Asthma's blight on New Zealanders' lives

By ANGELA GREGORY

Travis Grosse is your classic asthma whatdunnit.

The Paihia teenager, born in Remuera, is a severe asthmatic who has been in hospital repeatedly with the chronic disease. But doctors do not have a clue why the 13-year-old has it.

Travis' parents and older brothers do not suffer from asthma, and his mother, Sonja Grosse, cannot even figure out what triggers the attacks.

"The cat was sent away from home, we lifted the carpets. Sometimes it seemed to be just the way the wind was blowing, or the way he got out of bed that started it."

The possible causes of asthma, which will be explored in tomorrow's Herald, have included theories of antibiotic use, poor diet, house-dust mites, indoor living, pollution, chemicals and maternal smoking.

It can start at any age but mainly begins in childhood.

Known triggers for some asthmatics include tobacco smoke, dust, allergens, fumes, strong odours, drugs, food and infections.

Travis was what doctors called a bronchial baby, but a severe asthma attack which had him being rushed to hospital aged just 18 months confirmed he had serious asthma.

Mrs Grosse, a registered nurse, found it took years to work out how best to manage her son's condition.

It was not until Travis attended an asthma camp three years ago that she was given useful advice about the monitoring of his peak flow readings, which measure lung capacity.

Mrs Grosse was finally able to get on top of the problem and Travis has not been admitted to hospital since then.

Previously, during the years the family lived in Ellerslie, Auckland, Travis would wind up in Starship Hospital about twice a year.

It was the same when the family shifted north about five years ago.

Travis, by then eight, spent the next two years in and out of Kawakawa Hospital, having to visit about once every eight weeks.

For Travis, skipping school seemed a bonus and he was also getting out of sport which he did not enjoy.

Mrs Grosse, who had to take time off work, was less impressed.

"On average it would be two- to three-day visits at hospital where I would stay with him ... Sometimes up to five days. He has missed out."

Travis' story encapsulates many of the tricky issues surrounding asthma.

They include not just those mystery causes of the disease and baffling range of triggers, but inadequate education about asthma management and the direct and indirect costs to families burdened with the disease.

The medical director of the Asthma and Respiratory Foundation, Professor Ian Town, says everyone can be doing a better job in tackling the killer disease.

A medical professor at the Christchurch School of Medicine and Health Sciences, Professor Town says there is a sense of complacency in New Zealand about asthma management.

There is a perception the problem is being dealt with because of falling mortality rates.

But Professor Town says the numbers of wheezing New Zealanders rolling up to hospital emergency departments and days taken off work or school tell a different story.

Every year an estimated 550,000 school days are lost due to asthma and thousands of New Zealanders are admitted to hospital with the disease.

In-patient asthma care costs the country about $14 million a year and New Zealanders are entering hospital at more then double the rate of 30 years ago.

In the year to June 1999 hospital admissions reached 9405.

Around 6000 admissions were for asthmatic children, the disease being the most common cause for children being admitted to hospital.



Maori and Pacific Island children tend to have more severe asthma and hospital admissions are twice as high for Maori than non-Maori.

Professor Town accepts there are signs of improvement in attitudes towards asthma care, but says too many medical professionals and government agencies still fall short.

He questions the difficulty in accessing some drugs, the motivation of GPs and the awareness of district health boards.

"There remains a lack of recognition of the burden on individuals and the health care system and the wider costs to society."

Even many patients tend to start tolerating their symptoms, reducing their level of activity and expectations. They may for instance choose to work part-time rather than full time and avoid exercise, he says.

Employers are also not generally tolerant of people with chronic health conditions and subtle discriminations are evident in some workplaces.

Severe asthma sufferer Lisa Rolfe is glad she works at Middlemore Hospital when she recalls how many sick days she had to take a few years back.

When the hospital undertook a survey of chronically ill employees to identify their health problems, Mrs Rolfe had no trouble convincing them of her illness.

The 31-year-old was regularly seen by a respiratory specialist at the hospital, where two years ago she spent an anxious few days hooked up to intensive care equipment to help her breathe.

"If I went for another job I would not like to have to say I had chronic asthma," she says.

"They would look at one person who is healthy and one who is not."

Whangarei marathon runner Maryanne Hooson puts her success in managing asthma down to self-help.

The 41-year-old developed asthma in the Bay of Islands as a toddler.

"I remember one night not being able to breath ... After going to the doctor a few times he ascertained I had asthma."

Each year she would be in and out of hospital, often in panic.

Mrs Hooson was another mystery case.

None of her six sisters, one brother, or her parents had any symptoms of the disease.

She says she avoided sport at school because of her asthma, but as an adult wanted to improve her health and keep her weight down.

She has now run 16 marathons - her inhaler tucked in her socks, and swum long distances - her inhaler wrapped in plastic and stuck down her togs.

Last year Mrs Hooson was admitted to Greenlane Hospital with collapsed lungs, but even then she bounced back, pounding the road within weeks to complete a 60km run.

"I do go slowly though," she concedes.

Mrs Hooson encourages her asthmatic seven-year-old son, Jonti, to exercise to.

"He plays rugby, goes to karate and swims. I had discovered some teachers and other parents were letting him sit out of sport because they knew he was asthmatic, but I put a stop to that."

Mrs Hooson wishes she had received more support and information about asthma as a young person. "In the end it was my own determination to carry on a normal life."

Her positive attitude would impress Nelson community paediatrician Dr Nick Baker.

Dr Baker says too often parents and schools let asthmatic children off the hook over exercise.

"If you have asthma you can lead a very normal life ... It is very sad to see children not being able to run and play because they are too short of breath ... There is still some acceptance that asthma is something to be lived with."

Dr Baker says if asthma is showing itself to be a daily problem with an individual, it usually means the condition is not being properly managed.

Parents should talk to their GPs, local asthma society and support groups.

Dr Baker, the president of the Paediatrics Society, says about 20 per cent of New Zealand children have asthma symptoms and national guidelines are being developed to help manage their condition.

He expects the final document to be weighty but hopes some sensible and accessible advice will be distilled from it for caregivers.

"The big gains are often not the high-tech, fancy stuff in medicine but the simple things."

Already some New Zealand schools are becoming much more asthma aware.

One such asthma-friendly primary school is Corinna School in Porirua, where 48 of the 320 children had asthma.

Principal Kerry Hoskin says the school was into its third year of running an asthma programme to help teachers and pupils cope should a child suddenly have an attack.

The school published a set of asthma guidelines and individual plans were recorded for each child detailing medication.

An asthma register is also kept noting the severity of each child's illness.

Mr Hoskin says the plan was devised with the local public health nurse, who originally suggested asthma procedures be put in place.

The nurse put the school in touch with the Asthma Respiratory Foundation which had led education sessions with the school's staff.

Doctors around the country are also getting much more proactive in asthma management and care.

In West Auckland the general practices together achieved a 42 per cent drop in the hospital admission rates for asthma through their improved primary care management.

Dr Lannes Johnson, president of Integrated Primary Care Services (IPCS), says asthma was a huge problem in West Auckland about eight years ago.

The admissions to Waitakere Hospital were extremely high, indicating that asthma was not being well managed in the area.

IPCS, which represents about 100 doctors and more than 130,000 patients, employed asthma educators and set up a training programme for all the medical practice nurses.

Dr Johnson says other independent practitioners associations have since started similar work.

"I think asthma is generally very well managed in primary care."

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