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As of January 2019, we will no longer be sending out the doctorportal email newsletter. The final issue of this newsletter will be distributed on 13 December 2018. Articles from this issue will be available to view online until 31 December 2018.

Vitamin D cuts asthma attack risk: study

 

 

Asthmatics who take vitamin D supplements could halve their chances of winding up in hospital being treated for a serious asthma attack.

British researchers reviewed data from 955 people, mainly adults with mild-to-moderate asthma, involved in seven trials that tested the use of oral vitamin D supplements.

Use of the supplements lead to a 50 per cent drop in the number of people being admitted to a hospital emergency department because of an asthma attack, the study published in The Lancet Respiratory Medicine journal on Thursday said.

There was also a 30 per cent slide in the number of asthmatics needing to be treated with steroids, the researchers from Queen Mary University of London found.

The supplements were found to be particularly beneficial for people who had low levels of vitamin D.

“These results add to the ever-growing body of evidence that vitamin D can support immune function as well as bone health,” lead researcher Professor Adrian Martineau said.

“Vitamin D is safe to take and relatively inexpensive so supplementation represents a potentially cost-effective strategy to reduce this problem.”

About one-in-nine Australians have asthma, a long-term lung condition that makes the airways in the lungs particularly sensitive and can cause breathlessness, coughing and wheezing.

Asthma Australia chief executive Michele Goldman says while the findings are encouraging as they suggest vitamin D could be another possible way of managing asthma but people should not ditch their preventer medication.

“This could be an effective way to manage asthma in addition to taking your regular preventer medication but it should in no means ….be taken in place of the preventer medication,” Mrs Goldman said.

“Preventer medication remains the best way to treat underlying inflammation in the airway.”

You can read the full study here, and a linked comment here.

The quick fix that dramatically cuts antibiotic use

 

Simply asking patients to wait a couple of days to see if their symptoms resolve before filling their script substantially cuts antibiotic use, an Australian meta-analysis has found.

The Cochrane review, led by the University of Queensland’s Primary Care Clinical Unit, looked at 11 studies involving 3,500 patients with suspected common respiratory tract infections. It essentially found no significant clinical difference in outcomes between patients randomised to immediate prescription of antibiotics, delayed prescription, or no prescription.

There were also very low rates of complications or missed treatment of serious complications in those randomised to the ‘wait-and-see’ prescriptions.

But delaying prescription led to a massive drop in antibiotic use. Over 90% of patients with an immediate prescription filled it, compared with around 30% of those with a delayed prescription.

Patients were more satisfied with being given a delayed prescription compared with being given no prescription at all – a significant finding since it’s well recognised that some of the pressure to prescribe antibiotics comes from the patients themselves.

The studies reviewed involved acute respiratory tract infections, including cough, sore throat, colds and otitis media.

Lead author Dr Geoffrey Spurling said the review showed delayed prescribing could be an acceptable compromise if a doctor didn’t believe antibiotics were needed at the time of the consult, but was uneasy about adopting a ‘no-antibiotics’ approach.

“The evidence indicates that delayed prescribing is an effective strategy for reducing antibiotic use and now we need to get this message out the medical community,” he said. “Individual GPs can feel confident implementing this strategy for reducing antibiotic use as a way of treating infections if they are uncomfortable with not prescribing antibiotics.”

As outlined in research recently published in the MJA, Australia has a very high rate of prescribing antibiotics for respiratory tract infections, with antibiotics prescribed at 4-9 times more often than is recommended by therapeutic guidelines.

Australia’s Chief Medical Officer recently sent written warnings to the top 30% of antibiotic prescribers, asking them to think about what they can do to reduce their prescribing.

You can access the Cochrane Review here.