Asthma Australia

Asthma remains a significant burden on health systems and individuals, with many hospitalisations in Australia considered preventable through improved management and community care. This study aimed to explore end-user perspectives on preventing potentially avoidable asthma hospitalisations and identify key themes, research questions and priorities. This cross-sectional study involved administering an anonymous online survey as part of a national asthma research priority-setting initiative. The participants included people living with asthma, their carers, healthcare professionals, and policymakers in Australia, all of whom were asked to provide free-text responses regarding the research questions they considered important for preventing asthma hospitalisations. Responses underwent thematic and content analysis to identify themes. Of the 554 respondents, 461 (83%) were individuals living with asthma, primarily females aged 45-64 years. The analysis identified nine key themes; however, subgroup analysis revealed four dominant themes: 1) self-management support, focusing on increasing knowledge and confidence, awareness of when to seek help, and the use of digital health tools; 2) pharmacological approaches, seeking better medication options with minimal side-effects; 3) strategies for avoiding major asthma events, emphasising improved proactive measures to reduce asthma attacks; 4) asthma care, highlighting the need to make medications more affordable, and enhanced access to care. This study highlights key research priorities from the collective voice of end-users on preventing potentially avoidable asthma-related hospitalisations. These novel data provide a foundation for future research aimed at supporting Asthma Australia's vision to reduce asthma-related hospitalisations by 50% by 2030.

Housing conditions are emerging as an important consideration in climate change adaptation. Housing modifications have the potential to improve health outcomes by reducing exposure to changing weather conditions and extreme events. This scoping review aimed to explore the existing evidence examining the contribution of housing conditions to the impacts of climate change on health and identify any research gaps. Literature searches were conducted in Scopus and PubMed from January 2013 to September 2023 and data were analysed using thematic analysis. The review included 38 articles consisting of original studies, reviews, and reports, with broad geographical coverage. The most common focus among included articles was on heat-health impacts; housing conditions found to improve heat-health health outcomes included air conditioning, ventilation, and window shading, and there was support for multifaceted housing adaptations rather than single fixes. Ventilation was found to be a priority for improving indoor air quality, while inappropriate insulation and excessive air tightness were found to increase indoor heat and reduce indoor air quality. The scoping review reveals a need for more empirical and qualitative research into indoor heat in homes, climate change hazards other than heat, and intervention studies to inform climate change adaptation policies around housing and improve public health outcomes.

IntroductionFrequent asthma attacks in children result in unscheduled hospital presentations. Patient centered care coordination can reduce asthma hospital presentations. In 2016, The Sydney Children's Hospitals Network launched the Asthma Follow up Integrated Care Initiative with the aim to reduce pediatric asthma emergency department (ED) presentations by 50% through developing and testing an integrated model of care led by care coordinators (CCs).MethodsThe integrated model of care was developed by a multidisciplinary team at Sydney Children's Hospital Randwick (SCH,R) and implemented in two phases: Phase I and Phase II. Children aged 2–16 years who presented ≥4 times to the ED of the SCH,R in the preceding 12 months were enrolled in Phase I and those who had ≥4 ED presentations and ≥1 hospital admissions with asthma attack were enrolled in Phase II. Phase I included a suite of interventions delivered by CCs including encouraging parents/carers to schedule follow-up visits with GP post-discharge, ensuring parents/carers are provided with standard asthma resource pack, offering referrals to asthma education sessions, sending a letter to the child's GP advising of the child's recent hospital presentation and coordinating asthma education webinar for GPs. In addition, in Phase II CCs sent text messages to parents/carers reminding them to follow-up with the child's GP. We compared the change in ED visits and hospital admissions at baseline (6 months pre-enrolment) and at 6-and 12-months post-enrolment in the program.ResultsDuring December 2016-January 2021, 160 children (99 in Phase I and 61 in Phase II) were enrolled. Compared to baseline at 6- and 12-months post-enrolment, the proportion of children requiring ≥1 asthma ED presentations reduced by 43 and 61% in Phase I and 41 and 66% in Phase II. Similarly, the proportion of children requiring ≥1 asthma hospital admissions at 6- and 12-months post-enrolment reduced by 40 and 47% in Phase I and 62 and 69% in Phase II.ConclusionOur results support that care coordinator led integrated model of asthma care which enables integration of acute and primary care services and provides families with asthma resources and education can reduce asthma hospital presentations in children.

The impact of bushfire, particularly on those with chronic lung diseases, is now recognized.1, 2 Individuals with asthma are among the most vulnerable groups.3 As bushfires are anticipated to be longer and more intense in many regions of the world, their adverse impact, particularly in asthmatic individuals, will impose a significant burden. Between July 2019 and March 2020, Australia experienced an unprecedented number of bushfires. At its worst, the smoke resulted in the Air Quality Index reaching more than 25 times the hazardous level in Canberra on 1 January 2020. It is estimated the bushfire smoke was responsible for more than 400 deaths, 2000 respiratory hospitalizations and 1300 presentations to the emergency department (ED) for asthma.4 In response to the unfolding public health emergency caused by this prolonged period of bushfire, Asthma Australia conducted an online survey (19 December 2019–30 January 2020) to capture the experiences of people across Australia. The survey was posted on the Asthma Australia website, and disseminated via Asthma Australia networks, social media and media articles, including an email to Asthma Australia's database of approximately 60 000 people with asthma or their carers. It included both quantitative and qualitative questions. The survey was completed by 12 152 people of which 7285 (61%) reported a history of doctor-diagnosed asthma.5 People with asthma were particularly vulnerable to the impacts of smoke exposure, with 93.6% experiencing respiratory symptoms compared to 70.2% in those without asthma (Fig. 1). People with asthma were significantly more likely to report seeking medical assistance (23.3%) and being sick more than a week (33.0%) than those without asthma (13.3% and 19.9%, respectively). Notably, people with asthma reported significantly higher rates of serious health outcomes including attending the ED (5.9%), hospitalization (2.4%) and requiring corticosteroid medication (16.3%) compared to those without asthma (1.4%, 0.6% and 2.4%, respectively). These outcomes were reported despite people with asthma being significantly more likely to take actions to reduce smoke exposure (e.g. staying inside with doors and windows shut: 85.7%; using air conditioning on the recycled setting: 55.1%; using a portable High Efficiency Particulate Air (HEPA) air cleaner in small, enclosed areas of a house: 12.3%; and using a P2/N95 face mask: 28.7%) than those without asthma (72.4%, 43.3%, 8.9% and 22.8%, respectively). Children with asthma were disproportionately impacted by the smoke exposure. Carers were more likely to report their child attended the ED or was admitted to hospital as a result of smoke exposure. The survey also found sustained exposure to bushfire smoke had significant impact on the quality of life in people with asthma. Those with asthma reported significantly reduced capacity in daily activities (65.6% in asthmatic individuals vs 47.4% in those without asthma), social engagement (e.g. needed to cancel important sporting/social engagement: 35.4% in asthmatic individuals vs 23.7% in those without asthma) and being absent from work/school (29.4% in asthmatic individuals vs 14.8% in those without asthma). People with asthma were twice as likely to experience financial stress (24.9%) compared to people without asthma (12.9%). This was due to lost or reduced income, and additional costs from extra doctors' visits, additional medication and the costs of protective equipment. One particular aim of the survey was to understand if actions taken by people with asthma during the bushfire period helped to reduce the adverse impact of smoke exposure. Despite their efforts, people with asthma who reported taking action to minimize smoke exposure both before and during bushfire season were still more likely to report respiratory symptoms, require medical attention (general practitioner visits, ED visits, hospital admission and requiring steroid medication) and experience negative impacts on their quality of life (e.g. sick for >1 week, financial stress, absent from work/school, restricted daily activities and social engagement) than those with asthma who did not take action. This is unexpected and may be related to asthma severity. Among people with asthma, those who reported taking their preventer medication daily were also more likely to report taking protective actions to reduce smoke exposure. It is possible these people had more severe asthma and therefore were more at risk of adverse respiratory outcomes during hazardous smoke exposure. In addition, the smoke was present for unprecedented periods at hazardous levels, and often out of the individual's control to minimize or avoid exposure completely despite taking protective actions. The survey findings reveal the substantial acute impact of the bushfire crisis on people with asthma. Importantly, it is likely that these catastrophic fires will have long-term health effects.2 Exposure to woodsmoke may cause long-lasting lung and airway injuries and contribute to the progression to irreversible airflow limitation.6 The findings highlight the need for effective primary and secondary preventative measures in people with asthma. Monitoring for long-term respiratory consequences is essential to quantify and qualify the extent of the impact and use this information to explore preventive measures. Public health programmes to increase awareness and preparedness for bushfires should be strengthened. Appropriate allocation of healthcare resources for respiratory care, the availability of additional services such as smoke pollution warning and advice on preventive measures before and during bushfire seasons are also warranted. In addition to preventative measures specifically for people with asthma, the impact of bushfires in this survey and others7 on people with and without asthma highlights the need for holistic national strategies to prevent and mitigate the adverse impact of bushfires. Timely and effective risk communication and education targeting environmental health literacy is needed. Authorities should improve the air quality monitoring network, including a better distribution, consistency across state borders on risk thresholds and use of temporary air quality stations where necessary. Long-term surveillance of affected communities for adverse health impacts and appropriate allocation of health care resources is also essential to support both the acute phase and mitigate the long-term impact. National policies including control of prescribed burning are needed, as are strategies to ameliorate the factors contributing to the increase in frequency and severity of catastrophic bushfires, namely, global warming. Lessons learned from the 2019–2020 bushfire crisis and these recommendations could benefit both Australia and other countries.

IPCRG World Conference 2004 Hotel Sofitel, Melbourne, Australia - February 19 th - 22 nd 2004

The 3+ Visit Plan was developed by the National Asthma Council's General Practitioners' Asthma Group in response to the comments and experiences of General Practitioners that the Six Step Asthma Management Plan is difficult to apply in GP settings. The 3+Visit Plan is a re-working of those six steps of best asthma practice into the format of three (or more) consultations specifically for asthma. It is a proactive program, requiring a partnership between GP and patient with the aim of engaging both parties, so that all the elements of best asthma management are completed in a structured, logical and timely way. This is in contrast to the more usual reactive care, e.g. providing rescue medication when the patient visits with exacerbations or dealing with asthma as an “add-on” issue in a consultation which was primarily for another reason. The resources consist of a doctor's aide memoire, with the recommended steps for each visit and illustrations to assist in patient education, and a pad of tear-off sheets for patients. The patient resource sets out the steps per visit in clear, layperson's English and also contains illustrations. It also includes space for appointment times. This initiative of the National Asthma Council has now been taken up, and substantially funded by, the Australian government and a national implementation plan is currently underway.