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Background and Objective: Most evidence about difficult‐to‐treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult‐to‐treat'. Methods: We conducted a cross‐sectional survey of Australians aged ≥18 years with current asthma from large web‐based survey panels. Enrolment was stratified by gender, age‐group and state/territory based on national population data for people with asthma. Difficult‐to‐treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high‐dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID‐19)‐related behaviour. Weighted data were analysed using SAS version 9.4. Results: The survey was conducted in February–March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non‐DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2–5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3–4.4, p < 0.0001]) in the previous 12 months. Conclusion: Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under‐represented in registries or clinical trials. In this cross‐sectional study of a nationally‐representative population of 6048 adults with current asthma, 21.7% had difficult‐to‐treat asthma. Burden for patients and health system was seen in poor general health status, poor asthma symptom control, frequent urgent GP and emergency department (ED)/hospital visits and high prevalence of multimorbidity, particularly anxiety and/or depression. See relatededitorial [ABSTRACT FROM AUTHOR]

Background: Respiratory disease is common in people with intellectual disability (ID). The inhaled route is preferred for medication administration in treating respiratory diseases, including asthma. People with ID often need assistance with taking medicines due to cognitive, physical, and sensory impairments; in supported accommodation this assistance is provided by direct support professionals (DSPs). Method: A qualitative study design was used to explore DSPs' experiences with asthma medication management. Data were collected via in-depth, semistructured, face-to-face or telephone interviews.Results Key findings included the complex balance of duties undertaken by DSPs, and a lack of consistency in asthma management processes across sites. Conclusions: This exploratory research suggests that DSPs are involved in asthma management and required to use clinical judgement, but are not provided with education and tools to manage asthma in, and foster correct inhaler use by, their clients. This highlights the need for tailored guidelines that integrate with the principles of the National Disability Insurance Scheme.

The survey was completed by 12 152 people of which 7285 (61%) reported a history of doctor-diagnosed asthma.5 People with asthma were particularly vulnerable to the impacts of smoke exposure, with 93.6% experiencing respiratory symptoms compared to 70.2% in those without asthma (Fig. Notably, people with asthma reported significantly higher rates of serious health outcomes including attending the ED (5.9%), hospitalization (2.4%) and requiring corticosteroid medication (16.3%) compared to those without asthma (1.4%, 0.6% and 2.4%, respectively). Keywords: asthma; bushfire; impact EN asthma bushfire impact 296 297 2 03/22/21 20210401 NES 210401 The impact of bushfire, particularly on those with chronic lung diseases, is now recognized.1,2 Individuals with asthma are among the most vulnerable groups.3 As bushfires are anticipated to be longer and more intense in many regions of the world, their adverse impact, particularly in asthmatic individuals, will impose a significant burden. [Extracted from the article]

Australian data suggest up to 15% of people with intellectual disability (ID) have asthma. The inhaled route of administration is optimal for the management of obstructive airways diseases; however, correct inhaler use requires dexterity and particular breathing patterns and potentially represents a problem in this population due to physical and cognitive deficits. Understanding the nature and extent of inhaler use in persons with ID is important, as correct inhaler technique is imperative for optimal clinical outcomes; however, currently no evidence base exists to inform health professionals. This study describes respiratory medication use, reported prevalence of asthma, and asthma management practices undertaken in a clinic sample of Australian adults with ID. Results showed a prevalence of retrospectively reported asthma of 6%, with 86% of asthma patients prescribed inhaled medication. A review of patient records also indicated omission of some recommended asthma management strategies. [ABSTRACT FROM AUTHOR]

Background and Objective: Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults., Methods: A cross-sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self-reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant-reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults., Results: Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co-morbid conditions, the aRR was slightly attenuated to around 1.85-1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1-29.1) and after further adjustment for co-morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men., Conclusion: Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity., (© 2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

For over 200 years, equine anatomic literature has chiefly portrayed the attachment points of the nuchal ligament lamellae (NLL) from the second to the seventh cervical vertebrae (C2-C7). However, recent studies have shown that the modern domestic horse, Equus caballus, primarily exhibits the attachments points from C2-C5. Here we present the rare finding of a complete NLL attached from C2-C7 in one Australian Stock Horse (ASH) and discuss the potential implications of these findings. Previously, this trait has only been confirmed among close descendants of Equus ferus ferus; namely the primitive Dutch Konik and Bosnian Mountain Horse. The examination of the NLL attachment points in 55 unrelated horses of mixed breeds revealed that 52 horses had attachments from C2-C5; 1 horse (Welsh Cob) had attachments from C2-C6; and only 2 horses (ASH and Dutch Konik) presented with a complete NLL attached from C2-C7. In light of earlier findings that suggest this loss of NLL attachment at C6 and C7 occurred after domestication, a possible explanation for this finding in 1 ASH is that it is a remnant trait from the founder population of Waler horses that contributed to the early development of the ASH breed. The reported rare occurrence of a complete NLL (C2-C7) in a modern domesticated equine (ASH) suggests that there may be other individuals expressing this unique trait, providing opportunity for its preservation., (Copyright © 2019 Elsevier Inc. All rights reserved.)