Baby-boomer women at highest risk of asthma death

Australian deaths from asthma have fallen significantly over recent decades – to 441 in 2017 from a peak of almost 1000 in 1989.
 
But while the drop is a great sign that asthma awareness campaigns are working, 441 is still far too many deaths, according to respiratory physician and Chair of the National Asthma Council Australia, Dr Jonathan Burdon.
 
‘Death from asthma doesn’t have to happen; we know most of them are avoidable,’ he told newsGP.
 
Dr Burdon is also concerned that death rates are actually rising among a particular group – baby-boomer women.
 
‘The number of deaths in the 55–65-year-old female age group doubled in the 2017 statistics [since 2016], from 16 to 32,’ Dr Burdon said.
 
Asthma has a higher prevalence among boys than girls, but the situation reverses once people reach adulthood. However, adult women’s higher prevalence is not enough to explain why their death rate is higher than men’s by almost 50%.
 
Dr Burdon believes societal factors may have a significant part to play, particularly for women in the 55–64-year-old demographic.
 
‘That’s the age group where women are often beginning to look after elderly parents, they have children growing up, partners or husbands,’ he said.
 
‘Putting yourself first sometimes is quite okay, you don’t have to be running around looking after everybody else.’
 
Dr Burdon urges GPs to be aware of the asthma statistics and keep an eye on this particular patient group, although he is also keen to encourage increased vigilance for all people with asthma.
 
‘It’s good to see the overall death rate coming down, but if you look back over the last three or four years, it’s sort of creeping up again,’ he said.
 
‘Per head of population, [the rate] is really static, but I’m concerned about total numbers.’

‘Death from asthma doesn’t have to happen; we know most of them are avoidable,’ Dr Jonathan Burdon, Chair of the National Asthma Council Australia, said.
 
Dr Burdon has found that one of the major problems in asthma care is maintaining medication adherence.
 
‘We know that something like 40-odd percent of people prescribed regular medication – in other words, take it once or twice a day as prescribed, even if you’re feeling great – don’t do that,’ he said.
 
‘And these people are certainly over-represented in the presentations to hospital and the mortality statistics.’
 
Many patients with asthma may also underestimate their risk.
 
‘A lot of people don’t realise that it’s not just those with very severe asthma who are at risk of dying; people with very mild asthma die sometimes, too,’ Dr Burdon said.
 
‘The fact that you are not terribly afflicted doesn’t mean you’re off the hook.
 
‘You may well be in trouble in certain circumstances, and because you’ve only had very mild asthma you have not really worked out how to look after yourself when you’re in trouble.’
 
In order to counter this problem, Dr Burdon advises GPs and respiratory specialists to set up regular check-ups with patients who have asthma.
 
‘If any of your patients are taking medication, make sure they are taking it regularly. Patients should see their doctor once a year to have their asthma reviewed,’ he said.
 
‘Most people who are taking regular medication need to see somebody at least every six months to get a new prescription on the PBS [Pharmaceutical Benefits Schedule].
 
‘And make sure they have an asthma action plan, and follow it. It’s always best if it’s written down because that reinforces it. Let them know if their asthma is out of control or getting out of control, to follow their action plan.
 
‘And if the action plan is not working, seek medical assistance early; don’t wait until things are really terrible.’
 
Although Dr Burdon is cautious about keeping on top of asthma healthcare to keep the mortality rates trending down, he is very pleased with progress that has been made over the years.
 
‘I would dearly love to see the death rate halve again, but I think we did very well getting it down from 964 in 1989, and that was by community awareness, doctor awareness, asthma action plans and all of these sorts of things,’ he said. 
 
‘But I think, like everything else, one gets a bit dulled to [the need to be vigilant]. The thunderstorm asthma in Victoria served as a wake-up call, I think, and we’ve got to keep at it.’

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