Revamped asthma guidelines more age-specific

A substantial update of the Australian Asthma Handbook has introduced separate recommendations for 1-5 year-olds and children 6 years and over, and expanded the advice on management of acute and life-threatening asthma.

The Handbook, launched in Melbourne last week by the National Asthma Council, incorporates evidence and TGA and PBS changes since the 2014 edition.

Dr Louise Owens, a paediatric respiratory physician in Sydney and working group member, told the limbic the separate recommendations for pre-school age children versus older children made diagnosis and management much clearer.

“Pre-school aged children are prone to a lot of viral-induced wheeze which may not be as responsive to asthma preventer medications; they can’t do lung functions; we can’t confirm things like a Ventolin response or airway obstruction. So these guidelines now provide advice through tables and flow charts on how to assess the children in that age group, how to decide on their management and then how to re-assess.”

She said the guidance strengthened advice on possible neuropsychiatric side effects with montelukast – reminding prescribers to warn parents when prescribing, to ask about side effects and to cease the drug if there were any concerns.

“For children we are also emphasising that when starting a preventer therapy to start on an inhaled corticosteroid and step up as needed rather than starting patients on a combination inhaler.”

“In the preschool and younger age groups, we have taken chromones out of the picture a little bit because there really isn’t the evidence to support them.”

“We have gone through all the evidence we could find and summarised it as much as we could. As much as possible, it is evidence-based instead of expert opinion.”

Dr Owens said adolescents and young adults also required some special attention in the Asthma Handbook.

“This is a group that can be problematic with regards to asthma management as they are getting more independence and pulling away from parental supervision a little bit.”

“Then adolescents are also at increased risk of having life-threatening events possibly because adherence has dropped off or because they are relying on asthma relievers to get them through the day rather than realising that is a sign their asthma is poorly controlled and they need to have a doctor involved.”

She said the Asthma Handbook includes lists of those people who are at increased risk of exacerbations, hospitalisations and life threatening episodes.

“Life-threatening episodes are covered in more detail and with easy to follow flow charts to manage those severe events.”

It also revises guidance on discharge for more effective transition from hospital back to primary care.

“Certainly the guidance was patients should have an appointment with the GP within a couple of days of discharge to confirm their symptoms are resolving and they should also be followed up at a later date when symptoms have resolved for an overall management review rather than waiting for until they get sick again to go back to their GP.”

Other changes in the handbook include:

  • the addition of thunderstorm asthma and advice for people with asthma or allergic rhinitis symptoms
  • revision of oxygen saturation thresholds and targets to reflect TSANZ guidelines in acute asthma
  • statements on overuse of short acting beta-2 agonists
  • updated evidence on primary prevention of asthma.

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