FAST ONSET AND EFFECTIVE ASTHMA CONTROL * 1, 2, 4
7 SEPTEMBER 2018 australiandoctor. com. au
Kids on Nauru at risk of death
† 1 – 3
FAST ONSET AND EFFECTIVE ASTHMA CONTROL * 1, 2, 4
† 1 – 3 minutes onset of LABA component bronchodilation. 1 – 3 * Significant reduction in time to first severe exacerbation # with Symbicort ® maintenance and reliever therapy vs. fixed-dose Seretide ®( fluticasone / salmeterol) plus SABA. 1, 2, 4
# Severe exacerbation was defined as deterioration in asthma, resulting in hospitalisation / emergency room treatment, oral steroids for ≥3 days or an unscheduled visit( i. e. patient-initiated) leading to treatment change. 4 SABA = short-acting beta-agonist; LABA = long-acting beta-agonist.
PBS Information: Authority required( STREAMLINED). Asthma. Refer to PBS Schedule for full authority information.
Sarah Wiedersehn DOCTORS caring for refugee children on Nauru say there’ s been a spate of incidents of self-harm on the island and fear there will be suicides.
Some 130 children are detained on the island, but many are self-harming, according to reports, including a 14-year-old girl who doused herself in petrol and threatened to set herself alight.
The situation has become so extreme that many of the children have been diagnosed with resignation syndrome— a rare psychiatric condition that presents as progressive social withdrawal and reluctance to engage.
The most serious stage of the disorder is when the child becomes comatose, according to Dr Vernon Reynolds, who worked on Nauru as a child psychiatrist for almost two years.
“ What we see is these young people and adults basically withdraw from life and generally take to their bed, and their whole functioning deteriorates,” Dr Reynolds told the ABC.
“ So they stop eating much, they stop drinking much, they stop looking after their day-today self care. They stop interacting with people, they stop talking.”
He added:“ Am I concerned that children could die in Nauru, that some of these refugee children could die?
“ I am absolutely concerned about that. I am reasonably surprised that no one has.”
The claims triggered a call from the Royal Australasian College of Physicians to end offshore processing immediately.
A former government adviser on asylum-seeker and refugee mental health, Professor Louise Newman, said the situation on Nauru had reached a crisis point.
“ We are now seeing this virtual epidemical outbreak on Nauru of very severe traumatic responses, which can be life-threatening,” Professor Newman said.
“ We had a child last week who had poured petrol on herself and was going to set herself alight, we’ ve had a young child about to jump off a cliff, so we’ ve had near, near misses.
“ We have children who have stopped speaking entirely other than to say they want to die, and these are children as young as 10.”
Professor Newman said she held little hope the situation would change because of the bureaucracy in Canberra.
“ We’ ve had delays in getting seriously ill people to treatment, which are currently being investigated by coroners.
“ Concerns are being raised about a system that is not governed by health in any way.”
BEFORE PRESCRIBING PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342 OR www. astrazeneca. com. au / PI Symbicort ® Turbuhaler ®( budesonide and formoterol( eformoterol) fumarate dihydrate *) for oral inhalation. Indications: Asthma: Treatment of asthma where use of a combination( inhaled corticosteroid and long acting β2-agonist) is appropriate in adults and adolescents. COPD: Symptomatic treatment of moderate to severe chronic obstructive pulmonary disease( COPD),( FEV1 ≤50 % predicted normal) in adults with frequent symptoms despite long acting bronchodilator use, and / or a history of recurrent exacerbations. Symbicort is not indicated for the initiation of bronchodilator therapy in COPD. Dosage: Asthma: There are two alternative treatment regimens for asthma: Symbicort Maintenance and Reliever Therapy( SMART TM) or Symbicort Maintenance Therapy. Refer to Product Information for full details on dosage. Symbicort Maintenance and Reliever Therapy( SMART TM) for Asthma: Symbicort 100 / 6 and 200 / 6: Adults and adolescents ≥12 years: 2 inhalations per day given as either 1 inhalation twice daily or 2 inhalations in either the morning or evening. For some patients, a maintenance dose of Symbicort 200 / 6 2 inhalations twice daily may be appropriate. Patients may take an additional inhalation as needed in response to symptoms, up to 6 inhalations at one time. If patients experience a three-day period of deteriorating symptoms after taking the appropriate dose, the patient should be re-assessed. A total daily dose of up to 12 inhalations can be used temporarily. Symbicort 400 / 12: The 400 / 12 strength should not be used for Symbicort Maintenance and Reliever therapy. Symbicort Maintenance Therapy for Asthma: Symbicort 100 / 6 and 200 / 6: Adults and adolescents ≥12 years: 1 – 2 inhalations twice daily. Symbicort 400 / 12: Adults ≥18 years: 1 – 2 inhalations twice daily. Dosage: COPD: Symbicort 200 / 6: 2 inhalations twice daily. Symbicort 400 / 12: 1 inhalation twice daily. Contraindications: Hypersensitivity to any of the ingredients. Precautions: Symbicort therapy should not be initiated to treat a severe exacerbation. Not for initiation of inhaled steroids in patients transferring from oral steroids; impaired adrenal function; infections of the respiratory system; increased susceptibility to sympathomimetic amines; severe cardiovascular conditions; hypokalaemia; diabetes; impaired renal and hepatic function; pregnancy( category B3); lactation; children < 12 years. Pneumonia: Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap. Pneumonia has been reported following the administration of inhaled corticosteroids. Interactions: CYP3A4 inhibitors( e. g. ketoconazole); beta-receptor blockers; beta-adrenergic stimulants; sympathomimetic amines( e. g. ephedrine); MAOIs; tricyclics antidepressants; quinidine; disopyramide; procainamide; phenothiazines; antihistamines associated with QT interval prolongation e. g. terfenadine, astemizole; if hypokalaemia: xanthine derivatives, mineralocorticoids, diuretics, digoxin. Adverse effects: Common: tremor, palpitations, oropharyngeal candidiasis, headache, throat irritations, coughing, hoarseness; others, see full PI. Date of first inclusion in the ARTG: 27 May 2002( Symbicort Turbuhaler 100 / 6 and 200 / 6); 5 May 2004( Symbicort Turbuhaler 400 / 12). Date of most recent amendment: 19 December 2017. Symbicort ® Rapihaler ®( budesonide and formoterol fumarate dihydrate *) for oral inhalation. Indications: Asthma: Treatment of asthma where use of a combination( inhaled corticosteroid and long acting β2-agonist) is appropriate in adults and adolescents. COPD: Symptomatic treatment of moderate to severe chronic obstructive pulmonary disease( COPD),( FEV1 ≤50 % predicted normal) in adults with frequent symptoms despite long acting bronchodilator use, and / or a history of recurrent exacerbations. Symbicort is not indicated for the initiation of bronchodilator therapy in COPD. Dosage: Asthma: There are two alternative treatment regimens for asthma: Symbicort Maintenance and Reliever Therapy( SMART TM) or Symbicort Maintenance Therapy. Refer to Product Information for full details on dosage. Symbicort Maintenance and
Reliever Therapy( SMART TM) for Asthma: Symbicort 50 / 3 and 100 / 3: Adults and adolescents ≥12 years: 4 inhalations per day given as either 2 inhalations twice daily or 4 inhalations in either the morning or evening. For some patients, a maintenance dose of Symbicort 100 / 3 4 inhalations twice daily may be appropriate. Patients may take 2 additional inhalations as needed in response to symptoms, up to 12 inhalations at one time. If patients experience a three-day period of deteriorating symptoms after taking the appropriate dose, the patient should be reassessed. A total daily dose of up to 24 inhalations can be used temporarily. Symbicort 200 / 6: The 200 / 6 strength should not be used for Symbicort Maintenance and Reliever Therapy. Symbicort Maintenance Therapy for Asthma: Symbicort 50 / 3 and 100 / 3: Adults and adolescents ≥12 years: 2 or 4 inhalations twice daily. Symbicort 200 / 6: Adults ≥12 years: 2 inhalations twice daily. Dosage: COPD: Symbicort 200 / 6: 2 inhalations twice daily. Contraindications: Hypersensitivity to any of the ingredients. Precautions: Symbicort therapy should not be initiated to treat a severe exacerbation. Not for initiation of inhaled steroids in patients transferring from oral steroids; impaired adrenal function; infections of the respiratory system; increased susceptibility to sympathomimetic amines; severe cardiovascular conditions; hypokalaemia; diabetes; impaired renal and hepatic function; pregnancy( category B3); lactation; children < 12 years. Pneumonia: Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap. Pneumonia has been reported following the administration of inhaled corticosteroids. Interactions: CYP3A4 inhibitors( e. g. ketoconazole); beta-receptor blockers; beta-adrenergic stimulants; sympathomimetic amines( e. g. ephedrine); MAOIs; tricyclics antidepressants; quinidine; disopyramide; procainamide; phenothiazines; antihistamines associated with QT interval prolongation e. g. terfenadine, astemizole; if hypokalaemia: xanthine derivatives, mineralocorticoids, diuretics, digoxin. Adverse effects: Common: tremor, palpitations, oropharyngeal candidiasis, headache, throat irritations, coughing, hoarseness; others, see full PI. First inclusion in the ARTG: 22 February 2006( Symbicort Rapihaler 200 / 6), 20 April 2011( Symbicort Rapihaler 50 / 3), 26 July 2012( Symbicort Rapihaler 100 / 3). Date of most recent amendment: 28 March 2017.
* Please note changes to Product Information- eformoterol fumarate dihydrate is now known as formoterol fumarate dihydrate
References: 1. Symbicort ® Turbuhaler ® Approved Product Information, 19 December 2017. 2. Symbicort ® Rapihaler ® Approved Product Information, 28 March 2017. 3. Seberová E et al. Respir Med 2000 Jun; 94( 6): 607 – 611. 4. Vogelmeier C et al. Eur Respir J 2005 Nov; 26( 5): 819 – 828. Symbicort, ® Rapihaler ® and Turbuhaler ® are registered trademarks and SMART ™ is a trademark of the AstraZeneca group of companies. Seretide ® is a registered trademark of GlaxoSmithKline Australia Pty Ltd. Registered user AstraZeneca Pty. Ltd. ABN 54 009 682 311. 66 Talavera Road, Macquarie Park, NSW 2113. www. astrazeneca. com. au. For Medical Information enquiries: 1800 805 342 or medinfo. australia @ astrazeneca. com. au. To report an adverse event: 1800 805 342 or via https:// aereporting. astrazeneca. com. Date of preparation: August 2018. AU-4312. 15057-1 / 2Vb.
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Move over opioids: pregabalin misuse up
Antony Scholefield THE TGA says it is investigating the rapid rise in overdoses and deaths linked with pregabalin misuse.
The decision follows a new study of the neuropathic pain therapy, which reports the schedule 4 drug has been implicated in 82 deaths in NSW since it was listed on the PBS in 2013.
As part of its investigation, the medicines watchdog is planning to review pregabalin prescribing in general practice though longitudinal GP data held by NPS MedicineWise.
Dr Rose Cairns( PhD), the pregabalin study’ s lead author and a lecturer at the University of Sydney, noted the UK Government announced plans to upschedule pregabalin in 2017 because of similar concerns.
It will prevent UK GPs from issuing repeat scripts, unless special circumstances apply.
Writing in the journal Addiction last month, Dr Cairns’ team found that one in seven patients were“ high-risk users” who were seeing multiple doctors, seeking refills less than 20 days later or being prescribed opioids or benzodiazepines in the same month. More than half of all pregabalin by volume was being prescribed to such patients, the researchers said.
And between 2005 and 2016 there were 1158 cases of poisoning in NSW related to intentional misuse of pregabalin.
Perth GP Dr Amanda Stafford wrote on the Australian Doctor website last week:“ Pregabalin has been abused on a grand scale for years now.
“ As someone who works with street homeless patients, I can say that it is highly appreciated for its powerful anxiolytic properties.
“ Since we don’ t want to prescribe benzos for anxiety, the new antipsychotics are expensive unless you scam the PBS with a diagnosis of‘ bipolar type 1’ and since we don’ t want to spend the money to really fix broken, shitty lives, we have an epidemic of PBS-subsidised pregabalin use.”
Dr Hester Wilson, chair of the RACGP addiction medicine specific interest group, said the Federal Government’ s real-time prescribing system needed to cover pregabalin and other dangerous S4 drugs.
Children on Nauru are being diagnosed with resignation syndrome.