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Asthma is a chronic inflammatory disease of the airways and a major health risk in childhood not only in Australia, but also in other developed and developing countries across the world (Calogero et al 2009).
Although the risk factors for childhood asthma include smoking during pregnancy, familial record of asthma, young maternal age at pregnancy and low socioeconomic standing (Li et al 2013), available country-specific literature demonstrates that there is a multiplicity of factors responsible for the prevalence of childhood asthma despite hospitalisation rates for asthmatic children going down as demonstrated in Figure 1(Chua et al 2011).
This report discusses three such factors, namely deprived neighbourhoods, latitude and ultraviolet (UVR) exposure, and lack of effective guidelines to diagnose and treat asthma in infants.
In their study, Li et al (2013) found that cases of childhood asthma have been on the rise in developed countries due to the increasing number of families residing in deprived neighbourhoods.
This study found that the level of neighbourhood deprivation influences the risk of childhood asthma through several general mechanisms, which include “unfavourable health-related behaviours, neighbourhood social disintegration (i.e. criminality, high mobility, or unemployment), low social capital, and neighbourhood stress mediated by factors that can influence immunological and/or hormonal stress reactions” (Li et al 2013, p. 656).
In the Australian context, living in deprived neighbourhoods has been associated with an increase in childhood asthma as such neighbourhoods not only cause air pollution and related effects, but also trigger isolation from health-promoting environments (e.g., safe places to exercise, decent housing, smoking-free areas) and services (Berenznicki et al 2013).
Figure 1 Asthma & Bronchitis Hospitalisation Levels in Selected Asia Pacific Countries (Source: Chua et al 2011)
Hughes et al (2011, p. 328) report that “asthma prevalence has been shown to correlate negatively with latitude (lower prevalence at higher latitude) and positively with ambient UVR.”
Although findings have not been conclusive, there is a likelihood that asthma cases in Australia are on the rise particularly in areas with increasing geographic latitude, which inevitably decreases the amount of vitamin D that people are able to get through exposure to sun (Krstic 2011).
Indeed, according to this author, there is considerable evidence to show that vitamin D deficiency triggered by decreasing sun exposure and increasing geographical latitude in the varied Australian landscape is responsible for the development and exacerbation of asthma.
Lastly, available literature demonstrates that the national Asthma Council of Australia (NAC) guidelines on the diagnosis, treatment and management of asthma in infants are controversial due to the considerable body of opinion reinforcing the fact that “a diagnosis of asthma should not be made in the first year of life as wheezing in infancy is very common” (Calogero et al 2009, p. 143).
Indeed, according to these authors, “very few clinical studies are available to guide treatment of persistent wheezing in infants, and, in the absence of evidence, similar medications are used to treat wheezing in infants as used to treat asthma in older children” (p. 143).
This orientation has presented many challenges to healthcare practitioners particularly in terms of the efficacy of drugs prescribed to infants, hence the need for effective asthma management guidelines for this group of the population (Berenznicki et al 2013).
From the findings presented above, it is evident that childhood asthma remains a considerable burden in Australia due to socioeconomic, geographic, and health-related issues such as deprived neighbourhoods, decreasing sun exposure and increasing latitude, and lack of effective guidelines on the diagnosis, treatment and management of asthma in infants.
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These factors need to be addressed to lower the prevalence of asthma in Australian children and ensure that asthma no longer presents a substantial burden to the health care system.
To deal with the factor of deprived neighbourhoods, it is important for the local council and other relevant stakeholders to commit adequate resources to the socioeconomic and physical development of neighbourhoods that are largely perceived as deprived.
Such resources can be used to educate deprived families about favourable health-related behaviours and also to develop structures and amenities that will guard against social disintegration (Li et al 2013).
To decrease the rate of childhood asthma, the local council needs to develop education programs on what families need to do to ensure that they do not expose their young children to vitamin D deficiencies, as this element has been found to influence the development and exacerbation of asthma (Krstic 2011).
Such educational programs need to be incorporated into the mainstream public health campaigns to achieve effectiveness in ensuring that people understand how environmental factors can increase the rate of childhood asthma.
Lastly, concerted efforts need to be made to fill the gaps in childhood asthma management by coming up with a body of evidence that could be used to diagnose, treat, and manage asthma in infants. There is need for the relevant health agencies to not only develop effective asthma guidelines for managing infants, but also to come up with effective drugs that could be used by this group of the population.
List of References
Berenznicki, BJ, Norton, LC, Beggs, SA, Gee, P & Berenznicki, LRE 2013, ‘Review of the management of childhood asthma in Tasmania’, Journal of Paediatrics and Child Health, vol. 49 no. 8, pp. 678-683.
Calogero, C, Kusel, MMH, Van Bever, HPS & Sly, PD 2009, ‘Management of childhood asthma in western Australia’, Journal of Paediatrics and Child Health, vol. 45 no. 3, pp. 139-148.
Chua, KL, Ma, S, Prescott, S, Ho, MHK, Ng, DK & Lee, BW 2011, ‘Trends in childhood asthma hospitalisation in three Asia Pacific countries’, Journal of Paediatrics and Child Health, vol. 47 no 10, pp. 723-727.
Hughes, AM, Lucas, RM, Ponsonby, AL, Chapman, C, Coulthard, A, Dear, K…Williams, D 2011, ‘The role of latitude, ultraviolet radiation exposure and vitamin D in childhood asthma and hay fever: An Australian multicenter study’, Paediatric Allergy and Immunology, vol. 22 no. 3, pp. 327-333.
Krstic, G 2011, ‘Asthma prevalence associated with geographical latitude and regional insolation in the United States of America and Australia’, PLoS ONE, vol. 6 no. 4, pp. 1-9.
Li, X, Sunquist, J, Calling, S, Zoller, B & Sundquist, K 2013, ‘Mothers, places and risk of hospitalisation for childhood asthma: A nationwide study from Sweden’, Clinical & Experimental Allergy, vol. 43 no. 6, pp. 652-658.