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Health: Asthma

Specialists urge 'radical' change to asthma treatment

A group of respiratory specialists has called for change to the way patients access asthma medications, including corticosteroids, in a bid to improve control of the disease.

In an MJA commentary, three Melbourne specialists say a million Australians have uncontrolled asthma, based on figures from a 2015 survey of more than 2600 patients.

A quarter of those in the survey did not regularly use preventers, despite having uncontrolled asthma. Another 20% had uncontrolled symptoms even while regularly using preventers.

"The logical solution to this problem is to re-design access to asthma medications," they write. "Preventers must be made more accessible."

They say they welcome discussions about making low-dose inhaled corticosteroids (ICS) available OTC, as floated in the draft new National Asthma Council (NAC) strategy.

They also propose other "radical" measures including monitoring reliever medication dispensing, setting up dedicated "difficult asthma" specialist centres and the introduction to the market of a combined short-acting reliever and preventer puffer.

Co-author Associate Professor Mark Hew, head of respiratory medicine at the Alfred Hospital, Melbourne, says as yet there is no combined low-dose ICS plus short-acting reliever product in Australia.

"The MJA article aims to highlight the need for conceptual changes ... in the way we manage asthma, over and above improving guideline implementation," he says.

"The ideas are just examples of how we might proceed, and reduce the risk of high frequency reliever use without concomitant preventers - a practice which increases the risk of exacerbations and asthma death."

Tasmanian GP Dr Bastian Seidel, the RACGP's representative on the NAC, has doubts about the benefits of specialist centres and of the combination product.

He says a study quoted in the commentary on the benefits of a combined ICS and short-acting beta-agonist is from 2007 and has been superseded by 2013 Cochrane review.

Dr Seidel does, however, see value in a trial of OTC preventer medication to gather evidence.

With regard to "difficult asthma" centres, he says primary care with referral to specialists in managing chronic illness such as asthma is still the best way to go.

"It needs to be tackled in primary care and that has been internationally proven to make a difference," he says.

Contributed by Carmel Sparke Medical Observer - medical news, opinion and analysis

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