Asthma-related mortalities rise 30%

Preventable deaths on the rise

Recent figures from the Australian Bureau of Statistics (ABS), commissioned by the National Asthma Council Australia, shed light on the persistently high asthma-related deaths in Australia, particularly among women over 75 years. This alarming statistic comes as 2022 saw the report of 467 Australians who had lost their life in asthma-related deaths, a 32% increase on the year prior. Those in community medicine would understand the preventable nature of these deaths, and many healthcare professionals are now reeling to make sense of this alarming rise.

In 2020, there were 417 recorded asthma-related deaths, comprising 274 females and 143 males. This data emphasises the gravity of asthma as a public health issue, especially considering Australia’s high asthma mortality rates in the global context. Dr. Jonathan Burdon AM, a Respiratory Physician and spokesperson for the National Asthma Council Australia, raises concerns about the increasing number of women succumbing to asthma. Women now represent 65% of all asthma deaths in Australia, with a notable increase in recent years. This trend is particularly alarming in women aged over 75, who contribute to 72% of all female asthma fatalities. These figures underscore the need for targeted interventions and support systems, especially considering the life changes women in this age group often face, such as widowhood, retirement, and multiple medications.

Dr. Burdon emphasises that while asthma remains incurable, effective control measures can significantly reduce the risk of severe flare-ups and potential fatalities. This is especially pertinent for older adults, who may experience changes in their living situations and routines, potentially leading to decreased focus on asthma management.

Longitudinal data confirms concerns

The history of asthma mortality in Australia has been marked by fluctuations, with peaks in the late 1950s, mid-1960s, and late 1980s. Although there has been a substantial decline in asthma mortality rates in recent years, these rates remain relatively high on an international scale. In 2011, asthma was the underlying cause of 378 deaths, accounting for 0.3% of all deaths in Australia, with a median age at death of 80 years in the period from 2007 to 2011.

This high median age comes at a shock to the status quo, as many consider asthma to be uncontrolled in children, adolescents and markedly higher in sporting settings. Asthma fatalities are seen across all age groups but tend to increase with age in both males and females. Interestingly, females aged 35 and over have higher asthma mortality rates compared to their male counterparts, while rates are similar for males and females aged 5-34. Moreover, there is a noticeable peak in asthma deaths during the late winter, especially for those aged 64 and over.

This gender imbalance raises a few questions. It could be attributable to various factors, including biological, behavioural, and environmental influences, and certainly prompts a need for gender-sensitive healthcare approaches and research.

The persistently high mortality rates due to asthma call for a re-evaluation of current healthcare policies and practices. This includes enhancing patient education, improving adherence to medication, implementing targeted preventive measures, and addressing the specific needs of high-risk groups. Additionally, ongoing research into the gender, age-specific, and seasonal factors influencing these diseases can inform more effective treatment and prevention strategies.

Preventative medicine for better outcomes

Dr. Burdon advises, “Good asthma control can prevent symptoms from progressing into a severe flare-up that could end in death.” This underscores the importance of effective healthcare policies focusing on patient education, adherence to treatment, and preventive measures. Considering the significant prevalence of asthma in Australia, the National Asthma Council Australia highlights the criticality of awareness, stating, ‘Australia has one of the highest prevalence rates of asthma in the world… it is crucial that people are aware of the risks.’ They also emphasise the importance of proactive healthcare management, urging Australians with asthma to regularly consult their doctors, review their Written Asthma Action Plans, and ensure correct inhaler usage. These steps are vital for effective asthma control and preventing severe complications.

Understanding asthma and the risks

This common yet complex respiratory condition presents with a variety of symptoms that can vary significantly among patients. It’s crucial for practitioners to recognise that not all individuals with asthma exhibit the same symptoms, and these symptoms can fluctuate in severity and frequency.

Often the first sign; a simple cough. Often persistent, this symptom may be exacerbated at night, during physical activity, or in response to emotional stimuli like laughter. Wheezing may be another key symptom, characterised by a whistling sound during breathing, indicating airway narrowing. With this may come shortness of breath and difficulty breathing due to constricted airways. Lastly, chest tightness may indicate a red zone of asthma treatment. These symptoms may worsen at night or early morning, impacting sleep quality. Other associated symptoms can include fatigue, increased heart rate, and sweating, often due to the extra effort required for breathing.

A Written Asthma Action Plan saves lives

A Written Asthma Action Plan is a personalised, detailed document created by a healthcare provider in collaboration with a patient who has asthma. This plan serves as a critical tool in the management of asthma and is tailored to the specific needs, triggers, and severity of the patient’s condition. This plan can be utilised in any care setting, by any team of health professionals, and creates a universal care model around the patient; regardless of where they might be when they need assistance. 

1. The plan outlines the specific medications the patient should take daily for asthma control, including the names, dosages, and frequency of use. It also provides guidance on how to adjust medications in response to changing symptoms or during an asthma flare-up.
2. It helps identify common triggers that can exacerbate the patient’s asthma (such as allergens, irritants, respiratory infections, exercise, or stress) and provides strategies to avoid or minimise exposure to these triggers.
3. The plan includes instructions on how to monitor asthma symptoms and use of peak flow metre readings, if applicable. It details the signs of well-controlled asthma, as well as how to recognise warning signs of worsening asthma or an impending asthma attack.
4. One of the most important aspects of the plan is the clear, step-by-step guidance on what actions to take when asthma symptoms worsen. This might include instructions on increasing medication, using a rescue inhaler, or seeking emergency medical attention. It also outlines the specific steps to take during an asthma emergency, including when and how to use rescue medications (like a short-acting beta-agonist inhaler), and when to contact a healthcare provider or go to an emergency room.

The Written Asthma Action Plan is an essential component of asthma self-management education and empowers patients with the knowledge and confidence to control their asthma effectively and to act quickly when symptoms change or worsen.

Initiatives like this are just one of the frameworks highly recommended by the National Asthma Council Australia to aid in reducing asthma-related mortalities in Australia. To find more information or revisit the best practice guidelines, see https://www.nationalasthma.org.au/

Australian Institute of Health and Welfare (2014) Mortality from asthma and COPD in Australia, AIHW, Australian Government.