Asthma rates increasing in New Zealand

Press, 2 November 1989, Page 10

Asthma rates increasing in New Zealand

Asthma poses a major health problem in New Zealand, says Dr Ken Dawson, the senior lecturer in paediatrics at the Christchurch School of Medicine. Not only is it common — 28 per cent of New Zealanders are estimated to wheeze at some time in their childhood — but our hospital admission rates for it are rising faster than anywhere else in the Western world. In 1966, 21 children were admitted to Christchurch Hospital with asthma. In 1985, the number was 609. Acute asthma is now the single commonest cause of emergency admission to the children’s wards at Christchurch Hospital. What this implies, Dr Dawson believes, is not so much that the number of people suffering from asthma is increasing, but that the attacks they have are getting more severe. Why this is, he does not know. One theory is that it has something to do with Westernisation. “Changes in Third World countries, such as New Guinea, show a striking increase in asthma. Whatever it is, it seems to be associated with modern living,” he says. Another factor may be changes in the medical management of asthma. “There has been an impressive increase in asthma drug sales in many countries. This has gone hand in hand with major improvements in asthmatic treatment for children and a better understanding of a the actions of asthma drugs, improved preparations, and better delivery systems,” Dr Dawson says.

“Paradoxically, the group receiving

these new preparations has shown the greatest increase in hospital admissions. There is now concern that the bronchodilating drugs which open up the airways, while excellent for treating the acute episode, may, in fact, be masking the onward progression of the disorder.” He also says there is mounting evidence that if these drugs are given without preventive treatment they may be increasing the irritability of the airways. Investigations are under way to assess what evidence there is to substantiate these claims and theories. The rise in admission numbers, and the increased proportion of attacks graded severe runs parallel with the rising death rate from asthma in this country. A study of 271 deaths from asthma recorded from August 1981 to July, 1983 showed that, whereas asthma used to be regarded as a rare cause of death in childhood, 16 children under the age of 15 died in that two-year period. Maori children were disproportionately represented in the numbers. “There’s no evidence of ethnic bias, but whether we like it or not, more Maori children die of asthma. It’s probably not the disease, but its management,” he says. The authors of the study highlighted under-assessment of severity of the asthma by families and their doctors, along with failure of the family to call for help when required, and inadequate responses of medical services. In other words, most of these deaths were preventable.