Summary

This section presents selected findings from the report. Comparisons noted here are statistically significantly different, unless otherwise stated. Each chapter also begins with its own list of key points.

Introduction 

  • Asthma is a chronic inflammatory condition of the airways associated with episodes of wheezing, breathlessness and chest tightness.
  • Asthma affects people of all ages and has a substantial impact on the community.
  • There is currently no cure for asthma. However, good management can control the disease and prevent symptoms from occurring or worsening.
  • Chronic obstructive pulmonary disease (COPD) is a serious long-term lung disease that mainly affects older people and is often difficult to distinguish from asthma.

Prevalence, incidence and natural history 

  • Asthma remains a significant health problem in Australia, with prevalence rates that are high by international comparison.
  • For 2007–08, the prevalence of current asthma in Australia was estimated about one in ten (9.9%), equivalent to about 2 million people.
  • Since 2001, the prevalence of current asthma has declined in children and young adults but remained stable in adults aged 35 years and over.
  • Among those aged 0–14 years, current asthma is more common among males than females, but among those aged 15 years and over, the reverse is true.
  • Asthma is more common among Indigenous Australians than among other Australians, particularly in adults.
  • The prevalence of current asthma increases with decreasing socioeconomic status. The gap in prevalence between areas of highest and lowest socioeconomic status increased between 2004–05 and 2007–08.
  • Asthma commonly coexists with other chronic conditions, such as rhinitis and sinusitis, and mental and behavioural disorders.

Asthma control and quality of life 

  • Poor asthma control (frequent symptoms and asthma exacerbations) is a common problem in both adults and children.
  • Overall, levels of asthma symptoms and frequency of dispensing reliever medication in the Australian community are higher than is consistent with good asthma control.
  • People with asthma rate their health worse than do people without the condition.
  • Asthma is associated with a poorer quality of life.
  • Most of the impact of asthma is on physical functioning and on the person’s social and work life.
  • People with current asthma are significantly more likely to take days off work, school or study than people without current asthma.
  • Australians with asthma report worse psychological health than those without asthma and the difference is more pronounced in females.

Mortality 

  • There were 411 deaths attributed to asthma as the underlying cause in 2009. This represented 1.60 per 100,000 people and 0.29% of all deaths in that year.
  • Between 1997 and 2009, the mortality rate due to asthma decreased by 45%.
  • The mortality rate due to asthma in Australia remains high on an international scale.
  • Deaths due to asthma occur in all age groups, although the risk of dying from asthma increases with age.
  • The age distribution of asthma deaths is different to that observed for all-cause deaths. Of all asthma deaths between 2003 and 2007, 31% occurred among people aged 5–64 years. In contrast, the proportion of all-cause deaths in this age group was only 20%.
  • People living in areas of lower socioeconomic status and Indigenous people have a higher risk of dying from asthma.

Use of health-care services 

General practice encounters

  • The rate of general practice encounters for asthma decreased among adults (by 33%) and children (by 27%) between 2000–01 and 2009–10.
  • Lung function testing and provision of asthma action plans occur in less than 9% of general practice encounters for the management of asthma.
  • Claims for completed Asthma Cycle of Care Practice Incentives Programs are highest for children, especially boys aged 0–4 years, girls aged 5–14 years, and for people aged 65 years and over. They tend to peak in the winter months.
  • Among people with asthma, Asthma Cycle of Care programs are less likely to be completed for adults aged 15–34 years, people living in inner regional areas and people living in areas of a relatively lower socioeconomic status.

Hospitalisations and emergency department visits

  • The hospital separation rate for asthma among adults and children remained stable between 2004–05 and 2008–09. Between 1993–94 and 2002–03, the rate declined by 32% for adults and 47% for children.
  • Hospital separations for asthma are higher in:
    • boys compared with girls
    • adult women compared with adult men
    • adults living in remote areas compared with adults residing in major cities
    • Indigenous people aged 5 years and over compared with other Australians of the same age
    • people from an English-speaking background compared with those from a non-English-speaking background
    • people living in areas of lower socioeconomic status compared with those living in areas of higher socioeconomic status.
  • Peaks in emergency department and hospital admissions for asthma vary by age, with higher rates in late summer and autumn among children and in winter among adults.
  • Respiratory infections are commonly listed as an associated diagnosis among people of all ages admitted to hospital for asthma.

Invasive mechanical ventilation

  • In 2008–09, 1.6% of hospitalisations for asthma included a period of invasive mechanical ventilation (supported breathing using a ‘life-support machine’).
  • People who receive invasive mechanical ventilation during their hospital stay for asthma have a longer length of stay and a higher rate of in-hospital mortality than those who do not receive the procedure.
  • The highest proportion of hospitalisations for asthma that included a period of invasive mechanical ventilation was among adults aged 35–64 years. In this age group, people from non-English-speaking backgrounds were more likely to receive invasive mechanical ventilation during hospitalisation than people from English speaking backgrounds.

Management 

Asthma action plans

  • The majority of people with asthma do not have a written asthma action plan, despite national guidelines over the last 20 years recommending their use for people with asthma.
  • Adults, particularly young adult males, are less likely to possess a written asthma action plan than children.

Medication use

  • Drug therapy is the mainstay of asthma management.
  • The supply of medications used to treat asthma and other respiratory disorders remained stable between 2005 and 2009.
  • The dispensing of medications for asthma (inhaled and oral corticosteroids, long-acting beta-agonists and short-acting beta-agonists) increases with age.
  • Most adults and children with asthma are dispensed inhaled corticosteroids intermittently, despite treatment guidelines recommending regular use in people with persistent asthma.
  • Among adults who received any inhaled corticosteroid medications, 30% were dispensed these medications only once in 2009.
  • Over 80% of inhaled corticosteroids are supplied in combination with long-acting beta-agonists, despite guidelines recommending that in asthma, these medications should only be used in patients whose asthma is not well-controlled with inhaled corticosteroids alone.
  • Prescriptions for combination formulations containing inhaled corticosteroids and long-acting beta-agonists are relatively common among children, despite treatment guidelines recommending against their use in most children.
  • Among adults, the majority of inhaled corticosteroids are prescribed in combination with long-acting beta-agonists.
  • In data sources available, there is no way of distinguishing medications dispensed for asthma from those for other obstructive lung diseases, such as COPD.

Smoking and occupational exposures

  • People with asthma smoke at least as much as people without asthma, despite the known adverse effects.
  • In 2007–08 the prevalence of smoking was higher in females with asthma than in those without asthma, particularly females aged 18–34 years. This trend was not observed in males.
  • Socioeconomic status is a strong determinant of the risk of smoking among people with asthma, with smoking rates higher in areas of lower socioeconomic status.
  • An estimated 7.8% of children with asthma reside where smoking occurs inside the home.
  • Nearly 10% of adult-onset asthma is caused by occupational exposures and, hence, could be avoided if exposure to triggering agents in the workplace were removed.
  • Occupational asthma is the one truly preventable form of the disease.

Focus chapter: chronic obstructive pulmonary disease among people aged 55 years and over 

  • The prevalence of self-reported COPD among people aged 55 years and over in Australia was estimated at 5.3% in the 2007–08 National Health Survey. This is likely to underestimate the true prevalence when using objective measures.
  • The prevalence of self-reported COPD increases progressively with age, from 4.0% among people aged 55–69 years to 9.1% among those aged 85 years and over.
  • In 2007, there were 5,051 deaths attributed to COPD among people aged 55 years and over. This represented 100 per 100,000 population aged 55 years and over and 4% of all deaths in this age group.
  • Many more deaths were attributed to COPD than to asthma (100 compared with 6 per 100,000 population).
  • Between 1997 and 2007, the mortality rate attributed to COPD decreased by 65%.
  • The rate of general practice encounters for COPD decreased between 2000–01 and 2009–10, although the rate has remained relatively stable in recent years.
  • Between 1998–99 and 2008–09, the hospital separation rate for COPD remained relatively stable but substantially higher than the rate for asthma.
  • Among people aged 55 years and over, hospital separation rates for COPD are higher in:
    • males compared with females
    • people living in remote areas compared with those living in major cities
    • Indigenous people compared with other Australians
    • people from an English-speaking background compared with those from a non-English-speaking background
    • people living in areas of lower socioeconomic status compared with those living in areas of higher socioeconomic status.
  • People with COPD admitted to hospital have higher rates of assisted ventilation (non-invasive and invasive mechanical ventilation) compared to those with asthma.
  • Cancer was commonly listed as an associated diagnosis among people aged 55 years and over admitted to hospital for COPD.
  • Access to pulmonary rehabilitation programs is very limited, despite evidence that these programs are effective.
  • Long-term home oxygen therapy is recommended for patients with COPD and low levels of oxygen in the blood. There is no national database or register of use of oxygen therapy to help assess the use of this intervention.
  • The prevalence of current smoking is twice as high among people aged 55 years and over with COPD (20%) compared to those without the disease (11%).