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Living with asthma
Asthma in children
In 2001 asthma was the most commonly reported long-term health condition for children aged 0-14 years (13%). Of those aged 0-4 years, 8% currently had asthma which had been diagnosed by a doctor or nurse, and this increased to 16% for both 5-9 year olds and 10-14 year olds.
Asthma is difficult to diagnose in children, but is commonly a cause of wheeze. For this reason, several studies have investigated the presence of wheeze among children. In 1997, 27% of children aged 0-14 years were reported to have had wheeze in the past 12 months (Woolcock et al. 2001).
The prevalence of wheeze among Australian children is also high by international standards. In a study conducted in over 30 countries across all continents, Australia had the second highest prevalence of a current wheeze among 6-7 year olds, and the third highest among 13-14 year olds (Beasley et al. 1998).
Asthma can largely be controlled by good management, under the guidance of a general medical practitioner (GP). On average, there were 16 asthma-related GP visits per 100 population per year between July 1998 and June 2002 (3% of all GP consultations over that period) (AIHW 2003a).
Asthma Action Plans (AAPs) have formed part of national guidelines for the management of asthma since 1989. There is evidence that the use of a written AAP, in conjunction with training in self-management and regular medical reviews, improves health outcomes for people with asthma. Better outcomes include improved lung function and a reduced need for hospitalisation, urgent GP visits and additional medication. In 2001, 12% of people with asthma reported having a standard AAP provided by a GP. Children aged 0-14 years with asthma were more likely to have a standard AAP (18%) than people aged 15 years and over with asthma (10%).
The use of medication is the most common health-related action taken by people with asthma. In 2001, 59% of people of all ages with asthma used asthma medication to prevent and/or relieve their symptoms.
There is evidence that preventers (inhaled corticosteroids) are effective in controlling the symptoms of asthma and in preventing complications. However, in 2001, less than a third of people with asthma (31%) used preventers, while over half (51%) of people with asthma used relievers. People aged 0-39 years with asthma were almost twice as likely to use relievers (51%) as they were to use preventers (26%). The use of preventers increased markedly after the age of 40 years, with people aged 60 years and over the most likely of all age groups to use preventers (graph 9.25).
Despite the range of ways in which people with asthma may manage their symptoms, acute asthma episodes can still result in hospitalisation. Asthma accounted for 41,000 hospital separations in 2001-02 and is one of the most common reasons for emergency department attendance and hospitalisation among children. In 2001-02 just over half (51%) of the 41,000 hospital separations with a principal diagnosis of asthma (20,900) were for children aged 0-14 years (AIHW 2003c).
While the prevalence of asthma increases as children move into their teens, hospitalisation for asthma is highest among much younger children (aged 0-4 years), and steadily decreases over the life cycle (graph 9.26). The reasons for the disparity between asthma prevalence and the rate of hospitalisation of very young children are not known, but are likely to reflect a range of complex issues.
Consistent with asthma prevalence, boys are more likely to be admitted to hospital for asthma than girls, while, from late teens, women are more likely than men to be admitted to hospital for asthma.
Quality of life
People with asthma can experience a reduced quality of life and be restricted in their daily activities. In 2001 people aged five years and over with asthma were more likely to report that they had experienced days where they had to reduce their usual activities (18%) than people without asthma (11%). Adults with asthma were also more likely to rate their health as poor or fair (28%) than people without asthma (17%), and less likely to rate their health as good, very good or excellent (72% compared with 83%).
While the number of deaths of children caused by asthma is very low, asthma can affect and disrupt children’s lives in a range of ways. Asthma is a major cause of school absenteeism, and children aged 5-14 years who had asthma were more likely to have had a day away from study in the previous two weeks (24%) than children in the same age group who did not have asthma (16%).
AIHW (Australian Institute of Health and Welfare)
Beasley, R, Keil, U, Von Mutius, E & Pearce, N 1998, ‘World wide variation in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema: ISAAC’, The Lancet, vol. 351, pp. 1125-1132.
Woolcock, AJ, Bastiampillai, SA, Marks, GB & Keena, VA 2001, ‘The burden of asthma in Australia’ Medical Journal of Australia, vol. 175, pp. 141-145.
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