Wake up call regarding asthma mortality

Australia cannot afford to take its eye off the ball when it comes to preventing asthma deaths, according to a leading respiratory physician.

Professor Christine Jenkins, from the George Institute for Global Health, told the limbic improvements in asthma mortality had plateaued and it was time to change approach.

“While I acknowledge the efforts to reduce asthma mortality in the past, it’s going to be an even tougher job over the next decade or two.”

“We now have to focus on harder to reach populations and those who are harder to bring into the conventional care paradigms.”

Professor Jenkins was responding to research in The Lancet that found global asthma deaths reduced by 57% between 1993 and 2006. However there was no subsequent improvement between 2006 and 2012.

In an accompanying Comment, Professor Jenkins said the deaths were not necessarily in people with the most severe asthma but people with ‘poorly controlled mild-to-moderate asthma’.

She said issues such as comorbidity, smoking, psychosocial dysfunction and poor health literacy were likely to be important factors in the residual mortality rates.

Most deaths were now occurring in the over 50s – people who were often more concerned about their blood pressure or osteoporosis.

“Older people with asthma are a neglected group,” she said.

“They gradually lose lung function, don’t realise their progressive decline, and then a trigger such as the ‘flu leads to catastrophic effects in combination with undertreated asthma.”

“The other group which is extremely challenging is those who don’t want to have interaction with the health care system. They might come into hospital but are happy to abandon treatment and not see anyone in follow-up.”

Professor Jenkins said mental health issues were also a significant issue.

However there were some practical strategies that could be adopted.

For example, the availability of low-cost inhaled corticosteroids could help people who were avoiding treatment due to financial pressures.

She said doctors also needed to step up their practice to ensure patients were having their lung function measured and checking inhaler technique.

“Many patients are not receiving spirometry and we should be ashamed of this.”

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