News in brief:  FeNO testing recommended by ATS; Concern over rising asthma deaths in females; Specialty training colleges’ ‘dirty secret’

 FeNO testing recommended by ATS

Patients with asthma in whom treatment is being considered should undergo testing for Fractional Exhaled Nitric Oxide (FeNO), the American Thoracic Society has recommended in an updated Clinical Practice Guideline.

The ATS said made a conditional recommendation for FENO-based care based on evidence showing that testing was associated with fewer asthma exacerbations and lower use of oral corticosteroids – a marker for asthma severity.

The Society said FeNO was a simple, non-invasive and relatively low cost test that had few disadvantages, and which could be useful to guide treatment decisions. However the authors emphasised  that their guideline did not address the question of FeNO to establish the diagnosis of asthma or the utility of FeNO in monitoring asthma.

Concern over rising asthma deaths in females

New data showing high rates of asthma-related deaths – especially for women aged over 75 years – are cause for concern according to the National Asthma Council Australia.

Figures commissioned by the Council show that there were 417 asthma-related deaths recorded in Australia in 2020 made up of 274 females and 143 males.

NAC spokesperson, respiratory physician Dr Jonathan Burdon, said the figures should act as a reminder to all people with asthma to see their doctor to review the Written Asthma Action Plan and make sure they are using their inhaler properly.

“It is concerning that the number of women dying from asthma is going up the last few years rather than going down and women now account for 65% of all deaths from asthma in Australia,” he said.

“Asthma remains a significant cause of ill health, disability and poor quality of life in Australia and women aged over 75 are still the most at risk, with 72 per cent of all female asthma deaths coming from this age group.

Dr Burdon said that another group of concern included the 55 to 64 years age group, as they had jumped from 29 deaths in 2019 to 47 deaths in 2020, an increase of 18 asthma related fatalities.

Specialty training colleges’ ‘dirty secret’

Training colleges, consultants, and hospital executives have been blamed for enabling ongoing abuse and overwork of registrars, in an article about speciality training written by an anonymous junior doctor deploring what they describe as medicine’s ‘dirty secret’.

Published in mainstream newspapers this week, the article entitled ‘Distressed doctors don’t bend, so they break’ describes a training regime that encourages mental distress and suicide among registrars who are given a heavy workload and responsibilities but no support from senior doctors or management.

“They are the first to arrive at the hospital and the last to leave. You are told not to make waves, to keep your head down, to get through it. You are often working unsupervised with vast responsibilities and unsupportive distant supervisors. The less you complain, the more you’re willing to endure, the more attractive and hireable you become. Troublemakers do not get hired,” it says.

The article says the current approach by training colleges is flawed because “the focus has been on coping with abuse rather than ending abuse.”

“The medical fraternity needs to host a meaningful discussion about how to fix our training system to provide more support for doctors and improve their wellbeing. Workload is an issue but the crux of the problem is the lack of support from those in authority,” it concludes.

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