This informal report briefly examines the asthma in Australia: its causes, symptoms, prevalence rate among all age groups and also its management and treatment. The symptoms of asthma as described are breathlessness, coughing and chest tightness which could be as a result of narrowing of airways. The prevalence rate showed that asthma affects Australian adults more often than children, and in adults it affects females more than the males. It also showed that at the moment there is no cure for the condition in Australia and so it was recommended that the best method of treatment is special management strategies which can best be effective if carried out by the patient.
Asthma is a common chronic inflammatory condition of the airways which presents variable and recurring symptoms such as wheezing, breathlessness, coughing and chest tightness due to widespread narrowing of the airways. Among those with the condition, airway narrowing and the above symptoms can be triggered by viral infections, exercise, air pollutants, tobacco smoke or specific allergens such as house dust mites, pollens and animal danders. The symptoms of asthma are usually reversible, either spontaneously or with treatment. Researchers think a combination of factors (family genes and certain environmental exposures) interact to cause asthma to develop, most often early in life.
These factors include:
An inherited tendency to develop allergies, called atopy
Parents who have asthma
Certain respiratory infections during childhood
Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing.
Asthma affects people of all ages with a substantial impact on the community. While there is currently no cure for asthma, there are effective management strategies available to control the condition and reduce the worsening of asthma symptoms. It has been stated that ‘there is evidence that the uptake of these strategies has not been optimal among people who could benefit greatly in terms of reducing the impact of asthma on both themselves and the community’ (1). For these reasons, it is important to continue to monitor the prevalence of asthma, its distribution within the community, markers of asthma exacerbations and the uptake of effective clinical management practices.
This report, describes the status of asthma in Australia using a range of data sources. It aims to cover a wide audience, including health professionals, policy makers, health planners, academics, consumers and interested readers, with up-to-date summaries of data and trends for asthma in Australia.
Asthma affects 7% of the population of the United States, 6.5% of British people and a total of 300 million worldwide. It has been reported that, ‘In Australia, the prevalence of current asthma among Aboriginal and Torres Strait Islander Australians in the 2004–05 NATSIHS was 16.5% with a lower prevalence in males (12.5%) than females (19.9%)’(2). The age-adjusted prevalence of current asthma was higher among Indigenous Australians (16.5%) than other Australians (10.2%) in 2004–05, Indigenous males had a higher prevalence of asthma (12.5%) than non-Indigenous males (9.0%), and Indigenous females reported a higher prevalence (19.9%) than their non-Indigenous counterparts (11.4%). It can be seen that the difference in prevalence of current asthma exists across all age groups; though it is more prominent in older adults, especially females. Among those aged 35 years and over, the prevalence of asthma among Indigenous Australian females was double that observed for other Australian females in the same age group (22% versus 11%). In contrast to the age trend in non-Indigenous people, among Aboriginal and Torres Strait Islander Australians, the prevalence of current asthma was considerably higher in older adults than in children. The explanation for the relatively high prevalence of asthma among older Indigenous people, compared to non-Indigenous people of the same age and compared with younger Indigenous people, is not certain. Possible factors include the cumulative impact of life-long exposure to environmental factors adversely affecting the airways (such as tobacco smoke and infections) and long-term improper treatment of asthma.
The Australian Government Department of Health and Ageing recently developed an asthma action plan specifically for Indigenous Australians living in remote areas. This plan includes images from the Short Wind educational materials, developed by the Asthma Foundation of the Northern Territory. It is associated with terms such as ‘whistle breathing’, ‘blue puffer’, ‘send someone to health clinic for help’ describe symptoms for quick response’ (1). The proportion of people using pharmaceutical medications for their asthma increased with age, from 38% among those aged 5–14 years to 79% among those aged 55 years and over among Australians.
There is evidence of relative under-use of treatments for asthma among Indigenous children of Australia. In a study of children starting kindergarten in the Australian Capital Territory, it was shown that ‘8% of Indigenous children compared with 17% of non-Indigenous children with parent-reported respiratory symptoms in the previous 12 months or asthma diagnosis were using inhaled corticosteroids’(3). In the Western Australian Aboriginal Child Health Survey, ‘it was found that 42.0% (95% CI 37.6–46.3%) of children with asthma in the state were managing it without medication’ (4). One study in Far North Queensland found a high level (55–88%) of suboptimal asthma therapy and a higher level of persistent symptoms in Aboriginal and Torres Strait Islander Australian children (30%) than non-Indigenous Australian children (5–7%). Couzos & Davis (2005) reported that (5) ‘80% and 48% of ACCHSs indicated a problem in patient access to spacer devices and patient access to asthma medications, respectively’. In response to this, the Australian Government introduced the Asthma Spacers Ordering System (ASOS) in July 2006. The system makes available spacers to Indigenous communities at a significantly reduced cost.
There is no direct cure for asthma yet, but some management steps can be taken by patients to reduce its symptom to a minimal level to permit them live a normal healthy life. Asthma education is an important management step in asthma guidelines in developed countries like Australia. Although there are no data on the availability of culture-specific asthma education programs for Indigenous Australians with asthma. Cultural influences on the management of asthma include symptom perception and understanding of disease and self-management procedures. Health workers should be trained directly for management of asthma and should be targeted at their own ethnic group specifically for an Indigenous health worker intervention group. Australians should be advised against smoking especially the adults and also exposure to smoke especially in pregnant women.
Conclusion and Recommendations
Asthma has continuously remained the second most common self-reported long-term illness in Indigenous Australians. Though there seem to be some differences in published survey data but, overall, it is likely that asthma or asthma-like symptoms are more common in older Indigenous people and among young Indigenous children than their non-Indigenous counterparts. The discrepancies are greater in people living in non-remote areas and, among adults, are greater in females than males. Smaller differences are seen in older children and young adults. Asthma is quite difficult to diagnose accurately in young children and older adults, it is possible that the differences in the reported prevalence of asthma and asthma-like symptoms are, in fact, attributable to related diseases such as bronchiolitis, chronic obstructive pulmonary disease and chronic suppurative lung disease.
From the facts gathered in this report, it can be recommended that management of asthma in Indigenous Australians is identical to that in non-Indigenous Australians, that is, use of effective asthma medications and devices, appropriate asthma education and an asthma action plan by the government, as well as managing generic health-care issues such as mental health status and other comorbidities, reducing exposure to tobacco smoke and consumption of a healthy diet. However, Indigenous programs need to be culturally appropriate in order to maximise effectiveness
It can clearly be seen from the above informal report that there is currently no direct cure for asthma in Australia. The best recommendation for patient X is to give him good and appropriate asthma education that will help him manage his asthma effectively and live otherwise as a healthy man. He should not smoke; he should avoid smoky and dusty environment, and heavy exercise that affect his breathing. He should use appropriate medication and devices prescribed for him and a balanced diet will also be helpful.
1 AIHW(Australian Institute of Health and Welfare) 2008e. Occupational asthma in Australia. Bulletin no. 59. Cat. no. AUS 101. Canberra: AIHW.
2 NAC (National Asthma Council Australia Ltd). Asthma management handbook. South Melbourne: NAC [online] 2006 [cited 2010 May 5]. Available from: URL:. http://www.nationalasthma.org.au.
3 Glasgow NJ, Goodchild EA, Yates R, Ponsonby A-. Respiratory health in Aboriginal and Torres Strait Islander children in the Australian Capital Territory. Journal of Paediatrics and Child Health.2003 39:534–9.
4 Zubrick SR, Lawrence DM, Silburn SR, Blair E, Milroy H, Wilkes T et al. The Western Australian Aboriginal Child Health Survey: the health of Aboriginal children and young people. Perth: Telethon Institute for Child HealthResearch. 2004.
5 Couzos S, Davis S. Inequalities in Aboriginal health: access to the Asthma 3+ Visit Plan. Australian Family Physician. 2005 34:837–40.