Severity not realised?

Press, 18 March 1983, Page 6

Severity not realised?

Lack of patient education seems to be the main culprit for the “epidemic” of asthma deaths in New Zealand, says a Christchurch specialist, Dr John Gillies. Case studies he has inve itigated in the northern hai' of the South Island paintea a different picture from recent newspaper headlines about other possible causes. Dr Gillies, a visiting respiratory physician at Princess Margaret Hospital, is looking at asthma deaths An the region as part of? a national two-year survey started by doctors worried about the rising death rate, particularly among young people. The survey will finish on July 31 but over-all results will take several months to compile. Most of those who died in Canterbury were chronic sufferers. Only one of the 45

deaths in Dr Gillies’ first study year was a person younger than 20, unlike Auckland where many of those who died in one year were children. Patients who did not realise the severity of asthma attacks seemed to be the main problem, he said. Dr Gillies does not agree with a Scots respiratory specialist, Dr lan Grant, vho last year blamed the ir.creasing use of nebulisers, which dispense salbutamol in spray form, as the most likely cause of the rising death rate. “There is no evidence that drug treatment has contributed to those deaths,” said Dr Gillies. Nor were the deaths limited to a particular area or season. A pilot study of asthma deaths in Christchurch during the winter of

1981 found that the number of people who went to hospital with severe asthmatic attacks dropped on heavy pollution days but Dr Gillies said that asthmatics tended to stay indoors on smoggy days. The pilot study had also not included ' those who visited their regular doctor, and he could not discount smog as a contributing factor to asthma or bronchitis.

“Under-treatment" had also not been found in fatal cases as suggested by studies done in the United Kingdom. Dr Gillies said he had found no evidence that delays in attending doctors or lack of medical supervision contributed to the deaths.

“In most cases they were dead when the doctor arrived." he said.

Taking the survey one step further, Dr Gillies has examined some cases of near-fatal attacks.

“Those patients are surviving because they reach hospitals where there are resuscitation facilities,” he said. Chronic asthmatics needed to work out a “crisis plan” such as keeping emergency oxygen at home or possibly 'admitting themselves to hospital. People with a mild asthmatic condition also needed to know how to recognise and deal with a severe attack. Dr Gillies recommended that they get in touch with their doctor and failing that, visit the hospital casualty department if four to six “puffs” from a bronchodilator had not eased the attack within 30 minutes.