Melioidosis is a tropical disease of socioeconomic disadvantage caused by the environmental, Gram-negative bacterium Burkholderia pseudomallei. The previously recognised geographical boundaries of melioidosis are expanding and in northern Queensland, the incidence is increasing. Melioidosis is an opportunistic infection; people with diabetes mellitus, hazardous alcohol use, chronic lung disease, chronic kidney disease, malignancy and/or immunosuppression are most at risk at developing the disease. People with melioidosis usually present with pneumonia and/or bacteraemia, but any organ can be involved. The disease can be severe; around 25% of people will require intensive care unit support and even in well-resourced health settings, approximately 10% of people die from the disease. To effectively treat melioidosis and prevent it from recurring, intravenous antibiotics followed by oral antibiotics are required. Treatment is prolonged and significant adverse drug reactions are common. This presentation will provide a brief overview of the epidemiology, clinical manifestations, diagnosis and treatment complexities of melioidosis.

Updates in paediatric asthma management emphasise a shift away from short‑acting beta‑agonist (SABA)–only treatment. Children and adolescents should not be managed with short‑acting beta‑agonists (SABA) alone, as SABA monotherapy may promote airway inflammation and receptor down‑regulation. Current evidence supports the routine use of a single combined anti‑inflammatory reliever inhaler containing low‑dose inhaled corticosteroid (ICS) budesonide and fast‑acting long‑acting beta‑agonist (LABA) formoterol. This 2‑in‑1 approach has demonstrated safety and efficacy in adolescents and in children aged 5–12 years.
Anti‑inflammatory reliever (AIR) therapy is now recommended as first‑line treatment. A stepped strategy begins with as‑needed low‑dose budesonide–formoterol for mild asthma, progressing to 2 inhalations daily low‑dose maintenance plus as‑needed use for persistent symptoms. This regimen significantly reduces severe exacerbations, with studies showing a 45% reduction in asthma attacks in children compared with SABA‑only regimens. Clinicians are encouraged to avoid tolerating breakthrough symptoms, including exercise‑induced episodes, as indicators of suboptimal control.
Management should follow a structured step‑up/step‑down ICS–LABA framework supported by an individualised asthma action plan. Priorities include minimising oral corticosteroid exposure due to adverse effects and ensuring follow‑up to assess inhaler technique, adherence, and modifiable risk factors such as smoking or vaping.
Environmental considerations should be integrated into routine care. Metered‑dose inhalers (MDIs) contribute substantially to carbon emissions; therefore, optimising asthma control with ICS/LABA therapy to reduce SABA use and transitioning to dry‑powder inhalers (DPIs) where appropriate can significantly lower environmental impact. MDI have a large carbon footprint… the best way to decrease the impact is to achieve good asthma control with ICS/LABA.