135 www.expert-reviews.com ISSN 1744-666X 2009 Expert Reviews Ltd 10.1586/1744666X.5.2.

135
Meeting Report
Leane Poulos, on behalf of the Australian
Centre for Asthma Monitoring (ACAM; NSW,
Australia) opened the scien tic session by pre-
senting a summary of the third Asthma in
Australia report compiled by ACAM.
Over 2 million Australians have asthma, includ-
ing 9.9% of adults and 11% of children, with an
overall prevalence of 10%. There was a contin-
ued rise in the prevalence of asthma throughout
the 1990s, but this has now reached a plateau.
As with the last two surveys, the present review
has conrmed a reduction in asthma in children
and young adults, but a rise in its prevalence in
those aged over 35 years. There is a gender bias
in asthma prevalence, with males being more
affected in the 014 years age group, switching to
a female preponderance after the age of 15 years.
While the death rate from asthma has declined
since its peak in the 1990s, the burden of this
disease remains great. The majority of asthma
deaths occur in the over 65 years age group.
Socioeconomic factors continue to be
important, with a general trend of increas-
ing prevalence among those living in
disadvantaged circumstances.
The burden of this disease in indigenous com-
munities is substantial. Asthma is the second
most-reported illness after ear and eye problems.
There are differences in prevalence between
remote (12.2%) and urban (17.7%) communi-
ties. Indigenous populations have higher hos-
pitalization rates and a threefold higher mor-
tality rate. There is double the rate of smoking
in indigenous compared with nonindigenous
communities, and very high rates of passive
smoking are seen in indigenous households.
Current data on smoking rates remain disap-
pointing: a total of 37% of 1834 years olds
with asthma continue to smoke compared with
32% who do not have asthma. Smoking occurs
in 11% of households that have a child with
asthma compared with 9% of households where
there are no children with asthma.
The report highlighted the progress achieved
as well as the challenges that remain. Key points
included:
The prevalence of disease has decreased in
chi ldren and has reached a plateau
in adults
Death rates have fallen by 70% in the last
two decades
Hospitalization rates for both children and
adults have fallen
There is reduced prescription of high-dose
inhaled corticosteroids
However:
The asthma mortality rate is still high by
international standards
The majority of patients with asthma do not
have an action plan
A high proportion of people with asthma and
those at risk of asthma are exposed to cigarette
smoke
Socioeconomic disparity is widening
There is signicant disparity between indigenous
and other communities
Connie H Katelaris
Immunology & Allergy,
University of Western Sydney
and Campbelltown Hospital
NSW, Australia
Tel.: +61 246 344 001
Fax: +61 246 344 011
connie.katelaris@
swsahs.nsw.gov.au
Australian Asthma Conference 2008: Advancing Asthma Where?
Sydney, NSW, Australia, 2021 October 2008
The Australian Asthma Conference provided a timely forum for rethinking research priorities
and strategies at a time when the Australian government is undertaking major national health
policy reviews. Until now, asthma has been a national health priority in Australia, and at the
conclusion of the conference, delegates issued a strong statement in support of asthma
continuing to be a national health priority in Australia.
Australian Asthma
Conference 2008: Advancing
Asthma Where?
Expert Rev. Clin. Immunol. 5(2), 135136 (2009)
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Meeting Report Katelaris
A number of eminent asthma researchers highlighted the progress
and the unanswered questions in asthma research. Professor Helen
Reddel (Woolcock Institute of Medical Research, Glebe, NSW,
Australia) explored the priorities for research to address patient
needs. She outlined the progress that has been made but stated
there are many unanswered questions regarding asthma; for eaxm-
ple, how do we dene the various forms of asthma? Is asthma a
syndrome rather than a single disease entity? Who gets asthma
and why? The major questions surrounding geneenvironment
interaction remain largely unanswered.
Research demonstrates that the effective utilization of an asthma
action plan as part of self-management education results in signi-
cant improvements in an individuals management of asthma, but
the national uptake of these plans is disturbingly low (22%). Revised
approaches are urgently needed to gain greater adoption of these
action plans. There is a place for utilizing consumer engagement
principles to target hard-to-reach groups, and to develop social mar-
keting approaches for promoting action plans. Much greater use of
digital technologies should be a key service-delivery mechanism.
Professor Peter Sly (Telethon Institute for Child Health
Research, Western Australia) reviewed the progress made in pri-
orities and unmet needs in childhood asthma research. In 2002,
the research priorities included understanding asthma pheno-
types, the cause of wheezing in young children, developing better
tools to study asthma in very young children, improving and
individualizing asthma treatment, as well as ways of preventing
asthma and increasing the publics understanding of the disease.
He outlined the progress that has been made in many of these
areas, but indicated that we are no closer to having true preventa-
tive strategies. Epidemiological research has indeed questioned
the validity of much of the advice given to parents regarding
environmental avoidance and there are still major obstacles to
compliance with medication, especially among adolescents.
Professor Peter Gibson (Centre for Asthma and Respiratory
Diseases, Newcastle, NSW, Australia) identied some key areas
for adult asthma research, including how lifestyle affects asthma,
the problem of obesity and ageing, and the role of respir atory
infections. Defects in the innate immune response to viruses have
been identied as a reason why such severe asthma exacerbations
occur with common cold infections. How and why this happens
are key questions to answer.
Professor Connie H Katelaris (University of Western Sydney,
NSW, Australia) highlighted the particular risks faced by indi-
viduals who have both asthma and a potentially life-threatening
allergy, particularly to food substances. Studies of people dying
from anaphylaxis caused by food allergy reveal some common
features: most are adolescents or young adults, and all have under-
lying asthma. Why asthma is a risk factor for anaphylaxis is not
completely understood. Delay in recognizing a systemic reaction
may play some part. Frequent hospitalizations and the presence
of food allergy are common features seen in children presenting
with life-threatening asthma. Management of the individual with
concomitant asthma and signicant allergies depends on reliable
identication of risk, food allergen avoidance education, strict
control of asthma and preparedness for emergency treatment.
A statement was issued at the conclusion of the 2-day conference
urging the government to keep asthma as a national health priority
because, although progress with the disease has been made, the bur-
den of the disease is great, the cost to the government and the com-
munity is high, and morbidity rates remain unacceptable. A number
of research areas were identied as priorities for future funding.
Research must continue to address the adverse impact of smok-
ing, particularly in indigenous communities. That more people
with asthma smoke than do individuals in the wider community
was of great concern to those at the conference. Smoking-cessation
programs targeted to people with asthma are urgently needed.
New approaches are available that are more effective than those
used previously.
More work is required to improve the measurement and report-
ing of asthma. Using standardized asthma control assessment
tools will reduce reliance on self-reported data and enhance our
knowledge regarding asthma interventions and outcomes.
Research from work from Australia and internationally shows
that different models of primary healthcare delivery can produce
substantial improvements in asthma management. More carefully
targeting and expanding asthma-education programs will result in
better outcomes. Specic attention is needed on asthma triggers,
managing asthma emergencies and inhaler techniques.
Education programs directed to specic areas notably schools
need to be continued and expanded, given their demonstrated abil-
ity to reach key target audiences and equip schools and their com-
munities to better manage asthma emergencies. This is an area of
major concern to the parents and carers of children with asthma.
In summary, research needs to focus on all aspects of the dis-
ease, from the basic science and clinical management of asthma
to studies of asthma consumer experiences and attitudes.
Financial & competing interests disclosure
The conference partner was the Australian Government Department of
Health & Ageing. The conference was supported by NSW Health and spon-
sored by Sportshaler and GlaxoSmithKline. The author has no other rele-
vant afliations or nancial involvement with any organization or entity
with a nancial interest in or nancial conict with the subject matter or
materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Information resources
Australian Asthma Conference 2008, Sydney
www.asthmaconference2008.com
Asthma Foundation New South Wales
www.asthmansw.org.au
Afliation
Connie H Katelaris
Immunology & Allergy, University of Western Sydney and
Campbelltown Hospital, NSW, Australia
Tel.: +61 246 344 001
Fax: +61 246 344 011
connie.katelaris@swsahs.nsw.gov.au