Guest: Associate Professor Graham Hall
Presenter: Patrick Reyes
Guest Bio: Professor Graham Hall is a Research Strategy leader and the Head of the Paediatric Respiratory Physiology group at the Telethon Kids Institute in Perth. Graham completed his PhD at the Telethon Institute before working in the University Children’s Hospitals in Zurich and Bern in Switzerland. In 2003, he was appointed as Senior Respiratory Scientist of the Respiratory Laboratory at Princess Margaret Hospital in Perth before returning to full-time research at the Telethon Kids Institute in mid-2010 as the Head of Paediatric Respiratory Physiology. Prof Hall an internationally recognized pediatric respiratory physiologist and contributes to a number of national and international working groups aimed at improving the standard of lung function testing.
Segment overview: In today’s Health Supplier Segment, Associate Professor Graham Hall joins us to discuss health issues associated with preterm birth, among these is the possibility of having asthma in light with the celebration of Lung Health Awareness Month this November. Professor Hall will talk about current statistics for asthma in Australia, why does Australia have one of the highest asthma rates in the world as well as some of the common triggers for asthma. November 17 commemorates World Prematurity Day and Professor Hall will also share his thoughts the health issues associated with preterm birth, among these is the increased possibility of having asthma.
Health Professional Radio – Australia’s High Asthma Rate
Patrick Reyes: Hello and welcome to Health Professional Radio, I’m your host Patrick Reyes and on today’s show we have Associate Professor Graham Hall who’s from the Curtin School of Physiotherapy and Exercise Science. He’s also an expert in lung health and he is also the Deputy Director of the Telethon Kids Institute. And he’s joined us today to talk about lung health since it is Lung Health Awareness Month where we talk about the importance of breathing and encourage everyone to stop and think about what they can do with just one breath. Welcome to the show Graham.
Graham Hall: Thanks Patrick and I’m glad to be here.
P: Alright, so for our first question, why are premature children more likely to have asthma or asthma-like symptoms.
G: Yeah Patrick, so we know that in Australia today and globally approximately 10% of births are born premature, so that is the babies are born at less than 37 weeks gestational age out of a normal 40 weeks term birth. Now for many of these children they go on not to have many lung problems, however for those who were born very preterm, that’s less than 32 weeks gestational age, a lot of their lung development happens outside of their mother’s womb and so this means that instead of the airways and the peripheral airways and the alveoli developing as they would normally they starts to develop in an abnormal environment. This leads to the structure of the lung being quite different. On top of that is babies are born very preterm often they need supplemental oxygen, they might have CPAP or mechanical ventilation in the neonatal intensive care unit and well of course these are lifesaving therapies, they can also cause some damage to the lungs. So what we found in some of our research is that up to 30-40% of 9 to 10 year old who are born very preterm their parents and the children report wheezing cough symptoms with exercise. So these are all of the symptoms that we see in asthmatic children. What we don’t know for certain is whether the symptoms they’re reporting are results of asthma i.e. these children who are born preterm have developed asthma or if there is some other underlying problems in their lungs. Of course, they do like all children have the same risks in developing asthma and maybe the risk is higher. So this stage we’re not quite sure if its asthma or not but there is a much higher proportion of these children born preterm, reporting symptoms, reporting medication, asthma medication use than we would expect in the general population.
P: Now as these children get older, is it possible for them to maybe grow out of asthma?
G: These preterm children? So in this cohort that we’ve been following we saw them, some of them first when they’re about 5-6 years of age and then we saw them again at 10-11 years of age and actually we’ve found that the symptoms and their lung function got a little bit worst. Not in all children, some of them did seem their lungs grew normally and not different to term born controls, but in some children it got worst. So our concern is that there might be some group of children born preterm whose lung function and breathing problems may actually progress and become worse over time. There isn’t a lot of studies following these children over a long period of time into young adult life, the ones that ours have do seem to suggest that while they may not catch up, they’re not falling further behind, but as we know treatments had changed over time and as we’re getting better at resuscitating and premature babies are becoming even more preterm. We really have moving goalposts in terms of their long term outcomes, in terms of lung health for these preterm children, so it’s something we need to focus on over the coming years.
P: Alright. Now can you tell us what are some of the common triggers for asthma?
G: Yes, so as many of your listeners will know there are a range of triggers that can cause individuals with asthma to develop respiratory symptoms and some of these are, the ones we would expect, cats, grasses, pollen, house dust, mites and so for example a lot of people would’ve read in the news, in Melbourne recently those tragic deaths as a result of ‘Thunderstorm Asthma’ where you have these thunderstorms coming through with rapid increases in grasses and pollens and other allergens. And of course if you have individuals who are sensitive to those triggers and perhaps their adherent to taking preventive medications it’s not optimal then they are had increased risk of having problems and unfortunately we’ve seen that this week in Melbourne which I think now four deaths being reported. The other triggers that can occur are just from common viruses and so we know particularly in children up to 80% of asthma flare-ups are triggered by a virus. We don’t know why some asthmatics are particularly influenced by viruses compared to others or even people on the general population but it does seem to be one of those triggers that can really put people in trouble.
P: Now I’ve never witnessed, for myself, an asthma attack but if sometime in the future I do, what would be the best plan of action when someone is having an attack?
G: Yes, so it does vary from the individual to individual but the key is to try and to get the airways open again. And so I would encourage everybody to talk to their local asthma foundation if they do have asthma, about asthma first aid and many of the asthma foundations across Australia run asthma first aid programs for both individuals with asthma, their families, but also they have programs in schools and workplaces. Generally, what we encourage is for people to take at least 4 parts of a reliever medication and that varies for different individuals but one common one that people often recognize is Ventolin and if that doesn’t work to take more and if that still doesn’t work then it’s really important that they call in emergency services. Because if their flare-up is not responding to 2 or 3 doses of Ventolin in a very short period of time then it’s likely to continue to get worst and it’s imperative that they contact emergency services, ambulance services, or get to an emergency department of a hospital to get the treatment that they need.
P: And can you explain in detail what an Asthma Action Plan is and why it’s important for all family members and schools?
G: Yes, Australia has quite a comprehensive system of asthma action plans. These are recommended by the Australian Asthma Management Handbook which is developed by the National Asthma Council in partnership with the federal government and health professionals and health care providers and it has fantastic results has really usable online system. So asthma action plans are really where individuals with asthma working with their physicians, they’re usually the GPs in primary care and they sit down and have a very clear plan and go through a conversation of, “Okay, well what does your asthma look like? What are your triggers? What medication should you be taking every day? And if you are treated or if you do get a flare-up how will you goanna respond?” So really it puts people with asthma back in the driving seat and so they have a very clear road map, if you’re likely saying, “Okay, well everything’s going along, I’m not having symptoms and so I’m taking my preventives twice a day and I don’t really need it… or similar very often. But then if something does happened, I have a very clear step and this is what I’ll do next.” And then if it continuous to get worse then there’s a clear step of what you’ll do after that and if it continuous to get worse, then it’s call your doctor or call an ambulance, go to an emergency department. So we know that in individuals who have an asthma action plan and if you follow that asthma action plan the outcomes for those individuals are very good. They have less unplanned presentations to their doctors, less emergency presentations and less asthma flare-ups. Unfortunately, in Australia the number of people who have an asthma action plan is quite low. So for example 40% of children have an asthma action plan but only 20% of adults do. So interestingly, parents are very good at having an asthma action plan for their children or 4 out of 10 parents. But when it’s the parents themselves, only 1 out of 5. So, I think there’s a lot that we can do there and it can be something as simple as making a plan with your GP and just go in and ask them the question, “Can I talk to you about an asthma action plan?”
P: Alright, in an article I’ve read it does state that Australia has one of the highest asthma rate in the world. Now, why is that?
G: Yes, so it’s not entirely clear, so Australia, the United States of America, New Zealand, the United Kingdom, Canada, all seem to have very high rates of asthma and harder than you would expect. Some of these may be the way the immune system grows and develops even before we’re born. Obviously our immune systems are not designed to respond to things like house dusts, dusts mites or cat’s fur or grasses it’s there to respond to parasitic infections of the guts, worms or really important infectious diseases and one of the series which your viewers may be familiar with so the term hygiene hypothesis is that as developed countries have developed better public health, everything has become clean and we have vaccinations and all of this that our environment now has become so clean that our immune system is now starting to responded to things that it would never responded to before. It’s very difficult to prove that this is true so it remains a hypothesis only but this is likely to be one of the things because of what we do see is in developing countries as they move to having better public health, better access to clean water, all of those things that moving along a development pathway include one that get less infectious disease, they do start to have more asthma symptoms but we don’t know for sure just yet.
P: Alright and for our final question, what is next for asthma research?
G: Well I think that’s probably a two-pronged question, clearly the ultimate goal is to cure asthma. However, I think we’re many years away from that and even if we were to prevent asthma in every new born baby from today we would still have over 2 million Australians who have asthma. So the key focus, I think for all health professionals is to help people with asthma control their asthma and to take control of their asthma so that they can prevent asthma flare-ups, so that we can prevent tragic preventable deaths like we’ve seen this week in Melbourne and likely we see every year. And so really finding ways to make it easier for people to be able to take their medications that we’ve got to make sure that the people who may to have those treatments by getting them and to work really closely with individuals with asthma and the doctors who are looking after them and other health care professionals looking after them to have the best plans that suits an individual, so that it’s easy for them to stay compliant to that asthma action plan.
P: Alright, well thank you very much. It’s been a pleasure talking to you Graham.
G: Thank You.
P: You’ve been listening to Health Professional Radio, again I’m your host Patrick Reyes and we’ve been in conversation with Graham Hall as we talked about lung health in relation to Lung Health Awareness Month. If you’ve missed our conversation or if you’d like to listen to this interview again, transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.