Asthma Management Handbook
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Table. Australian Asthma Handbook Version 2.0 major section revisions

Section

Topic

Amendment

Acute asthma Oxygen Revision of oxygen saturation thresholds for initiating supplemental oxygen and targets for oxygen saturation.
  Anaphylaxis Addition of alert to acute asthma management algorithms with hyperlinks to current ASCIA guidelines.
  Adrenaline Update of evidence and clarification of role of adrenaline in acute asthma management.
  Systemic corticosteroids Update of evidence and revision of dose recommendations for children (loading doses no longer recommended).
  Ipratropium bromide Update of evidence and revision of recommendations for initial bronchodilator to include routine use of ipratropium for patients with severe or life-threatening acute asthma.
  Magnesium sulfate Update of evidence.
  Aminophylline Addition of IV aminophylline to options for add-on treatment for patients with inadequate response to initial treatment
  Hospital admission Revision of criteria for admission to include risk factors for poor outcomes.
  Inhaled corticosteroids Amendments to emphasise recommendation to prescribe inhaled corticosteroids at discharge (if indicated) to reduce future risk of flare-ups.
  Discharge checklist Revision of discharge recommendations to promote effective transition to primary care, including appointment within 3 days in addition to review of asthma at 2–4 weeks.
  Discharge plans Addition of templates for discharge plans (interim asthma action plans) for children and adults.
Management of asthma in children Age-based recommendations

Restructure to separate recommendations for children 1–5 years and children aged 6 years and over.

Addition of new figure: Stepped approach to adjusting asthma medication in children aged 1–5 years.

  Infants 0–12 months Removal of recommendations for children under 12 months, with clarification that diagnosis and management of asthma in infants is not recommended within primary care.
  Symptom patterns

Simplification of terminology for describing symptom patterns in infants 1–5 years: removal of term ‘multiple-trigger wheeze’, separate classification systems for wheezing disorders (where asthma diagnosis uncertain) and asthma replaced by single classification system.

Symptom patterns integrated into treatment tables for each age group:

Classification of preschool wheeze and indications for preventer treatment in children aged 1–5

Classification of asthma and indications for initiating preventer treatment in children aged 6–11
  Risk factors for flare-ups Addition of new table: Risk factors for life-threatening asthma flare-ups in children
  Short-acting beta2 agonists Simplification of recommendation against the use of short-acting beta2 agonists in infants; recommendation against use extended to all infants under 12 months, consistent with current bronchiolitis management guidelines.
  Indications for preventer treatment

Separate tables for classification of symptom patterns and indications for preventer treatment replaced by a single table for each age group:

Classification of preschool wheeze and indications for preventer treatment in children aged 1–5

Classification of asthma and indications for initiating preventer treatment in children aged 6–11
  Approach to monitoring and adjusting treatment Update of evidence for effects of management guided by various approaches to monitoring (lung function tests, exhaled nitric oxide, sputum eosinophil count).
  Stepping up Simplification/reorganisation of advice for stepping up in each age group.
  Stepping down Update of evidence and simplification/reorganisation of advice for stepping down in each age group.
  Cromones Removal of sodium cromoglycate and nedocromil from main recommendations for preventer therapy.
  Montelukast Update of evidence for efficacy, update of evidence for behavioural and/or neuropsychiatric adverse effects.
  Tiotropium Addition of information on tiotropium following TGA approval for use in children aged 6 years and over.
  Inhaled corticosteroids Update of evidence for efficacy of increasing the dose at the onset of flare-ups, adverse effects.
  Inhaled corticosteroid/long-acting beta2 agonist combinations Update of evidence for efficacy in children up to age 12, potential tachyphylaxis with long-acting beta2 agonists.
  Oral corticosteroids Update of evidence on short courses of oral corticosteroids to manage flare-ups at home or primary care, as distinct from use in acute care settings.
  Back-to-school care Addition of advice on asthma management at the beginning of the school year.
  Severe asthma Addition of advice on managing severe asthma in each age group.
Management challenges Structure Replacement of former Troubleshooting section.
  Patient/person-centred care Revision of whole section to emphasise a patient-centred approach to caring for a child or adult with asthma that is not well controlled despite preventer treatment.
  Living with asthma Addition of evidence on lived experience of asthma.
  Cost of asthma medicines Addition of information about costs of asthma medicines and strategies for minimising costs to patients.
Primary prevention of asthma Risk and protective factors for developing asthma

Update of evidence for risk and protective factors.

Addition of table: Risk and protective factors for developing asthma

Update of evidence on effects on risk of developing asthma associated with various exposures.

  Paracetamol Update of evidence for effect of exposure to paracetamol (prenatal, early life) on risk of developing asthma.
  Nutrition Update of evidence for effects of nutrition on risk of developing asthma.
  Restriction diets in pregnancy Update of evidence for efficacy of restriction diets during pregnancy as a strategy for asthma prevention in children.
  Dietary supplementation during pregnancy and in newborns Update of evidence for efficacy of dietary supplementation as a strategy for asthma prevention in children.
  Allergen avoidance Update of evidence for efficacy of allergen avoidance as a strategy for asthma prevention in children.
  Hypoallergenic infant formula Update of evidence for efficacy of hypoallergenic infant formula as a strategy for asthma prevention in children.
  Specific allergen immunotherapy Update of evidence for efficacy of specific allergen immunotherapy as a strategy for asthma prevention in children with allergic rhinitis.
Severe asthma in adults and adolescents Structure

Replacement of single web page (Managing severe, high-risk and difficult-to-control asthma in adults) with more detailed guidance over four web pages:

  • Identifying severe asthma in adults and adolescents
  • Non-pharmacological strategies and general care
  • Add-on treatments
  • Monoclonal antibody therapy

 

Identifying severe asthma

Addition of more detailed information on steps for identifying severe asthma in adults and adolescents.

Revision of table: Differential diagnosis of severe asthma in adults.

Clarification of definitions of severe asthma and difficult-to-treat asthma.
  Investigations for severe asthma Update of current practice.
  Non-pharmacological strategies for managing severe asthma

Addition of advice on non-pharmacological strategies and general care in the management of severe asthma.

Addition of evidence and information on active Cycle of Breathing technique.

More detailed information and advice on monitoring and managing adverse effects of oral corticosteroids.

Addition of evidence on air temperature control.

Update of evidence for bronchial thermoplasty.
  Add-on treatment for managing severe asthma

Addition of advice on add-on treatments in the management of severe asthma.

Update of evidence for efficacy of various treatment options including:

  • tiotropium
  • oral corticosteroids
  • azithromycin
  • monoclonal antibody therapy.
  Monoclonal antibody therapy

Advice on providing ongoing care during monoclonal antibody therapy.

Update of evidence on efficacy, including newly introduce benralizumab.

Update of TGA-approved indications and PBS listings revised 1 December 2018.
  Lived experience of severe asthma Addition of evidence from Australian research on lived experience of severe asthma.
  Resources Addition of links to Centre of Excellence in Severe Asthma’s Severe asthma toolkit.

Asset ID: 124