Introduction
Asthma is a non-Communicable Disease (NCDs) which accounts for 9 million deaths globally (WHO, 2013). Australia is among the top ranking countries of the world with a rate of 11.6% in asthma (ABS, 2009). The rate of mortality in Australia due to asthma is believed to be high by international standards (AIHW, 2012). Even though asthma is influenced genetically, there are several environmental and lifestyle factors which impact the disease. This report outlines some of the important contributing factors associated with asthma with the aim of providing appropriate interventions and strategies to reduce morbidity and mortality associated with the disease.
Biology – Pathology, Natural Progression, Genetic Influences and Effects of Age
Asthma is described as an illness of the respiratory system caused due to inflammation of the airways which causes obstruction of airflow within the lungs (AIHW, 2012). Asthma is caused due to the inflammation of the airways which in turn induces cough, wheezing, breathlessness and a feeling of tightness in the chest. However, these symptoms are reversible with appropriate treatment (AIHW, 2012). There could be extreme coughing during the night. Asthma has been conceived as a disease of gene-environment which occurs as an allergy during the early stages in life (ACAM, 2011).
Asthma is believed to be impacted by environmental factors and lifestyle and does not become severe or worse with age. It is not a progressive disease (AIHW, 2012). The impact of asthma of the lives of patients could be severe or mild depending upon the seriousness of the condition. Symptoms could be triggered by viral infections and exposure to dust, allergens or pollen, air pollution (AIHW, 2012). Asthma could prove to be life threatening in some cases.
Epidemiology
The NHS survey of 2007-2008 indicates that about six million Australians suffer from chronic respiratory conditions (ABS, 2009). Studies indicate that asthma may be caused due to environmental, genetic and lifestyle factors (ACAM, 2011). Exposure to dust, pollution, viral infections, exercise and allergens such as pollens or mites could trigger asthma attacks (ACAM, 2011).
The developed nations have been reported to have higher rates of asthma than the developing countries. Statistics indicate that the prevalence of asthma is high in Australia as compared to the United Kingdom and other English speaking countries which were found to have higher rates of asthma than the non-English speaking nations (ACAM, 2011). In Australia, asthma affects people of all ages but is more commonly found in young people (ACAM, 2011).
Statistics from the National Health Survey of 2007 and 2008 indicate that about 19% of all Australians (3,888,952) have asthma (ABS, 2009). The same survey (NHS) reports that about 9.8% of Australians are believed to be affected by asthma and the percentage of children known to be diagnosed with asthma is 10.4%. Studies indicate that asthma is a leading cause of burden of disease in newly born children to about 14 years (ACAM, 2009). This includes children between the age group 0-15 years (ABS, 2009).
The National Health Survey of 2007 and 2008 confirms that the percentage of females diagnosed with asthma is higher than males (ABS, 2009). However, among children, more boys than girls were found affected by the disease. A higher rate of asthma prevalence is found among the Aboriginal and Torres Strait Islander Australians (17%) as compared to 10% of non indigenous Australians (AIHW, 2012). The ratio of Australians in the inner regions is 12% as compared to 9% of those living in major cities (AIHW, 2012). Australia has substantially high asthma death rates by international standards with an annual mortality rate of 0.3% (AIHW, 2012).
Environmental conditions
Asthma has largely been known as a genetic disease; however, the alarming rise of asthma over the last 50 years suggests that the environment and lifestyle factors play a crucial role in the onset of the disease (Peden, 2010). Individuals living in urban areas in apartments with moulds and improper ventilation are likely to be affected by asthma. In his study, Peden (2010) confirms the link between asthma and a Western lifestyle which includes increased automobile use and exposure to tobacco smoke. Environmental air pollution is among the primary factors affecting asthma in patients and is particularly high in towns and cities. In areas of dense population, the low quality of air and high degree of pollution contributes to respiratory diseases such as asthma.
Some pollutants known for their hazardous effects on asthma include nitrogen dioxide, carbon monoxide, sulphur dioxide, ozone, lead and allergens such as pollen due to the breathing discomfort, allergic reactions, irritation of the airways and asthma triggers they are likely to cause (ACAM, 2011). Other environmental factors such as viral infections, exposure to allergens such as house dust, pollen, animal fur, and exposure to air pollutants are known to trigger symptoms of asthma (ACAM, 2011).
Environmental tobacco smoke is a significant factor in aggravating cases of asthma due to the direct effect on the airways and the development of allergies in individuals. The use of tobacco within homes also negatively affects the quality of air and is associated with increased cases of asthma Air pollution from vehicular traffic is found to be a major trigger of asthma in patients (Peden, 2010).
Data indicates that asthma is more prevalent in Indigenous Australians as compared to other Australians. There is an increase prevalence of asthma among individuals with low socioeconomic status (ACAM, 2011). Asthma is the second most common cause of hospitalization in Indigenous Australians and can be attributed to high exposure to pulmonary toxicants such as tobacco smoke, and uncertainty of diagnosis among the very young and very old resulting in long term under treatment (ACAM, 2011). Social customs and practices such as smoking habits in rural residents, less exercise and lack of nutritional diets are likely contributors of asthma.
Smoking and poor access to good quality health care are among the important causes for the high rates of asthma in Indigenous Australians as compared to other Australians (ACAM, 2011).
Societal Responses to Asthma
There is a great deal of data linking low socioeconomic status to asthma, a non-communicable disease (ACAM, 2011). It has been reported that individuals from lower status are more likely to suffer from asthma. This has been attributed to certain risk factors associated with low socioeconomic status such as reduced physical activity, smoking, inactivity and alcohol abuse (Glover et al., 2004). Studies which analyzed the impact of socioeconomic inequalities in the prevalence of disease found a large percentage of the poor population affected by the asthma which has serious implications to society and increased health care costs (Glover et al., 2004).
Societal factors which prevent self management of asthma are the lack of proper knowledge about the disease, ineffective monitoring and management of signs and symptoms of asthma, in ability to adopt a management care plan agreed and negotiated in partnership with health care professionals and inability to adopt lifestyles which promote health by addressing the risk factors associated with asthma (NHPAC, 2006).
Data also suggests a huge gap in the mortality rates between Indigenous Australians as compared to other Australians (ACAM, 2011). Death in Indigenous Australians due to asthma was 2.5 times more than other Australians indicating the strong influence of socioeconomic factors on the control of asthma and access to appropriate health care. Limited access to quality health care is a problem in economically poor communities. Some other factors which could impact the high prevalence of asthma in socioeconomically poorer Australians are lack of knowledge about the care and treatment for asthma and inaccessibility of health care services for treating it.
Health Intervention
The significant relationship between socioeconomic status and asthma points to the need for intervention for better and adequate health seeking behaviour strategies and measures for people belonging to this group.
Health promotion programs and Interventions for Asthma Self-management
The prevalence of asthma in Australia has risen in recent years necessitating the need for measures to reduce the risk of developing asthma. Community based health programs for information on asthma symptoms, prevention of asthma and communicating with asthma healthcare professionals will help individuals in effective self management of the disease (NHPAC, 2006). Written asthma management plans (AMPs) help to increase patient adherence and self management through the use of AMPs which include information about actions necessary for regular management of asthma and actions in the case of an acute attack (NHPAC, 2006).
Doctor patient relationship and clinical guidelines
Poor knowledge about asthma and poor communication about the disease have been associated with low levels of patient adherence. There should be communication between the doctor and the patient about the nature of asthma and the required daily therapy. Communication should include the necessary medications and the side effects of the therapy. The doctor’s role includes educating the patient about asthma, prescribing medication, discussing side effects, teaching and advising patients about the alleviation of burdens related to the disease (NHPAC, 2006). Doctors should adhere to clinical guidelines and include strategies such as written asthma management plans (AMPs) for patients as well as their family members. A program called the Stop Asthma Clinical System (SACS) enables doctors to get access to real time strategies about communication and teaching at their computers in their clinics (NHPAC, 2006).
Interventions to reduce smoking
Since smoke from tobacco is believed to be an important risk factor, policy measures need to devise interventions consistent with the National Tobacco Strategy which prevents tobacco intake in non smokers, importantly children; reduces products made from tobacco; and reduces the exposure of non smokers to tobacco smoke (NHPAC, 2006).
Aboriginal and Indigenous Groups with special needs
Special interventions need to be designed keeping in mind the asthma patients from the poor socioeconomic backgrounds that have significant risks of exposure to conditions which could cause asthma. Intensive programs delivered by child health nurses have had a positive impact on reducing exposure to environmental tobacco smoke (NHPAC, 2006). Measure to educate and promote measures among the disadvantaged groups should include community based strategies and counselling programs to highlight the risks associated with the following: smoking during pregnancy, exposure to environmental tobacco smoke during pregnancy and infancy and the risk of exposure to dust, allergens and termites within homes.
Conclusion
Asthma is a NCD with a high impact in Australia. However, effective education and management of the disease can reduce the risks of morbidity and mortality associated with the disease. The report suggests that the adoption of strategies and interventions including appropriate knowledge and education about the disease could have positive outcomes. With the help of interventions, clinical guidelines and community based support programs, it is possible to reduce the impact of asthma in Australia. However, there is a need for further research for the best intervention strategies to effectively address the problem of asthma among the Indigenous and socioeconomically disadvantaged Australian populace, which seems to be at a greater risk due to asthma.
References
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Australian Institute of Health and Welfare. (2012). Australia’s health 2012. Australia’s health series no.13, Cat. no. AUS 156. Canberra: AIHW.
Peden, D. B. (2010). Genetic and Environmental Factors in Asthma. In: Harver A. & Kotses H. (Eds.), Asthma, Health and Society: A Public Health Perspective. (pp 43-58).
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National Health Priority Action Council. (2006). National chronic disease strategy. Australian Government Department of Health and Ageing, Canberra.
Glover, J. D., Hetzel, D. M., et al. (2004). The socioeconomic gradient and chronic illness and associated risk factors in Australia. Aust New Zealand Health Policy 1(1): 8.
WHO (2013). Noncommunicable diseases. Web.