Bushfire asthma toll shows need for revised public health approaches


By Michael Woodhead

9 Jun 2020

People with asthma were unable to protect themselves against bushfire-smoke induced asthma attacks despite following public health advice, a report from Asthma Australia has found.

The long duration and intensity of the bushfires in late 2019 and early 2020 resulted in more than 400 respiratory deaths, 2,000 respiratory hospitalisations and 1,300 ED presentations for asthma, according to the Bushfire Smoke Impact Survey that documented the experiences of more than 12,000 Australian with asthma.

The survey found that lack of suitable face masks, air purifying filters and the inability to avoid going outdoors meant that almost all people with asthma had symptoms and about a third were so sick they were unable to work or take part in daily activities for a week or more.

The survey found that during the bushfires most people with asthma (76%) had to increase the use of reliever inhaler” and 41% had to increase the dose or frequency of their preventer, with 16% requiring oral or injected steroids (16%).

People with asthma were four times more likely to report “attended ED” or “hospitalised” compared to people without asthma, and nearly seven times more likely to report “steroid use (oral or injection).”

Other key findings included children and young people being the worst affected by bushfire smoke-induced respiratory symptoms, and the increased rates of anxiety and depression among people with asthma due to the smoke.

An unexpected finding was that taking many people with asthma had symptoms and required medical attention despite following public health advice to minimise smoke exposure.

This was because many people could not avoid going outside during the bushfire season, and many lacked reliable information on air quality for when it was safest to do so. Even indoors many people with asthma had problems because they could not afford air filters, recycled air conditioners or P2 masks.

“When exposed to intense smoke pollution over days and weeks, our findings showed even best practice advice did little to protect thousands of people from experiencing serious asthma attacks leaving people in need of steroids, medical or emergency care leading to increased hospitalisations and now attributed to up to 445 deaths,” said Asthma Australia CEO Michele Goldman.

Drawing on the lessons from 2019-2020, Asthma Australia has made ten recommendations on how to reduce the impact of future periods of bushfire smoke, particularly for people with asthma or other respiratory vulnerabilities.

These include:

  • Medicare rebates for telehealth and mental health consultations for people with asthma;
  • Access to face masks from the medical stockpile;
  • Financial assistance to people with asthma for air purifiers;
  • Public buildings with clean air criteria such having HEPA filter recycled air conditioning;
  • Better and more regular reporting of air quality measures.

“It disheartens me to say so, but the reality is this won’t be the last catastrophic bushfire season – we need to ensure all Australians can protect themselves and others from the impact of smoke pollution,” Ms Goldman said.

Asthma Australia is also sharing its key tips for patients to minimising the effects of bushfire smoke which include having a written Asthma Action Plan and signing up for fire alerts.

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