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Guide: Australia's National Guidelines for Asthma Management

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  • Scope
  • Target Audience
  • Development
  • Links
  • Diagnosing and managing asthma in adults
  • Diagnosing and managing asthma in children
  • The Australian Asthma Handbook aims to improve health outcomes and quality of life for people with asthma by providing clear guidance for the health professionals involved in their care. It gives evidence-based, practical guidance to primary care health professionals on the most effective strategies in the diagnosis and management of asthma in adults and children.
    The Australian Asthma Handbook is proudly published by Australia's lead asthma authority, the National Asthma Council Australia.

    Scope

    The Australian Asthma Handbook includes all aspects of the diagnosis and management of asthma within a primary care chronic disease management framework, with a particular emphasis on practicality and accessibility.
    While specific advice is provided on identifying high risk and difficult-to-treat asthma, including referral criteria, advice on the management of asthma in specialist settings is outside the scope of the Handbook.

    Guidance is provided on the management of asthma and comorbid conditions with an emphasis on differential diagnosis, interaction or overlap with asthma, and specific asthma management considerations. Users are directed to the current national treatment guidelines for the comorbid condition where possible.

    Recognising the limited access to high-level acute care services for immediate treatment of patients with acute asthma, particularly in rural and remote areas, the Handbook also includes guidance on acute asthma management applicable to a range of clinical settings.

    Target Audience

    The Australian Asthma Handbook has been developed for use by Australian:

    • general practitioners
    • community pharmacists
    • asthma and respiratory educators
    • primary healthcare/practice nurses
    • Aboriginal and Torres Strait Islander health workers and practitioners.

    The Handbook is also intended as a practical reference for other related health professionals who may treat people with asthma occasionally. These include health professionals working in acute care settings, specialists from non-respiratory disciplines, and clinicians with an interest in comorbid conditions.

    Healthcare administrators, and healthcare students, are also encouraged to use the Handbook as their guide to current best-practice asthma care in Australia.

    Development

    A multidisciplinary approach was adopted in developing the Australian Asthma Handbook to ensure the advice remained relevant and implementable by the target users.
    The whole primary care team was represented in the multidisciplinary working groups and overarching Guidelines Committee, which was chaired by a general practitioner.

    Overall, the Handbook development involved more than 100 experts from general practice, nursing, pharmacy, asthma education, Aboriginal and Torres Strait Islander health, respiratory medicine and science, allergy, sports medicine, emergency medicine, psychiatry and scientific research.

    Consideration of the practicality and accessibility of the recommendations was fundamental to the development of the Handbook. To facilitate implementation of the guidelines into everyday clinical practice, the key recommendations are summarised as practical figures: flow-charts for diagnosis, stepped ziggurats for management and treatment algorithms for acute asthma.

    Links

    Australian Asthma Handbook

    Quick Reference Guide

    National Asthma Council Australia

    Diagnosing and managing asthma in adults

    Asthma is defined clinically as the combination of variable respiratory symptoms (e.g. wheeze, shortness of breath, cough and chest tightness) and excessive variation in lung function.
    There is no single reliable test ('gold standard') and there are no standardised diagnostic criteria for asthma. The diagnosis of asthma is based on:

    • history
    • physical examination
    • considering other diagnoses
    • documenting variable airflow limitation.

    In some patients, observing a response to treatment may help confirm the diagnosis, but lack of response to bronchodilators or to inhaled corticosteroids does not rule out asthma.
    Asthma management in adults is based on:

    • confirming the diagnosis
    • assessing asthma control (recent asthma symptom control and risk factors)
    • identifying management goals in collaboration with the patient
    • choosing initial treatment appropriate to recent asthma symptom control, risk factors and patient preference
    • reviewing and adjusting drug treatment periodically
    • providing information, skills and tools for self-management, including:
      • training in correct inhaler technique
      • information and support to maximise adherence
      • a written asthma action plan
      • information about avoiding triggers, where appropriate
    • managing flare-ups when they occur
    • managing comorbid conditions that affect asthma or contribute to respiratory symptoms
    • providing advice about smoking, healthy eating, physical activity, healthy weight and immunisation.

    *This guidance generally also applies to older adolescents.

    Examples of figures available in the Australian Asthma Handbook:

    Steps in the diagnosis of asthma in adults Stepped approach to adjusting asthma medication in adults

    Diagnosing and managing asthma in children

    Asthma is defined clinically as the combination of variable respiratory symptoms (e.g. wheeze, shortness of breath, cough and chest tightness) and excessive variation in lung function, i.e. variation in expiratory airflow that is greater than that seen in healthy children (‘variable airflow limitation’).

    There is no single reliable test (‘gold standard’) and there are no standardised diagnostic criteria for asthma. The clinical diagnosis of asthma in children involves the consideration of:

    • history of recurrent or persistent wheeze
    • presence of allergies or family history of asthma and allergies
    • absence of physical findings that suggest an alternative diagnosis
    • tests that support the diagnosis (e.g. spirometry in children able to perform the test)
    • a consistent clinical response to an inhaled bronchodilator or preventer.

    It can be difficult to diagnose asthma with certainty in children aged 0–5 years, because:

    • episodic respiratory symptoms such as wheezing and cough are very common in children, particularly in children under 3 years
    • objective lung function testing by spirometry is usually not feasible in this age group
    • a high proportion of children who respond to bronchodilator treatment do not go on to have asthma in later childhood (e.g. by primary school age).

    The management of asthma and wheezing disorders in children is based on:

    • confirming the diagnosis
    • assessing the pattern of symptoms (including frequency of episodes and pattern of symptoms between episodes)
    • assessing triggers
    • discussing the goals of management with the child’s parents and the child (depending on age)
    • choosing initial treatment based on the child’s age and pattern of symptoms
    • reviewing and adjusting treatment periodically based on recent asthma symptom control and risk factors (see Figure: Stepped approach to adjusting asthma medication in children)
    • managing comorbid conditions that affect asthma (e.g. allergic rhinitis)
    • providing parents and children with information and skills to manage their asthma, including:
      • a written asthma action plan
      • information about avoiding triggers, where appropriate
      • training in correct use of medicines, including inhaler technique
      • information and support to maximise adherence
    • managing flare-ups when they occur
    • providing advice about avoidance of tobacco smoke, healthy eating

    Examples of figures available in the Australian Asthma Handbook:

    Steps in the diagnosis of asthma in children Stepped approach to adjusting asthma medication in children

    To download a PDF copy of this page, please click here.

    The information above is intended to be an introduction to the content available in the Australian Asthma Handbook. To access the full guidelines please visit the website.

    This guide was developed by the National Asthma Council Australia. Go to www.asthmahandbook.org.au for more information.