What asthma sufferers need to get better control of their condition

Many New Zealanders are living with poorly controlled asthma. They aren’t getting enough support and don’t realise how much better they could be doing. Those are among the findings of a recent survey by the
Asthma and Respiratory Foundation.

Of the 488 people who took part, 74% rated their asthma as always or mostly under control, but further questions revealed that only 18% would be defined as having well-controlled asthma. Meanwhile, 26% reported never having had their asthma reviewed by a healthcare practitioner and only 22% had had their inhaler technique checked.

“This survey wasn’t attempting to be a definitive scientific review,” says the foundation’s medical director, James Fingleton. “It’s a snapshot of what it’s like out there if you’ve got asthma in New Zealand.”

Over half a million of us are taking medication for asthma and it is one of the more common causes of hospital admissions for children. People with asthma have sensitive airways in their lungs that can narrow and swell in response to certain triggers, making breathing difficult. Symptoms include shortness of breath, tightness in the chest, wheeziness and cough. In the survey, 26% of participants said asthma significantly reduced their quality of life. And every year, some sufferers die from it.

“We’re very concerned,” says Fingleton. “This suggests there are a lot of people out there who have poorly controlled asthma and it is limiting their day-to-day lives. They may have got used to feeling that way and not realise a better standard of asthma control should be available to them.

“If your asthma is well controlled, you should be able to exercise and play sport, and it shouldn’t be dictating any of your decisions. And you certainly should be using your reliever inhaler less than a couple of times a week. Often, it doesn’t take anything complicated to achieve this.”

Some respondents were overusing their reliever inhaler, which contains the drug salbutamol, relying on that rather than daily use of a preventer inhaler. And a relatively low number had switched to the newer 2-in-1 inhalers, which have been shown to significantly reduce the risk of severe attacks and are now considered the preferred treatment.

If every asthma sufferer was having an annual review, then easily fixed issues with control and medication would be picked up. But for many of those who responded to the survey, the cost of medical care was a problem and 55% were worried about getting an appointment with a healthcare practitioner.

Fingleton wants to see an annual asthma review become part of the standard of care and to have some funding attached to it. If the workload is too great for the already burdened GP system, then asthma societies or pharmacists could be called on to help.

“Pharmacists definitely have a role to play. They are very well placed to recognise when people are coming in for their blue reliever inhaler, but not picking up anything else. So, that’s a really good point where we could intervene.”

Even if your asthma seems reasonably well controlled, Fingleton advises an annual review. Those who are having symptoms and flare-ups should be seeking medical help more often. “There may be a problem with the way they are using their inhaler or they need their inhaler changing. You can’t get asthma under perfect control in everybody, but getting the basics right can make a big difference to most people.”

This was the first survey to be conducted by the foundation. It was shared on social media channels and emailed out to its database. One limitation is there was a high proportion of responses from people identifying as European New Zealanders, when we know Māori and Pacific people are at least three times more likely to be hospitalised with asthma.

There are plans to repeat the survey and reach more of the groups that were underrepresented last time.

“We should be in a better place than this,” says Fingleton. “I think it’s a bit of a reality check.”