We spoke with John Harrington, Respiratory Clinical Nurse Consultant at the John Hunter Hospital in New Lambton Heights, New South Wales, Australia. He is a keen advocate for asthma patients and has published the book “Fast Facts for Patients and their Supporters: Asthma” with Karger which is freely available online.

 

May 5 was World Asthma Day. Can you tell us what this day means to you and your patients?

World Asthma Day for me is an opportunity to reflect on how far we have come in asthma treatments and how far we have to go to in controlling a disease that still causes much death and illness in my country (Australia). 1 in 9 Australians have asthma and 400 to 500 people die of asthma each year. Asthma affects adult females more than males, and Aboriginal and Torres Strait Islander people are more likely to have asthma than white Australian. These inequities within the population of people with asthma further highlight the urgency to achieve better for our patients.

For my patients World Asthma Day is an opportunity to acknowledge themselves and others who suffer from ongoing difficulty in breathing, loss of career opportunity and high health care costs.

Could you please tell us about current and possible future approaches and research in treating asthma?

We are fortunate in asthma to have the opportunity to apply a treatment directly to the affected organ. For asthma the advent of inhaled steroids and, soon after, combined long-acting bronchodilators have reduced asthma attacks, persistent symptoms and deaths dramatically. These remain the successful mainstay of asthma treatment for over 90% of patients with asthma. They have very low side effects and are very safe medications.

Some patients that continue to have symptoms and attacks of their asthma are now able to be treated with powerful new medications called monoclonal antibody medicines. These target specific “switches” in the immune system that are the likely culprits in causing peoples’ asthma to be unresponsive to standard treatments. They are regular injections under the skin. Some of these agents are currently still under research trials. Bronchial thermoplasty is a recent innovation in asthma treatment; it is a surgical procedure using a bronchoscope (lung camera probe) to heat the patients’ airways up, thus reducing the buildup of bunched muscle around the airway. There is good evidence this reduces symptoms and asthma attacks; it too is for those that don’t respond to standard treatment.

What impact has the current COVID-19 pandemic made on your work and on the lives of people living with asthma?

It is difficult to overstate the impact the COVID-19 pandemic has had on how we work in hospitals and on all aspects of our lives. We were very fortunate in Australia that we locked down early and kept pressure from building on our health service. I was flat out at that time advising and preparing. There was a huge need for guidance around how our services operate. The level of collaboration was heartening and there was a strong sense of “being in it together”. COVID has changed the way we see our patients drastically, in some cases for the better (more Telehealth options). Many of my patients had a tough time from early 2020 right through to now as they self-isolated to avoid COVID.

The new vaccines have offered some hope to be able to see friends and family and to travel further than they have all year. Early on in the pandemic there were some medication shortages for asthma treatments; fortunately normal stocks resumed. We think people were more adherent to taking their preventer medications during the pandemic.

For those not familiar with the term: What are the tasks and responsibilities of a Respiratory Clinical Nurse Consultant like yourself?

A Clinical Nurse Consultant (CNC) has a varied and demanding role. I provide expert clinical advice and patient care across various service groups and patient populations. In real terms – I look at what we do for our patients and work out if we should be doing things differently and then work out how we are going to do that. I also see patients with a variety of problems that may have factors that make them a little complicated to treat. I have a role helping with research projects in partnership with our Hunter Medical Research Institute as well as doing my own research. I assist in training the doctors and nurses in my area to better treat patients with respiratory disease such as asthma.

Being based in Australia, what influence do the recurrent wildfires have on those suffering from asthma or other respiratory issues?

This is a great question. The Black Summer bushfires of 2019/2020 were some of the worst Australia had ever seen, with 2.7 million hectares burnt in my State of New South Wales alone. The bushfire smoke caused the air quality to deteriorate drastically. There were several days in Sydney where the Particulate Matter 2.5 microns (the dangerous particle size) measure was four times the WHO safe upper limit. This caused our respiratory patients to experience a significant worsening of their symptoms, and some required hospitalization.

In our severe asthma group, some of the patients have still not recovered to pre-bushfire levels. Air quality is a basic human right; it was distressing to see our patients being harmed by this need not being met. More needs to be done to combat climate change to help mitigate future risks of catastrophic bushfires.

Thank you very much for the interview!

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