Peter Curson: Asthma death highlights woeful public ignorance

COMMENT

The recent tragic death of a 21-year-old woman from asthma highlights the fact that the disease remains a major public health problem, and that it is poorly understood and managed.

Asthma rates are soaring worldwide. In the past 25 years, the number of people suffering from the disease in many countries has more than doubled. Today, probably 200 million people have asthma, and the number is rapidly increasing.

No one really knows why. In the United States, probably 20 million people suffer from the disease and there are about 5000 deaths and 500,000 hospital admissions every year.

Australia and New Zealand have some of the highest asthma rates in the world. In Australia, one in every eight adults and possibly 15 per cent of all children under 15 have asthma. In New Zealand, the proportions may even be higher, particularly among the Maori and Polynesian populations.

In both countries, asthma is probably the most commonly reported long-term health condition of children, and the most common reason for emergency care and hospital admission.

Despite many improvements in medication and treatment, there remains an incomplete understanding of the underlying causes of an increase in the disease, and there is little doubt that it is poorly controlled, with high levels of community ignorance about what triggers an attack and what might be done to manage it.

There seems little doubt that asthma is an environmentally acquired disease. It would appear also that in some countries like New Zealand the biophysical and the built environment (that is, our homes) play an important role.

Asthma is also a multi-factorial disease. Contrary to popular opinion, it usually takes several factors to produce an attack. A sudden drop in temperature, seasonal pollens, a variety of common allergens and irritants associated with our homes such as dust mites, pet saliva and fur, dampness, molds and fungi, unflued gas heating, open fires and tobacco smoke are all implicated in asthma attacks, as are outdoor air pollution and winter respiratory viruses.

Given that New Zealanders have one of the highest atopy, or allergy-sensitivity, rates in the world, it is perhaps not surprising there is so much asthma around. But if an asthma attack is provoked by some aspect of the biophysical or human environment, it seems a great irony that most of the research into its causes over the past few decades has concentrated on investigating pathological processes and mechanisms.

It is, as one observer remarked, as if those wishing to discover the cause of scurvy had concentrated on the pathological changes in the gums of sailors. Doubtless this may have thrown up some interesting facts, but it is unlikely the actual causes of scurvy would have been among them.

In New Zealand, asthma probably costs the community $1 billion a year in medical treatment, medications, and days of lost productivity and schooling. To the individual sufferer and his or her family, the social and economic costs can be a substantial burden. Possibly, families with an asthmatic child may spend between 10 and 15 per cent of their family income annually on medical treatment and day-to-day management.

The social costs run deeper. Children who suffer from asthma have higher levels of sick days at home than do other children, as well as being called upon to modify their lifestyle. This places considerable burdens on the carer, who often must take days off work and devote considerable time and resources to looking after a sufferer.

There would also seem little doubt that loss of schooling days may have wide-ranging effects on achievement levels, as well as on patterns of socialisation.

Interestingly, unlike most diseases, asthma does not seem to show any relationship between socio-economic status and prevalence. On the other hand, it is clear that sufferers from lower socio-economic groups do not have the same access to medications and health care, largely because of restricted financial resources. Maori and Pacific Islanders, in particular, seem to be the worse off for such access.

The ability to cope with asthma depends much on the sufferers' and their carers' attitude to health risk, their knowledge and understanding of asthma and its management, their ability to recognise attacks, and the resources they can marshal to be able to intervene and manage such situations.

Unfortunately, it would appear there is a woeful understanding of asthma and its management in the community. Until we have a better understanding of the disease, the onus of day-to-day management will continue to fall on the sufferer and their carers, and this will require a far better community understanding of the disease and the factors that produce an attack.

To achieve this will require a partnership between those with asthma, those who care for them, the health system and the Government. In particular, we need a strategy to raise public awareness about asthma, particularly about how to recognise an attack, what factors might provoke an attack and what to do about it. We also need a health system that delivers the required medication and management plans, and a Government which makes such things readily accessible to all people regardless of their financial resources.

* Professor Peter Curson is director of the health studies programme at Macquarie University, New South Wales.