Asthma’s grim mortality rate
But new treatment reduces risk of severe attacks by up to 60 per cent.
Asthma is one of the most common respiratoryit diseases in New Zealand, affecting one in seven children and one in eight adults. Following World Asthma Day on May 3, Dr James Fingleton, medical director of the Asthma and Respiratory Foundation New Zealand, sheds some light on the condition and its care.
What is asthma, and how serious is it?
Asthma is a chronic condition ffectingg the airways, with symptomss including wheezing (breath whistling in and out), shortness of breath, tightness in the chest and a cough. These symptoms may occur suddenly as an ‘asthma attack’, or they can be constantly present.
When asthma is well-managed, it does not generally get in the way of people living active lives. However, it can be severe, and for some people it seriously affects their quality of life. There were also 122 deaths from asthma in 2017. Asthma mortality rates were highest in people aged 65 and over, and significantly higher in women than in men for the 30–64 years and 65-and-over age groups. Asthma mortality rates are also more than three times higher for Māori and 2.7 times higher for Pacific peoples compared to other New Zealanders.
How is asthma being managed for most people with the condition?
The New Zealand Adolescent and Adult Asthma Guidelines were updated in 2020, to align with both New Zealand and international clinical trials. The major, fundamental change in asthma treatment has been the recommendation to use a combination ‘2 in 1’ budesonide/ formoterol inhaler as needed to relieve symptoms, rather just than the traditional ‘blue’ reliever inhaler. Studies show this particular combination ‘2 in 1’ inhaler, taken as needed, reduces the risk of a severe asthma attack by between 30 and 60 per cent.
How has Covid affected those suffering from asthma?
The most recent research from GINA (Global Initiative for Asthma) found that people with asthma do not appear to be at increased risk of getting Covid-19, and those with wellcontrolled mild to moderate asthma are not at risk of experiencing a more severe case of Covid. However, the risk of dying from Covid was higher among people who had been hospitalised for severe asthma or who had needed oral corticosteroids.
The pandemic has been a timely reminder for those with asthma to ensure they have good asthma management, which means using their preventer inhaler as prescribed, usually every day; having an asthma action plan in place; and being up-todate with their influenza and Covid immunisations.
The theme of World Asthma Day this year was ‘Closing the gaps in asthma care’ — what are those gaps in a New Zealand context, and how can they be closed?
In New Zealand, Māori and Pacific people and those living in deprived communities are more likely to have asthma, be hospitalised with asthma and die from asthma.
The Asthma and Respiratory Foundation New Zealand’s most recent report into the impact of respiratory diseases found that Māori are almost three times, and Pacific peoples 3.2 times, more likely to be hospitalised because of asthma than Pākehā or other New Zealanders.
People living in the most deprived areas are almost three times more likely to be hospitalised than those in the least deprived areas.
These gaps can only be closed through a national, co-ordinated response to respiratory health. The foundation wants respiratory disease to be a health priority and to see funds invested into targeted programmes addressing these inequalities in care.
At the community level, we want to encourage all health practitioners to reflect on how they can improve their support of the most at-risk asthma groups and to make the best use of tools like personalised asthma action plans.