Asthma is not prevalent in Aboriginal and Torres Strait Islander children: a myth

Retrospective review of 200 children hospitalised with acute asthma. Identification of intervention points: a single centre study

AIM

Indigenous Australians with asthma have higher morbidity and mortality compared with non-Indigenous Australians. In children hospitalised with acute asthma, we aimed to (i) determine if acute severity, risk factors and management differed between Indigenous and non-Indigenous children; and (ii) identify intervention points to reduce morbidity and mortality of asthma.

METHODS

Retrospective review of 200 children hospitalised to Royal Darwin Hospital with asthma. We compared admission characteristics, severity indices, treatment, discharge plans and readmissions in Indigenous and non-Indigenous children.

RESULTS

Median age was 3.6 years (interquartile range 2.2, 6.8). A significantly higher proportion of Indigenous children (95.2%) were exposed to tobacco smoke compared with non-Indigenous children (45.7%). The difference in proportions was -0.41 (95% confidence interval (CI) -0.60, -0.22). Other risk factors, asthma severity (moderate 83.9% vs. 83.3%; severe 16% vs. 16.1%), length of stay (1.9 vs. 1.3 days) and readmission rate (27.4% vs. 27.5%) were similar between Indigenous and non-Indigenous children. Indigenous children were significantly more likely to be followed up in a community clinic (difference in proportions = 0.10, 95% CI 0.1, 0.17) and less likely by a paediatrician. Only 62.5% of all children had an asthma action plan on discharge.

CONCLUSION

Unlike other common respiratory diseases requiring hospitalisation, biological factors are unlikely major contributors to the known gap in asthma outcomes between Indigenous and non-Indigenous children. Intervention points include better identification, documentation and management of tobacco smoke exposure, delivery of salbutamol and discharge planning (including education and utilisation of asthma action plans).

Stable prevalence of asthma symptoms in school-aged children in the Torres Strait region

BACKGROUND AND OBJECTIVE

To (i) determine if the prevalence of asthma has altered in two previously studied communities and (ii) obtain baseline measures in two further communities in the Torres Strait region, Australia.

METHODS

A population-based cross-sectional study of school-aged children was conducted. Five schools in four communities were selected: 361 children aged 5-17 years participated. The study used the same epidemiological tool that had been utilized to measure asthma prevalence (locally adapted International Study of Asthma and Allergy in Childhood questionnaire).

RESULTS

The overall response rate was 30%; response rates in individual communities ranged from 23% to 100%. The prevalence of self-reported wheezing in the last 12 months decreased from 10.7% to 6.6% (P = 0.109) on Thursday Island and from 3.1% to zero (P = 0.358) on Warraber Island. The percentage of children with asthma symptoms was lower in this current study but changes were not statistically significant. Overall self-reported prevalence of ever wheezing was 12.5%; 5.4% reported wheezing in the previous 12 months, 5.9% reported wheezing after exercise and 12.2% reported ever having asthma. There was considerable inter-community variation in the prevalence of symptoms.

CONCLUSIONS

Asthma prevalence in school-aged children living in the Torres Strait region remains high but, as in mainstream Australian children, the prevalence is stable.