Purpose
The purpose of this document is to outline comprehensive strategies which will:
- significantly reduce the prevalence and severity of asthma and the risk of asthma;
- contribute to favourable health outcomes through better understanding, skill and commitment;
- reduce the social and economic impact of asthma on the community.
The strategies document brings to life the framework and direction already set down in National Asthma Strategy, Goals and Targets. It restates the magnitude of the asthma problem here in Australia and identifies the action required if the substantial changes needed are to become a reality.
In any twelve month period, up to 20% of our population, including children, will have symptoms of asthma1. For some ill health will be mild and occasional, whereas for others it is a daily problem requiring doctors' visits and even hospitalisation. More than 30% of Australian children have been affected by asthma by the time they reach 8 years of age and by the time they are 12 this may have risen to over 45%2.
The extent and cost of the asthma problem in Australia are still significant. Levels of ill health through asthma may have reached a plateau, judging by lack of changes in symptoms, drug sales and hospitalisation. Following increases in death rates due to asthma in the 1980s, the past three years have shown a fall which now seems to have stabilised.
The impact of asthma on families and on the broader community has been less well understood. Recent costings3, 4 established the substantial direct medical and equally important indirect economic and social effects at around 700 million dollars annually and growing, in part due to the cost of asthma treatment.
This document is based on what we already know and what we have yet to discover about asthma as a disease; its cause, prevention and treatment, and its impact on health, economic and social outcomes.
The major agencies working in asthma care have already established that effective liaison can improve asthma management. The next step in the consideration of these strategies will be for these agencies and others to prioritise the strategies jointly and to commence the implementation process together.
We know that to change the face of asthma in Australia we must ensure that:
- those without asthma and who do not have the
tendency to asthma remain so. This means raising
general awareness of potentially harmful
environments and protecting those currently not
at risk from situations which may put them at
risk. The general strategy is one of
environmental control. This will improve health
outcomes, with a flow-on of social and economic
benefits.
- those who don't have clinical asthma but
have the potential do not develop the disease.
This includes those who are atopic, those with
family history of asthma, hay fever or eczema,
and others who have had clinical asthma in the
past, but in episodes rather than chronic.
Current world-leading research being conducted
in Australia focuses on babies in utero and the
first twelve months of life. This research into
allergen exposure and alterations in early life
immune function may provide the key to
preventing the development of asthma.
Another challenge is to reduce the number of episodes of asthma in children and adults who don't have persistent asthma. Strategies involve the removal of potential triggers from their lives, environmental controls and adherence to individual Asthma Management Plans.
- ill health is reduced among those who currently have clinical asthma. For those in this category, the possibilities for improving health, quality of life and reducing mortality are to move from severe to mild asthma, persistent to episodic asthma or from episodic to no asthma. This requires education, management and risk control.
Figure 1. Present and desired change in asthma status in Australia5
We know that in a period when Australia experienced dramatic increases in the prevalence and death rates of asthma, other developed countries experienced a lesser increase. The level of asthma in some indigenous populations in traditional settings is significantly lower until they move out of their environment into a typical Western environment, leading us to believe that improvements are possible once we understand the causal factors and how we can influence them.
We also know that the rising level of knowledge about asthma through epidemiological monitoring, presentation, publication, discussion and its transference to the community in an orderly fashion have contributed significantly and quickly to improvement of health.
Finally, we know that improved outcomes are dependent on the demonstrated skill base of our researchers and support for their work to find the underlying causes, effective treatment and management of asthma; the policies of professional bodies; the management practices of clinicians and other health professionals; the effectiveness of asthma drugs; the communication skills of educators; the adherence to a management plan by those with asthma; and the commitment and ability of the media to inform the broader community about the disease.
While there is much we do know about asthma, there are also many questions we need to answer if we are to achieve our targets. The basis of questions or targets, together with an integrated research approach, are dealt with in some detail in the draft paper Research Priorities in Asthma. Specific points of research, including new areas of study, are outlined in this document as principal strategies. For example, the local strategy to date has been the Six Step Asthma Management Plan which, as a consensus statement, must be evaluated so that future Asthma Management Plans are evidence based.
The National Asthma Strategy document has been developed within a framework similar to National Health Goals and Targets, Better Health Outcomes for Australians and the current health priorities, and can be regarded as an adjunct to these. While at a national level, the health ministers have agreed for practical reasons to work with strategies for five health areas of which asthma is not one, this document cannot wait. The issue is too important.
As a result, this strategies document has been developed as a working plan outlining the activities needed if the goals are to be achieved and stated targets reached by the year 2010. In order to make this document as practical as possible, the actions have been linked to the organisations likely to be responsible for them.
A document like this is a dynamic one, and as the strategies are implemented and cause change to occur, the responsibilities may move from the proposed organisations to others. The challenge will be to ensure that strategies continue to be implemented and that new strategies are developed to meet changing circumstances.
Where possible the strategies for improving health outcomes are based upon evidence. In many areas the further development of data collection and information is necessary and this is set as an initial strategy. It is important to recognise, however, that the measurement of health outcomes is more than morbidity and mortality, and concerns quality-of-life issues for people with asthma and their carers. Measurable outcomes may not be possible for all strategies.
References
1. Comino EJ, Mitchell CA, Bauman A, et al. Asthma management in eastern Australia 1990 and 1993. Med J Aust 1996;164:403-406.
. 2Robertson CF, Heycock E, Bishop J, Nolan T, Olinsky A, Phelan PD. Prevalence of asthma in Melbourne schoolchildren: changes over 26 years. BMJ 1991,302:116.
3.National Asthma Campaign. Report on the cost of asthma in Australia. Melbourne, 1992.
4. Mellis C, Peat JK, Bauman A, Woolcock A. The cost of asthma in New South Wales. Med J Aust 1991;155(8):522-8.
