Objective: To review patient outcomes and the molecular epidemiology of multidrug‐resistant tuberculosis (MDR‐TB) strains isolated from patients living in the Western Province of Papua New Guinea (PNG) seeking treatment in Australia. Design, setting and participants: Review of all cases of MDR‐TB among people living in the open border region between the Western Province of PNG and the Torres Strait Islands of Australia who presented to health clinics in the region between 2000 and 2006. All cases of suspected TB were bacteriologically confirmed at the time of presentation by the Mycobacterium Reference Laboratory in Brisbane. Main outcome measures: Drug resistance patterns; drug use and duration; molecular typing of TB strains; patient outcomes. Results: Between 2000 and 2006, 60 patients from the Western Province of PNG were diagnosed with TB, of which 15 had MDR‐TB. Mortality was high, although no patient who was able to maintain access to supervised therapy died. All 15 MDR‐TB isolates were Beijing‐family strains showing the same unique mycobacterial interspersed repetitive unit (MIRU) profile, with the exception of a single strain that differed by a single repeat at one locus. Restriction fragment length polymorphism (RFLP) typing on 10 of these strains further differentiated them into two distinct clusters. Conclusion: Transmission of MDR‐TB is occurring in the Western Province of PNG. Additional resources are urgently needed to interrupt the ongoing transmission of MDR‐TB from the Western Province of PNG to the Torres Strait Islands. Good supervision and management of patient treatment, which includes ensuring a regular supply of second‐line anti‐TB drugs, are essential elements of TB control.

Objectives: To identify expressions used by patients to describe worsening asthma; to examine the relevance of the word “exacerbation” to patients’ experience; and to investigate whether their language is influenced by the severity of the episode and/or the target audience such as family members, friends and work colleagues. Design and setting: Qualitative study carried out from 1 January to 30 December 2004 among community volunteers to a research institute. Semistructured face‐to‐face interviews were used to elicit descriptions of episodes of worsening asthma, and further questioning was used to examine language used with family, employer and doctor. Participants: 25 people with asthma, aged 22–75 years. Main outcome measure: Themes identified by open coding about patient language for worsening asthma. Results: 12 participants were not familiar with “exacerbation” and only three would use it themselves. “Attack” was the only specific term spontaneously volunteered (20 participants), but it was used for anything from mild to life‐threatening episodes. Patients often downplayed the severity of worsening asthma to their families. Different language was used with employers, sometimes to justify sick leave and sometimes because of fear of perceived discrimination. When communicating with clinicians about worsening asthma, patients used symptom descriptors rather than specific terms. Conclusion: There are important differences in the language patients and clinicians use to describe worsening asthma, and the word “exacerbation” has poor utility for communication with patients.

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