Home' Australian Pharmacist : Australian Pharmacist October 2014 Contents Australian Pharmacist October 2014 I ©Pharmaceutical Society of Australia Ltd. 37
Arthur Boyd at PAC14 Dinner
Delegates to PAC14 in Canberra who
choose to attend the Gala Dinner will
have a unique opportunity to attend
a private viewing of the magnificent
Arthur Boyd Agony and Ecstasy
exhibition at the National Gallery of
Australia. The masque Gala Dinner,
on Saturday 11 October, will also be
highlighted by the announcement
of the Pharmacy Student of the Year.
This will see the winner announced
form the eight State and Territory
finalists, as well as the NAPSA wildcard
finalist, who earlier will have taken
part in their counselling competition.
The Congress will be held at the
National Convention Centre from
Friday 10 to Sunday 12 October.
The Pharmaceutical Society has
welcomed the appointment of Martin
Bowles as Secretary of the Department
of Health. PSA CEO, Dr Lance Emerson,
said Mr Bowles' appointment brought
great experience to the position at a
time of challenges and opportunities
for the health sector. 'Mr Bowles has
great experience as both a Secretary
and a Deputy Secretary in a number
of government departments.
PSA looks forward to working with
Mr Bowles and the department to help
implement some of the necessary
reforms to the health system and to
better utilise the skills and knowledge
of pharmacists to improve the health
outcomes of all Australians'.
vocal cords might beneficial for
improving asthma control. A total of
11 patients with abnormal vocal cord
movement, and who exhibited severe
asthma symptoms despite optimised
treatment were recruited. The authors
acknowledged that their findings of
'abnormal vocal cord movement' were
reminiscent of VCD, but could/did not
confirm they were the same condition.
A total of 24 injections were given to the
11 patients. Each patient received one
initial injection of 2.5 U of Botox (type
A; Allergan) in an injection volume of
Repeat injections were required
in seven of the participants whose
asthma control did not improve one
month after the injection, or who still
experienced recurrent symptoms three
months after the injection. There were
statistically significant improvements in
the two primary endpoints of asthma
control test score and abnormal vocal
cord movement (mean ± standard
deviation). The overall asthma control
test score was improved from 9.1 ±
2.4 before vs 13.5 ± 4.5 after treatment
(p <0.001), though a score change of
≥3 is required before it is considered
clinically significant. Abnormal vocal
cord movement was assessed by
measuring the percentage of time the
airway was narrowed below the lower
limit of normal, and was reduced from
39.4 ± 37.63% before vs 17.6 ± 25.6%
after treatment (p = 0.032).
There were no significant changes
in the secondary measures of lung
function tests via spirometry, and
oral and inhaled corticosteroid use.
The main side effects reported were
mild and transient dysphagia (with
no signs suggesting aspiration) in six
cases, and mild dysphonia in 17 cases
with all patients able to conduct normal
conversations and work activities.
While the results appear promising,
there are many limitations to this study,
e.g. small sample size, lack of blinding
and placebo control, and short follow
up time to name a few. More data is
required to define the role of Botox in
the management of refractory asthma
with abnormal vocal cord movement,
and which patients could benefit from
Dosing information: botulinum toxin (type A,
Botox; Allergan, Sydney, NSW, Australia)
2.5 U, repeated as required
as some cases (e.g. with
dystonia) required more
than one injection
Glabella lines: 4 U at 5
injection sites (= 20 U)
injection sites (= 12 -- 36 U)
injection sites (= 8 -- 24 U)
NB: dosing of Botox should be individualised for
each patient, and started at the lowest effective
dose, with the dosing interval typically not
being more frequent than every three months.
Commercially available preparations of botulinum
toxin are not interchangeable as the units by
which potency is measure is not therapeutically
equivalent. One unit (U) of Botox corresponds to
the calculated median intra-peritoneal lethal dose
(LD50) in mice, performed in mouse potency assay.
• Baxter M, Uddin N, Raghav S, Leong P,
Low K, Hamza K, Holmes PW, Hamilton
G, Thyagarajan D, Lau K, Bardin PG.
Abnormal vocal cord movement
treated with botulinum toxin in
patients with asthma resistant to
optimised management. Respirology.
• Gibson P. Laryngeal botoxification for
severe asthma. 2014;19(4):467--8.
• Low K, Lau KK, Holmes P, Crossett
M, Vallance N, Phyland D, Hamza K,
Hamilton G, Bardin PG. Abnormal
vocal cord function in difficult-to-treat
asthma. Am J Respir Crit Care Med.
• Christopher KL, Wood RP 2nd,
Eckert RC, Blager FB, Raney RA,
Souhrada JF. Vocal-cord dysfunction
presenting as asthma. N Engl J Med.
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