Page 45 - RPA Magazine December 2020

Asthma, one of the most prevalent non-communicable diseases among children in Australia, can be better managed through weight management and correct nutrition. Symptoms of the chronic disorder, which causes periods of airflow obstruction through inflammation and narrowing of the airways, include the coughing, wheezing, shortness of breath and chest tightness that have induced significant worry in many a parent. The extent to which a child’s nutrition and body weight can impact the development and severity of asthma is an important factor when it comes to what pharmacists and their assistants should pass on to anxious parents. According to Megan Jensen, a clinical researcher and Advanced Accredited Practising Dietitian working in the Priority Research Centre for Grow Up Well at the University of Newcastle, asthma is the leading chronic disease in childhood, with around 10 per cent of children affected by the condition. “It’s a significant problem, and that’s why it’s become a national priority in Australia,” she said. Dr Jensen is known for her focus on how nutrition and obesity can impact asthma in children and for her nutritional interventions and assessments in this area. She says she undertook a PhD in childhood asthma despite not having previously taken an interest in the condition. “My PhD really started me on this journey of nutritional interventions and nutritional assessments in childhood asthma, especially when I realised the impact of nutritional issues, particularly obesity, on childhood asthma,” she said. She adds that the development of asthma in her niece fuelled her motivation to continue on this path, with her research uncovering countless stories from “desperate” parents of asthmatic children. “It can really be quite heartbreaking,” Dr Jensen said. “Children are particularly vulnerable to exacerbations as well. The paediatric age group has the highest emergency department utilisation rate. “This puts a lot of stress on the child and their development in terms of poor health and missed school days, as well as on the child’s family, caregivers and the healthcare system. “And, as we know, young children can get many viral infections a year, which are major triggers for asthma exacerbation.” Dr Jensen says “all of this” motivated her PhD investigation into obesity in childhood asthma. Her main study, a world first, was a pilot randomised trial of dietary induced weight loss in children with asthma. The main finding was that acute weight loss within 10 weeks was associated with improvements in asthma control and lung volume measurements. “The research also revealed gender differences in airway inflammation for obese children, which has implications for how well their treatments work, including inhaled corticosteroids \\\\\\\[ICS\\\\\\\] because of the way they target inflammation,” Dr Jensen said. “ICS targets eosinophilic inflammation, so understanding the underlying airway inflammation is important.” Drug therapies for asthma include long-term control treatments such as long-acting beta-agonists. For acute episodes, oral corticosteroids, beta- agonists and inhaled bronchodilators are used. The management of pests and humidity, as well as regular vacuuming, can reduce airborne allergens, such as mould, dust mites and particulate matter. Dr Jensen says keeping the home and car free of tobacco smoke can reduce the risk of triggering asthma exacerbations. She highlights that pharmacists and their assistants are ideally positioned to engage with the child and their caregivers regularly, because of their position within the community. “They could be a calming presence in the conversation – I think that’s really important,” Dr Jensen said. “They could look at the amount of ‘rescue’ therapy or prednisone being doled out, as a conversation starter that could lead to a discussion as to whether a child has a written action plan, regular asthma management or regular GP consultations – that sort of thing. “Then what’s important is that they realise the importance of nutrition when it comes to overall health and respiratory health, and provide basic information from information pamphlets, etc, and refer a child back to their GP or accredited practising dietitian when need be.” However, when it comes to advising on weight management, Dr Jensen cautions LITTLE LEGENDS 43 pharmacists and their assistants. “It’s a tricky business in childhood,” she said, “because pharmacists don’t want to experience the repercussions of incorrect advice, taking into account children are growing. So, it’s better to leave it to the experts in this area.” However, general guidelines relating to diet in asthma management, which pharmacists and assistants can refer to for giving advice, can be found in the article, ‘The role of nutrition in asthma prevention and treatment’, in Nutrition Reviews. The article states that the evidence suggests diets emphasising the consumption of plant-based foods might protect against asthma development and improve asthma symptoms through their effects on systemic inflammation, oxidation and microbial composition. Additionally, increased fruit and vegetable intake, reduced animal product consumption, and weight management might mediate cytokine release, free radical damage, and immune responses involved in the development and course of asthma, according to the article. The American Lung Association (ALA) has pinpointed certain foods and drinks that may contain elements that exacerbate asthma symptoms, such as sulphites, which are food preservatives; salicylates, which are compounds in aspirin, coffee, tea, herb-flavoured foods and spicy foods; and fast food. On the other hand, the ALA recommends vitamin D-rich food such as fatty fish, liver, egg yolks, cheese and mushrooms, as well as fresh fruit and vegetables comprising rich sources of antioxidants – flavonoids and selenium – that have anti-inflammatory benefits, and beta carotene, which helps the body fight toxins that may damage tissues. Flavonoids are found in black and green teas, apples, berries and grapes. Selenium is found in bread, cereals, seafood, poultry, eggs and dairy products. According to the ALA, wholegrain foods could also play a part in reducing the symptoms of asthma. The article ‘Vitamin D for the management of asthma’ suggests that insufficient levels of vitamin D are associated with an increased risk of asthma attacks in children and adults. It also indicates that taking a vitamin D supplement every day can significantly reduce the risk of hospital admission for a severe asthma attack. RETAIL PHARMACY ASSISTANTS • DEC 2020