Mortality
In 2002, there were 397 deaths where the category asthma and status asthmatic (acute severe asthma) was identified as the underlying cause (158 males and 239 females). Death rates for asthma have declined over the recent decade. In 1992, the age standardised death rate for asthma was 5.0 per 100,000 persons compared with 2.0 per 100,000 persons in 2002. Although the risk of dying from asthma is low, this risk increases with age. The majority of deaths from asthma occurred in people aged 65 years and over. Asthma has been on the rise in Australia for many years. The number of deaths due to asthma has continued to decline. In 2003, 314 people died from asthma, representing 0.3% of all deaths. Asthma deaths have decreased in Australia since the early 1980s, but the rate of asthma deaths in Australia is still high in comparison to other countries. The risk of dying from asthma is highest in the elderly; however, asthma deaths occur in all age groups.
Morbidity Asthma affects 14–16% of children and 10–12% of adults. In primary school-aged children, asthma is more common among boys than among girls. After teenage years, more women have asthma than men. About 10 per cent of Australians have a problem with the disease, and probably about 20 per cent of children suffer from an asthma attack at some stage. Asthma ranks among the top ten reasons for visiting a doctor. Asthma is more common among Indigenous Australians, particularly adults, than among other Australians. Asthma is less common among Australians who were born in non-English-speaking countries than among other Australians. Asthma is in the top five problems referred to hospital by GPs. During 1997, asthma was the principal diagnosis in 60,280 hospital separations with an average stay of 3.5 days. Asthma is more commonly reported among Indigenous than among non-Indigenous people across all age groups. It was the most commonly reported condition for Indigenous children and young adults: 17% of those aged 5 and under, 23% of those aged 5–14, and 20% of those aged 15–24.
Risk factors Non-modifiable
- Heredity- family members with asthma
- Certain genetic mutations
- Age group and sex
- Inhaled allergens
- Respiratory infections
Modifiable
- Diet and lifestyle
- Exercise
- Viral infections
- Smoking
- Air pollutants
- Allergens e.g. house dust mite and mould spores
- Foods and additives
- Drugs
- Occupational factors
- Unborn babies whose mothers smoke during pregnancy
- children exposed to smoke in early childhood
Groups at risk
Changes in lung structure and function brought about by normal ageing may make the problems associated with asthma worse in the elderly. Also, problems with co-ordination may make using puffers and other asthma medication delivery devices difficult, and problems with eyesight may affect ability to read labels. In a national survey conducted in 2001, it was estimated that 7.3% of Australian men and 10.7% of Australian women aged over 55 years had been diagnosed with asthma that remained a current problem.
The prevalence of asthma in children in Australia is high by international standards. In Australia, asthma is a common condition that affects up to 25 per cent of all children. Infants born at a low weight are also thought to be at increased risk of developing asthma during childhood or adolescence. The mechanism is unclear, but may involve reduced airway size, caliber, and increased susceptibility to viral infections.
- People who work in Occupational fields that are exposed to asthma sensitisers
Many substances in the workplace may cause asthma to develop in a previously healthy person; these substances are called sensitisers. Exposure to a sensitiser at work may cause the airways to become sensitive, leading to the development of asthma. This usually occurs as a result of repeated exposures to a sensitiser over a period. Once the airways are, sensitised continued exposure to the same sensitiser, even in very small amounts, can produce symptoms. It may result in more and more severe symptoms and perhaps permanent asthma.
- infants whose mother smoked during pregnancy
Smoking during pregnancy causes abnormal fetal lung development and increases bronchial hyperresponsiveness in the infant.
- People with Respiratory infections
Viral upper respiratory infections are the commonest causes of exacerbations of asthma attacks.
- Aboriginal and Torres strait Islander
Indigenous Australians have higher rates of hospitalisation for asthma than other Australians do in all age groups. Indigenous Australians were more likely to report asthma as a long-term health condition than were the non-Indigenous population (17% and 12% respectively).
- Children who passive smoke
Exposure to environmental tobacco smoke (ETS) in childhood is a recognised risk factor for the development of
asthma symptoms and also for the worsening of pre-existing asthma. It has been shown that exposure to EST.
increases the risk of onset of wheezing illness in young children.
Social determinants
Location- a persons’ ability to access health information and services at times is determined by the geographical location of where they live. Statistics show people aged 35 to 64 years who live in outer regional and remote areas are more likely to die from asthma than people in cities or large areas. It is possible that part of this increased risk in remote areas can be attributed to the distance people are located in relation to acute medical facilities and, hence, their access to prompt treatment for severe attacks which may result in death. Other plausible explanations include differences in exposures of the harsh environment influencing disease severity and exacerbation risk, and differences in access to effective long-term asthma management. Global climate is changing and the factors causing this are of both natural and human origin. Health impacts could include increases in vector-borne diseases such as dengue fever, water-and sewerage related diseases and respiratory problems, which increases the risk of asthma related to urban population. Increased levels of pollution in cities may induce asthma, or fumes which are harmful and could trigger asthma.
Education- education refers to a person’s knowledge; people with low levels of education generally have lower levels of health. Mothers who smoke whilst pregnant do not have sufficient knowledge to make healthy choices. This lack of knowledge impacts not only on the health of the mother but also on her baby. Mothers experience a decline in lung function, more airway inflammation which is an associated risk factor for asthma or if they already have asthma, they experience more symptoms, worse, and a less beneficial response to inhaled corticosteroid treatment. Abnormal fetal lung development and increases bronchial hyperresponsiveness in the infant. Children and young adolescents may not be educated about how to use medications such as puffers, which could lead to severe asthma attacks if not used immediately or properly.
Gender- Among children, boys have a higher rate of asthma than girls do. However, after teenage years, asthma is more common in women than in men. The reasons for this risk are not known but some speculate that the reversal of trends in men and women are due to sex hormones.
Age- Deaths due to asthma occur in all age groups. The risk of dying from asthma increases with age, 62% of all deaths due to asthma occur in people aged 65 years and over. Older people with respiratory symptoms may not realise they have asthma and may simply assume that their symptoms are related to ageing and adapt to minimise the impact on their lives. Mobility problems may limit a person’s ability to drive or to use public transport, and so getting access to medications for asthma from shops and chemists may be difficult, hence not having access to necessary medications could be fatal. Children under the age of five, whose respiratory system is still developing, are at increased risk of developing permanent damage to their lungs upon exposure to allergens.
Socio-economic status- It is likely that lower socio-economic groups experience limitations to accessibility, availability of alternative forms of care, and efficacy of self-management of asthma. Some conditions under which they live increase their likelihood of dying from asthma. Aboriginal Torres Strait Islanders are usually associated with having a low socio-economic status, their limitations to medical services and medications puts them at higher risks of dying from asthma attacks because they are unlikely to seek medical attention. People who smoke are generally from low socio-economic backgrounds and as such at greater risk of developing and mismanaging asthma leading to impaired lung functioning.
Employment-occupational factors are an associated risk of asthma. Employment in certain fields and exposure to certain agents can induce asthma. Some occupational fields increase the risk of developing asthma, for example individuals who work with animals such as laboratory workers and veterinarians who are exposed to danger and animal urine proteins; and also manufacturing workers who may be exposed to certain chemicals. This could lead to permanent asthma as a result. Unemployment is highest among Aboriginal and Torres Strait Islanders, this leads to problems such as unsafe risk behaviors such as excessive alcohol and tobacco consumption. These behaviors are associated risk factors for asthma, which could increase the likelihood of the disease or result in death if they are asthmatics already.
