Clarification on the use of low-dose inhaled corticosteroids in children, the role of FEV1/FVC in diagnosis and how newly available combination therapy fits into the prescribing framework are just some of the changes made to the updated Australian Asthma Handbook released today.
Here’s a summary of the key clinical changes:
Inclusion of new combination medicine
The Handbook explains the role and use of fluticasone furoate/vilanterol(Breo Ellipta) (introduced in late 2014) which, unlike previously available ICS/LABA combinations, is not available in a low dose formulation.
Emphasis on long-term use of low-dose ICS in adults
The Handbook continues to emphasise that most adults with asthma need to stay on low-dose inhaled corticosteroid medication long term, once the diagnosis of asthma is confirmed, and now includes more detailed advice to explain the aims of continuing this treatment and the risks of cessation.
Clarification that low-dose ICS should not be continued indefinitely in children
The Update highlights the need for primary carers to continually monitor asthma medication in children, including stepping down or ceasing preventer treatment if appropriate.
Clarification of risk factors for developing asthma
The Handbook clarifies risk factors for developing asthma that have been identified in population studies.
Modification of acute management protocols
The Handbook also makes amendments to the treatment of acute asthma and clarifies management of acute asthma that is initially assessed as mild/moderate or severe but does not improve after initial bronchodilator treatment.
Other minor clarifications
Other minor clarifications include:
- Various amendments to clarify the role of FEV1/FVC in diagnosis in adults and to correct under-emphasis on this parameter in the previous version
- Recommendations regarding cromones in children amended to provide practical dosage information
- Advice regarding healthy eating for asthma amended to clarify intake of which foods high in saturated fats should be minimised
- Practical dosage information added for magnesium sulfate and IV salbutamol in severe and life-threatening acute asthma, including acknowledgement of the scarce evidence, lack of clinical consensus and limited roles for their use
The updated Australian Asthma Handbook version 1.1, including a full list of amendments is available at:www.asthmahandbook.org.au
An updated copy of the Asthma and COPD Medications wall chart is also available at: www.nationalasthma.org.au