"Education is vital for both patients and clinicians but, when whanau are isolated and without support, the task of giving medication goes on the back-burner as they deal with other everyday stresses."
Rapana agreed with other Rotorua clinicians and doctors that housing, cigarette smoke, viral illnesses and other social factors were contributing triggers for asthma in children.
"These are the things I regularly see within our community".
She said it had also been highlighted that, where many patients with previously uncontrolled asthma were prescribed the latest one puff a day, inhaled corticosteroid (preventer) inhaler, their asthma became controlled. "However this is only prescribed for patients over the age of 12."
She also noticed families with asthma sufferers moving to Rotorua.
"They move here with controlled asthma and it becomes uncontrolled.
"We do not know why this happens although there are contributing environmental factors," Rapana said.
"Rotorua sits in a basin and our air quality also has an impact. On top of that, we are next to the largest forestry plantation in the Southern Hemisphere which aggravates hay fever."
Rapana said these examples were just a few of the many contributing factors.
"Urgent action is needed and if we really want to reduce the poor asthma rates and the fiscal strain, we have to look at things holistically and support the family in other areas as well.
"In the meantime education across the district for health practitioners is a start.
"We are excited about our new paediatrician Dr Anna Mulholland who has worked with Paediatric Respiratory and Sleep medicine specialist Dr David McNamara at Auckland's Starship hospital, who has extensive knowledge in working with children with preschool wheeze."
According to Lakes District Health Board clinical director paediatrics Dr Stephen Bradley, childhood poverty was considered a major contributor to the number of hospital admissions.
"The population in the Lakes District Health Board has significant socio-economic deprivation. We understand that poor housing and overcrowding contribute to respiratory illness in general in children.
"As a result of the poor housing issue we have a referral to Healthy Homes as one of the interventions for children who are admitted with asthma."
He said the extent of smoke exposure suffered by children also had a bearing on the severity of asthma episodes in children.
"This is one of the reasons why the smokefree message is so important.
"General practice in the DHB area is of a high standard but the access to GPs can sometimes be limited, resulting in those children coming to the Emergency Department."
Dr Bradley said, for children experiencing their first asthma attack, there was limited opportunity to give them preventer medication.
"Children with recurrent asthma are often prescribed preventative asthma medications such as inhaler steroids [orange or brown puffer].
"These medications are best delivered to children through a spacer device and there is good evidence that in children with significant asthma, the use of these devices is likely to result in reduced severity or frequency of hospital admissions."
Dr Neil de Wet, Toi Te Ora Medical Officer of Health, said there were "a whole lot of factors" contributing to child asthma but it was difficult to say why Lakes DHB had such a high number of child admissions to the hospital.
"There are issues with air quality, particularly in winter, but we are seeing an improvement on the back of good work by Rotorua Lakes Council, Regional Council and other organisations," Dr de Wet said.
He said there were three things, two were free and one was a cost-saver, which could help reduce asthma attacks and help with all respiratory problems.
The first was to ensure standard child immunisations were up to date and to be immunised against influenza. The influenza vaccine was free for youngsters who took regular asthma medication.
"We are still in the middle of a whooping cough epidemic and children who get the infection struggle with their breathing,"
The second was to keep the home smokefree and ensure children were not breathing in secondary smoke. The third was to avoid using portable gas heaters.
"People mistakenly believe gas heaters are cheaper to run, but they are either equivalent or more costly than a good electric heater.
"Because they are not vented, the gases they produce can be a significant risk for children's breathing".
