August edition of Australian Prescriber out now

Long-acting beta2 agonists for childhood asthma

Long-acting beta2 agonists are overprescribed in children, according to Professor Peter van Asperen of The Children’s Hospital at Westmead and the University of Sydney. The drugs should only be given to children who remain symptomatic on optimal doses of inhaled corticosteroids.

The drugs are often used inappropriately as first-line therapy. There are few efficacy trials of long-acting beta2 agonists in children with asthma, and with ongoing safety concerns, the drugs are not recommended for pre-school children. The author highlights these safety concerns, compares long-acting beta2 agonists with other drugs and gives recommendations for treatment.

Editorial: Diagnostic tests and litigation

Diagnostic errors are responsible for almost half the legal claims brought against Australian GPs, according to Dr Sara Bird, Manager of Medico-legal and Advisory Services at MDA National. She highlights the most common errors in diagnosis and explains that underlying causes are complex and multifactorial.

There is some evidence that Australian doctors order more tests as a result of medico-legal concerns. According to Dr Bird, the key to minimising litigation should involve attention to ordering the correct tests and explaining their purpose to patients. Having rigorous recall systems will also ensure the appropriate follow-up of patients and their test results. Good communication and documentation are essential.

Medical management of endometriosis

Endometriosis is increasingly being recognised as a common disease affecting women through their reproductive years, write Dr Kirsten Black and Professor Ian Fraser of Sydney University and Royal Prince Alfred Hospital, Sydney. A greater awareness of the variability in the clinical presentation of endometriosis could reduce its social, health and economic impact.

As a greater understanding of endometriosis emerges, new targets for treatment will become available. However, the authors say that until then the best approach combines both medical and surgical treatments. The single biggest barrier to good management is still timely recognition of the disease, especially in adolescents.

Management of cystic fibrosis in adults

Due to improved childhood treatments, the life expectancy of patients with cystic fibrosis has increased. Doctors are now more likely to encounter adults with this disease. Dr Masel writes about current and emerging therapies.

Other topics in this issue include laboratory tests for tumour markers, and reviews of new drugs for prostate cancer, metastatic melanoma, Parkinson's disease, HIV and hepatitis C.

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Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published every two months and distributed to health professionals free of charge, and is also available online at