Asthma Treatment ‘Down Under’ Offers Unique Model
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Asthma Treatment ‘Down Under’ Offers Unique Model
Over the years, I have used athletes with asthma as good examples of how people can control their asthma and not let it control their lives. While the accomplishments of the athletes have generally made a favorable impression on some of the young patients, the feats generally have made an even more dramatic impression on their sometimes overprotective parents.
We now have a new role model who can help us encourage our patients and their families in the form of swimming Olympic Gold Medalist Tom Dolan.
Dolan had the crowd on its feet as he won the 400-meter individual medley in 4:11.76, lowering his previous record of 4:12.30 set at the 1994 world championships in Rome. A proven record-breaker, he is a severe asthmatic who struggled against a viral infection for the past month on top of his ongoing battle to control his asthma. He spent the afternoon of his most recent race tethered to an oxygen tank before participating in the final race in Sydney, Australia.
“I’ve been struggling a while with my breathing,” he told reporters. “But for me, it’s all about guts at the end. That’s what was able to pull me through.”
Asthma Care In Australia
Because the world’s attention has currently been heavily focused on the nation Down Under, I thought it appropriate to see how the Aussies handle asthma. The first Australian site I found pertaining to that topic was The National Asthma Campaign (NAC) at http://www.nationalasthma.org.au/index.htm. The organization’s e-mail address is email@example.com The site also has links to:
- patient and media resources,
- other asthma web sites,
- publications and resources for health professionals, including two familiar to U.S. respiratory therapists: the Asthma Management Handbook and the Spirometry Handbook,
- an asthma checklist for pharmacies, and
- information about the prevalent treatment of a patient suffering an asthma attack.
NAC, an Australian nonprofit group dedicated to improving asthma awareness, was formed in 1990 as an initiative of the Thoracic Society of Australia and New Zealand, the Royal Australian College of General Practitioners, the Pharmaceutical Society of Australia and Asthma Australia.
In 1998, the most recent year for which statistics are available, 685 Australians died from asthma. Dr. Chris Brown, spokesperson for NAC, noted in an April 2000 media release that, “More than 2 million Australians have asthma–one in four children, one in seven adolescents and one in 10 adults.”
Because of the high numbers, he wrote in the release: “It is vital that all Australians know how to treat an asthma attack.”
He maintains that almost all Australians will witness an asthma attack at some time in their lives and that they can be trained to provide early intervention. To reach that goal, NAC is urging all Australians to learn what to do if someone has an asthma attack.
The NAC’s First Aid for Asthma Chart, sponsored by the Shell Australia Foundation and distributed free of charge, recommends four simple steps to help someone who is having an asthma attack. Interestingly enough, the chart is filled with language reflective of the Down Under nation rather than terms more commonly used by U.S. therapists.
1. Sit the person comfortably upright. Be calm and reassuring.
2. Give four puffs of a blue reliever inhaler known commonly in Australia as a puffer. Relievers are best given through a spacer if available. Use one puff at a time and ask the person to take four breaths from the spacer after each puff. Use the person’s own inhaler if possible. If not, use the First Aid Kit inhaler or borrow one from someone. U.S. asthmatics are more familiar with the term MDI instead of reliever and are not acquainted with the kit.
3. Wait four minutes. If there is no improvement, give another four puffs.
4. If there’s little or no improvement, call an ambulance immediately and state that the person is having an asthma attack. Keep giving four puffs every four minutes until the ambulance arrives.
U.S. Asthma Awareness
For those who have an asthma attack in Australia, the odds are fairly good there will be individuals available to provide help, provided they are familiar with the asthma intervention program. Let’s compare that to what would typically occur in the United States.
In the Down Under continent, the care is fairly immediate and hands-on. In the United States, by contrast, the caregiver would call a managed care-approved physician to see if the asthmatic can go to the emergency room. Then the caregiver and patient would have to wait for EMTs. While playing the waiting game, patient and caregiver must try to wait calmly while hoping the EMTs are trained to administer bronchodilators.
Once under way in the ambulance, everyone involved in the crisis situation has to wonder whether the ER staff has even read the latest asthma guidelines and whether the hospital has recently cut the respiratory staff.
We have in this nation defibrillators that cost thousands of dollars each sitting in company first aid stations, in airports and even on New York City garbage trucks.
We have defibrillator training programs included in ACLS certification courses. The same type of training is about to be added to basic CPR courses too. Why can’t we initiate a hands-on intervention program similar to what the Aussies are trying to use to provide immediate emergency care for asthmatics in this country?
Our profession should be the leaders in developing an immediate care program for patients; we should take a closer look at what the Australians have started.
Larry McGrath is a New York practitioner.