ training — Recognise the limitations of education alone

Partnerships Asthma Australia works closely with a range of partners to ensure the asthma message gets out to the community through respected and trusted organisations. The conference showcased some of this work.

Participant focussed service delivery – A brave new world Gary Green, Community Engagement Coordinator, Australian Men’s Shed Association

Summary It has become apparent that developing training that involves the participant or in asthma’s case, the consumer, that future programs and courses need to include active participation and a sense of ownership by the participant. Men’s Sheds are run and developed by the participants,

however practically this does not happen for many parents for a range of reasons

without the bureaucracy that many mainstream training methods adopt, and Gary’s experience is that greater success has been achieved by reducing the burden and allowing more freedom to those who are present.

Recommendations

How this is achieved with such a diverse group of consumers with asthma is just one of the many tasks confronting our educators over the next few years.

— Group sharing options for schools and sports clubs where many people may need access to an individual’s asthma information

By listening and reviewing alternative methods of support is just one way that Asthma Australia will remain at the forefront of asthma education.

— Considerations of how CareMonkey can be promoted as a management tool for adults. This will require a different approach to engage services working with adults such as aged care facilities and disability services

CareMonkey – making the world a safer place for people with asthma Troy Westley, CEO CareMonkey

Key learning — Parents acknowledge the need to share health information with people involved with their child’s care

— A tool such as CareMonkey can be useful across all age groups

— We all know written asthma action plans are poorly utilised and unlikely to be shared between carers – can an online mode of engagement increase the utilisation of asthma action plans?

A Snapshot of Asthma – what could help in the future? Personally Controlled EHealth Record (PCEHR) – improving the asthma patient’s journey through primary healthcare Eleonor Pritchard, ACT Medicare Local eHealth Team

Key learning — Ehealth has helped to put the control back in the hands of the consumer allowing consumers access to information that is provided to health professionals and being able to contribute to this and moderating who has access to this — Ehealth records will ensure consistent, update to

date health information is accessible to the consumer and health professional at all times

Recommendations — Engagement with health professionals and consumers regarding the benefit of PCEHR for people with asthma and their patient journey and assistance with selfmanagement

How quality use of medicines for asthma can improve outcomes for young people and carers? Carlo Malaca, CHF Project and Communications Officer - QUM

Summary — Quality use of medications (QUM) – No matter how advanced in medicinal technology, it is only effective if we use it in the optimum way and with the correct techniques. — Health literacy, poly-pharmacy, packaging and labeling are among the barriers faced by young people and their carers on QUM. — Good communication between health practitioners, utilization of TIS/CALD/ATSI resources to break down barriers.

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Do you ever wish that you could change the healthcare system? Think about it. What is working for you? What isn’t working for you? How did things go at your last doctor’s appointment, your child’s doctor’s appointment, and your parents’? Have you been surprised at the costs of your asthma medication or have you ever been baffled at how long it takes to see a doctor? Do you ever feel that health professionals should just speak ‘plain English’? Have you wondered what you can do about it? It is common knowledge that one of the best ways to improve healthcare is to listen and learn from the experiences of consumers – the everyday Australians who use and pay for our health system. Healthcare, after all, has to be about the health and experiences of the patient. Consumer input improves health decision-making because it balances the views of health professionals, industry and Government. It helps to make sure that everyone is focused on what happens to the patient, carers and their families.

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Most consumer input is provided by health consumer organisations and consumer representatives who work to take consumer views into health policy and decision-making, locally and at the state/territory and national levels. To do this health consumer organisations and consumer representatives need to hear the views, ideas and healthcare experiences of Australian patients and their families and carers. Now there is a new, convenient way for you to have your say to help improve Australian healthcare and help make a difference. It is called the OurHealth website. Use OurHealth to share your healthcare ideas and experiences The OurHealth website – www.ourhealth.org.au – was developed by the Consumers Health Forum of Australia (CHF) to make it easy for consumers to have a say on healthcare, online. CHF is the national not-for-profit organisation working to represent the interests of consumers in national health policy. OurHealth was made possible by Australian Government funding of the CHF OurHealth, Our Community Project. OurHealth provides information and links to help you find your way to information that will help you use the health system, and invites you to ‘have a say’ about your healthcare experience and the way you would like it to change. OurHealth allows you to share your comments with other consumers,

consumer advocates and consumer organisations to help make things better in healthcare. Your comments: — might help another consumer understand the health system — might tell consumer advocates about an idea or a service that is working well or isn’t working well in your local community — will contribute to an important knowledge bank of consumer issues and experiences that can be used to improve healthcare for all Australians Have your Say on Asthma Health Consumer input into asthma health is vital. Join the conversation by visiting www.ourhealth.org.au and starting your own conversation or by contributing to the Asthma Australia conversation: ‘As a person with asthma or a carer of someone with asthma what would you recommend needs to be done to improve asthma care?’ If you would like to speak to us about OurHealth, please contact Laura or Debbie at: Email: info@ourhealth.org.au or on 1300 700 214. Asthma Australia is a keen supporter of the CHF Our Health, Our Community project.

Sponsors & exhibits Satchel Sponsor

C

Room Spons

Conference sponsors & exhibits

exhibits

Conference c

Silver Sponsor

Exhibitors

Platinum Sponsor

Asthma Australia and Asthma Foundations

Isonea

GlaxoSmithKline

Asthma AC

Room Sponsor

Satchel Sponsor

Gold Sponsor

Exhibitors

AstraZeneca

Calvary eH

Bird Healthcare

CareMonke

Avita Medical

Asthma Pe

Philips Home Healthcare

Bello Alito

Medical Developments International

Silver Sponsor

Asthma Australia and Asthma Foundations

Isonea

GlaxoSmithKline

Asthma ACT Network

AstraZeneca

Calvary eHealth

Bird Healthcare Satchel Sponsor

6

Avita Medical

CareMonkey Room Sponsor Asthma Peeps

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Philips Home Healthcare

Bello Alito

Medical Developments International

Room Sponsor Exhibitors

6

Asthma Australia and Asthma Foundations

Isonea

GlaxoSmithKline

Asthma ACT Network

AstraZeneca

Calvary eHealth

Like us on FacebookCareMonkey or follow us on Twitter before July 31st and go into the Asthma Peeps Avita Medical Asthma ACT Network draw for a great eco cleaning pack from Bello Alito Philips Home Healthcare Calvary eHealth our friends at WhiteMagic value at $120.

AA Conference Program 0313.indd 6

Bird Healthcare Isonea

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CMYK / .eps

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CMYK / .eps

Medical Developments International CareMonkey Asthma Peeps Bello Alito

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Helping people with asthma breathe better asthmaaustralia.org.au

To find out more about asthma information and training contact:

1800 ASTHMA (1800 278 462) Office hours


Asthma Update | Issue 47 | May 2013