Culturally targeted healthcare programmes based in churches and on marae are needed to help reduce the impact of severe asthma in Pasifika and Maori communities according to local experts.
New Zealand has the fourth highest hospital admission rates for asthma of all OECD countries with the proportion of Pasifika and Maori children admitted twice as high as European children.
Severe asthma is a specific type of asthma where symptoms do not improve even when maximum amounts of usual medications are taken, and where other possible causes for the symptoms have been eliminated.
Estimates suggest up to 10% of the asthma population have a severe form of asthma. In New Zealand, that could equate to more than 52,000 Kiwis who may struggle to control their day-to-day symptoms and continue to have frequent asthma flare-ups, despite taking their maximum prescribed doses of asthma medication.
The inability to control the symptoms of severe asthma with medication means that therapy options are limited and as many as 40% of adults with the disease may be hospitalised annually as a result. Around one in three adults with severe asthma are dependent on oral steroids - a treatment regimen which may cause a range of side effects including weight gain, an elevated risk of diabetes and infections as well as having a detrimental impact on their mood.
Asthma mortality rates are also highest among Maori and Pasifika peoples, with rates 4.8 and 5.8 times higher than rates for those of other ethnicities.
The condition is not always well managed following hospital treatment with one in five Maori/Pasifika people readmitted to hospital within a year of being first admitted with asthma symptoms.
A new report has found that the higher asthma burden in Maori can be attributed to a combination of exposure to the wider determinants of asthma, access to care, asthma treatment, cultural safety and self-management issues; strategies aiming to more effectively manage severe asthma in Maori should target these sites of action.
The report reviewed a number of marae based, asthma treatment programmes which were able to establish credibility among whanau and had improved outcomes for Maori with severe asthma.
Christchurch and Auckland based GP Dr Api Talemaitoga agrees Maori and Pasifika sufferers are most at risk of severe asthma and often require urgent after-hours medical attention or admission to hospital.
“One thing I see in my after-hours role is that there are a large number of Pasifika people who are not using preventative medications, and these can be patients who have previously been admitted with severe asthma, but once their episode has passed have not continued to use a preventer,” he says.
“The thing with asthma is it's quite invisible, if you had a bad cut, you would of course go to a doctor and get it looked at, but with asthma it's easy to minimise its effects until it's at a critical stage which can be terrifying for both adults and children,” he says.
Dr Talemaitoga says poverty plays a role in a family’s ability to prevent, manage and respond to severe asthma.
“What might start off as a cold, can become a bad cold, and combined with a poorly insulated house, and cooler nights, the patient is unable to get warm. Often they can develop a lower respiratory chest infection which makes their asthma worse. It is these type of environmental factors which mean that acute attacks often present in after-hours clinics,” he says.
Dr Talemaitoga says more needs to be done to better educate the Pasifika community on the danger of severe asthma at both a cultural and clinical level.
“I think health days at churches are very effective in communicating in a language and environment they are comfortable and familiar with. We’ve proven this approach works with the success of rheumatic fever, pneumococcal and whooping cough programmes, but now we need to address severe asthma,” he says.
As well as culturally appropriate education Dr Talemaitoga says healthcare providers need to ensure they are taking the time to delve into the family history, correctly diagnose severe asthma, and stress the importance of medication in combating severe asthma.
A member of the Asthma Foundation’s expert advisory group, Dr Talemaitoga spreads his time between clinics in Christchurch and Wellington, often training healthcare practitioners on severe asthma diagnosis.
“I tell them that using humour, appropriate language and making time to explain how to use medications are all critical steps in dealing with the disease.
“As doctors we need to know more than just their health issues to properly diagnose asthma, we need to know their social background, their home environment and their family history,” says Dr Talemaitoga.
“If we are not taking the time to find out family history (for example children whose parents have asthma are more likely to have it), we could misdiagnose it or miss it completely,” he says.
Severe asthma can in some cases be misdiagnosed as a chest infection, while the chest infection can be treated with antibiotics, a clinician could miss the respiratory inflammation which would result in another hospitalisation further down the track, he says.
He says there is some good news when it comes to severe asthma in that it is treatable with patients often able to make a recovery once given the appropriate medication or medical intervention.
Auckland woman Danielle Murray knows first-hand the impact of asthma on a family. The mother of four, her husband and two of the children all have asthma, with Danielle’s inhibiting her quality of life since she was two.
“I get hospitalised about once or twice a year, and I have to go to the doctor to go on a nebuliser an additional couple of times a year. It’s normally when I start getting sick ,with a cold or flu. I can’t keep on top of it. I have to have my puffer every four hours, then two hours, then one – then it stops working and I have to go into hospital for about three days and stay on the nebuliser,” says Murray.
“I have had severe asthma my whole life, which means I can’t go anywhere without a puffer. When I get an attack I literally can’t breathe – if I don’t have my puffer I could die. I always have an inhaler in my bra in case I can’t get to my bag in time!”
Murray says as a child suffering from severe asthma often made her anxious which culminated in a major asthma attack during a school cross country event.
“I was curled up in a ball, I couldn’t breathe, my puffer was at the other end of the field and I couldn’t get up. I was so scared. I managed to eventually make it back and it was ok, but I remember being absolutely terrified.
“I still have that every now and again, when the puffer’s at the other end of the house or the kids have moved it – I can’t breathe and it’s terrifying. Because I’ve lived with it for my whole life I’ve learned to manage it pretty well, but it can still go wrong really quickly sometimes,” she says.
Dr Talemaitoga’s advice to anyone suffering from the symptoms of asthma is to seek medical advice.