[ASC-media] CRCA Media Release - Asthma Emergencies - What's going wrong?
crca at crca.asn.au
Tue Apr 20 13:54:09 EST 2004
Cooperative Research Centres Association Inc.
April 20, 2004
ASTHMA EMERGENCIES: WHAT'S GOING WRONG?
Asthma sufferers in Australia have a high probability of ending up in a hospital emergency ward - and yet the prevention and treatment of asthma in this country is amongst the world's best.
According to Ms Dianne Goeman of Melbourne's Alfred Hospital, research funded by the Cooperative Research Centre for Asthma Ltd. shows that this paradoxical situation is due to a combination of social and medical factors.
These include the high cost of medication, and the perceived danger of unwanted side-effects.
"We have one of the highest per capita occurrences of asthma and other respiratory complaints in the world" says Ms Goeman.
"However we also have a number of very effective procedures and medications which should be able to deal with all but the most severe asthma attacks," she says.
Asthma should not be seen as a 'minor ailment', says Ms Goeman; although for many sufferers it is relatively mild, around four hundred Australians die each year from asthma.
"The puzzle for medical researchers has been the implementation gap: treatments which are highly effective in clinical trials, leading to extremely optimistic forecasts about the future control of asthma and related ailments, which turn out to be far less effective in 'real life' situations."
Ms Goeman says that central to the treatment of asthma is the effective use of the 'asthma action plan'.
"The 'asthma action plan' is a familiar strategy among both clinicians and patients, but the application of the plan can vary widely," she says. "In recent research studies we have found that many doctors simply don't have enough time with individual patients to develop a plan; and in many cases, where patients do have a plan, they modify it according to past disease experience. Doctors need to be aware of this."
Ms Goeman says that 'a good asthma doctor can help people with asthma to improve their quality of life'.
"Being a good asthma doctor means that the GP devotes enough time to individual patients to form a real partnership with the patient in dealing with the disease," she says. "Doctors must engage in a dialogue with asthma sufferers, and provide them with a written asthma action plan, if treatment is to be successful."
Even where these conditions are met, Ms Goeman says that research in Victoria show that there are many other factors which hinder effective asthma treatment.
"Although asthma treatments can take different forms, many patients are concerned about the costs involved," says Ms Goeman. "We have found that patients attempt to 'manage' their costs by lowering doses to prolong medication use, or even by simply giving up the medication entirely.
"In at least some cases, this was the cause of later hospital presentation," she says.
Three quarters of asthma patients interviewed are also concerned about possible side-effects of medication, change in skin or body appearance, tremors, mouth or throat soreness, and osteoporosis now or in the future.
"For many patients, it's a question of weighing up the perceived risk of side-effects against the benefits of medication," says Ms Goeman. "Some patients who we interviewed told us that they have modified their medication plan because of this concern."
According to Ms Goeman, asthma may be more prevalent amongst lower-paid workers, but frequently it is the possibility of asthma attack which can lead sufferers to choose low-paid or temporary employment.
"Asthma contributes directly to their low socioeconomic status through diminished employment opportunities," she says. "Many people with asthma are forced to lose significant numbers of working days, adding to the fear and discomfort already associated with the disease."
Ms Goeman says that the investigation carried out under the auspices of the CRC for Asthma has reinforced the importance of the doctor-patient relationship in the treatment of asthma.
"We urge doctors to engage with asthma patients in a real partnership, to understand the affordability and acceptability of medication for each individual patient, and to ensure that each patient has - and understands - a written asthma action plan," she says.
"Asthma has been recognised as the Sixth National Health Priority Area in Australia, and costs the Australian community heavily in both personal and economic terms.
"Yet we have proven and effective treatments available," says Ms Goeman.
Ms Goeman says that the work of the CRC for Asthma supports Australia's National Research Priority No.2, Promoting and Maintaining Good Health.
More information from:
Tracey Ellis, The Alfred Hospital 03-9276 2266 03-9276 2000 a.h.
Prof. Julian Cribb, CRCA Media 0418 639 245
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