|
Originally published in GP Review, March 2008. Reproduced with permission.
Dr Penny Abbott
GP, Aboriginal Medical Service Western Sydney
Asthma management in indigenous communities
Indigenous Australians are more likely to have asthma than non-Indigenous Australians. The disparity exists across all age groups, and is greater in urban indigenous communities and among older adults.
Asthma prevalence among indigenous women aged over 35 is double that of non-Indigenous Australians.1
The principles of treating asthma – known as ‘short wind’ or ‘asthma sickness’ in some communities – are no different for Indigenous Australians. However, mainstream asthma management strategies and programs are not necessarily appropriate for use in indigenous communities.
Get the diagnosis right
The most important step in asthma management is suspecting and then confirming that the patient actually has asthma. Differential diagnoses will vary between regions; knowing your local community will help guide your approach.
In adults, differential diagnoses that need to be considered include chronic obstructive pulmonary disease, heart disease and tuberculosis, all of which can coexist with asthma. In children, chronic suppurative lung disease, recurrent upper respiratory tract infections and bronchiolitis are potential differential diagnoses.
Spirometry is the key test for diagnosing asthma. Peak flow measurements are now recognised as unreliable and hard to interpret in the practice setting.2 Adults and children aged 7 years and older can perform spirometry, but correct practitioner technique is essential to obtaining reliable results.
Promote access to treatment
General practitioners and other health care providers need to be sensitive to the cultural and socioeconomic barriers that prevent some indigenous patients from accessing recommended treatments,3 and work with them to overcome any difficulties.
Certain Aboriginal community controlled health services can facilitate access to subsidised medications through the PBS section 100 scheme and access to spacers via the Asthma Spacer Ordering System (http://www.asthma.org.au/).
Support smoking cessation
Smoking cessation is a particularly significant issue because of the high incidence of smoking among Indigenous Australians.2 Utilising Aboriginal health workers, community elders and culturally specific health promotion resources can make smoking cessation messages more effective.4
Manage appropriately
Aboriginal health workers are invaluable in supporting ongoing self management for Indigenous Australians with asthma. Culturally appropriate patient information – such as the Asthma Foundation of the Northern Territory ‘short wind’ educational material – can be very effective. Other pictorially based resources – such as the National Asthma Council Australia’s ‘Managing your asthma’ chart – may also be useful.
A written asthma action plan is one of the most effective asthma interventions available; ensuring that written asthma action plans are culturally appropriate may increase their usage. For resources and information on asthma diagnosis and management, visit the National Asthma Council Australia (NAC) website at http://www.nationalasthma.org.au/.
The NAC’s recent panel discussion program ‘Taking a breather: asthma management for Indigenous Australians’ is now available at the NAC website or from the Rural Health Education Foundation at www.rhef. com.au/programs/720/720.html.
References
1. Australian Centre for Asthma Monitoring. Asthma in Australia: findings from the 2004–05 National Health Survey. Canberra: Australian Institute of Health and Welfare, 2007.
2. National Asthma Council Australia. Asthma management handbook 2006. Melbourne: NAC, 2006.
3. Brown A, Walsh W, Lea T, Tonkin A. What becomes of the broken hearted? Coronary heart disease as a paradigm of cardiovascular disease and poor health among Indigenous Australians. Heart Lung Circ 2005;14:158–62.
4. NSW Health. Environmental tobacco smoke: a manual for aboriginal health workers. Sydney: NSW Health, 2004.
Acknowledgement
Living with ‘asthma sickness'
Originally published in GP Review, March 2008. Reproduced with permission.
Download a PDF of this article from the GP Review website: http://www.racgp.org.au/gpreview/200803/23337
Content Updated March 2008
|
