WA, NT and TAS identified as asthma 'hot spots'

A recent study has identified Western Australia and parts of the Northern Territory and Tasmania as asthma ‘hot spots’, recording the highest numbers of people with difficult-to-treat asthma in Australia.

Published in the Journal of Asthma, the study also found the greatest prevalence of severe uncontrolled asthma and/or more frequent use of oral corticosteroids (OCS) was observed in South Australia and parts of Queensland and New South Wales.

National Asthma Council Australia Director and respiratory physician Professor Peter Wark, lead author of the paper, said the concern is that this represents a problem with access to care in rural areas.

“Despite global and national guidelines, regional differences in the prevalence of severe asthma, severe uncontrolled asthma and oral corticosteroid use exist in Australia,” Wark said.

“The study identified important variations across the country both by state and geography and it is our hope that understanding regional variation may inform policy and target treatment to areas with the greatest unmet need.”

While the reason for the wide variation isn’t yet clear, Wark said it was likely to be due to a number of factors. These include environmental and socioeconomic issues in relation to air quality and potentially access to health care. In the case of both Western Australia and the Northern Territory, remoteness was also an important factor, he added.

The study also found overuse of high-dose inhaled corticosteroids (ICS)/long-acting beta-agonists (LABA) with poor adherence and asthma control, and an alarming number of people exposed to high-dose cumulative oral corticosteroids (OCS) over just a 12-month period.

“Given what we know about the efficacy of both inhaled and oral corticosteroids, we are clearly not achieving the types of asthma control that we should and those individuals are at high risk of long-term complications from the use of corticosteroids,” Wark said.

“We have serious challenges implementing effective asthma management in Australia, likely due to a combination of factors including adherence to treatment, the use of devices and over-reliance on prescribing oral corticosteroids. It is also likely that too few people are being referred for assessment of severe asthma and consideration of biologic therapies,” he said.

Wark said that the next step would be to investigate the reasons behind the regional variation in asthma control, including the combination of environmental exposures, socioeconomic factors and access to health care.

“What is obvious is that this is not a small problem, as the data analysed represented 1.9 million Australians and 24% had difficult-to-control disease.

“This highlights the fact that asthma remains a very serious chronic health condition for the Australian population despite access to medications that should be highly effective,” Wark said.

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