Asthma NZ shuns ministry guidelines

By MARTIN JOHNSTON health reporter

Guidelines on how doctors should manage adult asthma are about to be published in an effort to bring the disease under greater control.

A summary of the guidelines, which already are attracting controversy, will be sent to all of New Zealand's more than 3000 general practitioners.

Asthma New Zealand yesterday dissociated itself from the guidelines, saying they were written in line with Government policies that overly restricted subsidised access to some of the latest drugs.

One in six New Zealanders has asthma, costing the country more than $800 million a year.

New Zealand's admission rate to hospital for treatment of the disease is among the world's highest.

Many New Zealand asthmatics have poor control of the disease, which causes breathlessness, coughing and wheezing.

The guidelines are the result of two years of work and are to be released at a GPs' conference on Friday.

They are designed to give clear advice to doctors on the diagnosis and management of asthma.

Professor Ian Town, co-chair of the Health Ministry-financed group which produced the guidelines, said yesterday that it was decided to write them after researchers found gaps in GPs' knowledge about asthma and that many patients were prescribed excessive doses of inhaled steroid drugs.

"We found that GPs did not feel that confident about how to use some of the new medications available," said Professor Town, the medical director of the Asthma and Respiratory Foundation.

Too few eligible patients were prescribed puffers containing so-called long-acting beta agonist (Laba) drugs, which are often used alongside an inhaler with a steroid such as Flixotide.

But the guidelines accept the conditions set by the Government drug-buying agency, Pharmac, for adults' access to a Laba, despite growing international evidence that supports a further easing below those implemented last year.

Pharmac's criteria include poor asthma control on 400mcg or more daily of Flixotide (or 750mcg of some other steroids).

Professor Town said the guidelines acknowledged the emerging evidence for including a Laba in a patient's drug kit based on poor control at 200mcg of Flixotide. This was excluded from the document "to keep coherence with Pharmac", but could be added later to internet-based updates.

Asthma New Zealand president Dr Allen Liang said he was consulted about the guidelines but his group decided to keep its name off them.

"We feel the guidelines are not in line with international best practice."

Doctors should be educated about the whole range of asthma medication, rather than just those paid for by Pharmac.

"We are behind countries like Australia and Turkey in the availability of combined drugs [which contain a steroid and a Laba]."

Pharmac pays for only one of the available combined therapies.

The criteria are strict and it is a breath-activated device - as opposed to an aerosol - which Dr Liang said some patients were unable to operate.

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