Emergency Department Presentations

AIHW Emergency department care (ref 1):

In 2024-2025 there were about 92,000 presentations to the Emergency Department of public hospitals with asthma. (ref 1)*

Specifically 91,480 presentations with asthma were recorded across complexity level A, B and C, of which:
– about 46,000 (50%) were admitted (including admission in the emergency department, admission to another hospital ward, including a short stay unit, or admission to hospital-in-the-home)
– about 45,000 (50%) were not admitted
– 1.5% were triaged as resuscitations
– 39% were triaged as emergencies
– 47% were triaged as urgent
– 12% were triaged as semi-urgent
– <1% were triaged as non-urgent

*ED presentations included all types of visits, including Emergency presentation but also Return planned visit (e.g for Follow-up treatment, test results etc), pre-arranged admission and dead on arrival (without resuscitation attempt) (see https://meteor.aihw.gov.au/content/684942)

Note: This data differs from AIHW asthma webpage which lists ED due to asthma (asthma as the principal diagnosis)

Note: the number of admissions here is different from the hospitalisation number provided through the AIHW “Admitted Patient Care”. Admitted patient care provides a count of hospitalisations with asthma as principal diagnosis (i.e. main reason for hospitalisation)

AIHW Asthma webpage (ref 2):

In 2024-25, there were:

• 60,300 ED presentations with asthma as the principal diagnosis
• ED rate was about 220 presentation per 100,000 population, slightly higher in females than males (245 vs 220 per 100,000)
• Age standardised ED rate in 2024-25 was 234 per 100,000, about the same level as in 2020-21 during the COVID pandemic, and the lowest since 2020-21 (highest was in 2022-23 at 272 per 100,000) – see figures below
• boys aged 0-14 had an ED rate 1.5 times as high as that of girls the same age (boys were 1.5 times as likely to visit an ED for asthma)
• ED rates (age standardised) are higher for people living in Remote and Very remote areas compared to people living in Major cities (535 and 140 per 100,000 population, respectively), and for people living in areas of most disadvantage compared to people living in areas of least disadvantage (320 and 64 per 100,000 population, respectively).
• First Nations: 6,200 ED presentations with asthma as principal diagnosis among First Nations people, a rate of 590 per 100,000 population (720 vs 460 per 100,000 in females vs males), which after adjusting for age, is 2.7 times higher than for other Australians

Fig 3 from AIHW: ED rates with asthma as principal diagnosis, by age and sex (ref 2)

ED rate (age standardised) trends from 2018-19 to 2024-25 (ref 2):

See linked Excel spreadsheets for ACT ED admission data 2022, 2023 and Jan-Sep 2024, for the two ACT public hospitals (Canberra and North Canberra Hospitals).

ACT Health asthma ED stats 2022 to 2023

ACT Health asthma ED stats 2022 to 2023.xlsx

ACT Health asthma ED stats Jan to Sept 2024 CHS DATA REPORT

ACT Health asthma ED stats Jan to Sept 2024 CHS DATA REPORT.xlsx

This data is obtained through the data Sharing Agreement with Canberra health services and should not be shared externally.

According to AIHW asthma report:

Between 2018–19 and 2021–22, ED presentation rates decreased from 300 to 240 per 100,000 population and were higher for females compared with males.

In 2021–22, asthma ED presentations rates were around twice as high for:

• people living in Remote areas compared with people living in Major cities (420 and 215 per 100,000 population, respectively)
• people living in areas of most disadvantage (lowest socioeconomic areas) compared with people living in the least disadvantaged areas (highest socioeconomic areas) (320 and 160 per 100,000 population) (Figure 18).

Like asthma hospitalisations, asthma ED presentations can also be impacted by seasonal variation. However, differences observed between 2019 and 2020 are more likely to be due to the 2019–20 bushfire season and the COVID‑19 pandemic.

In 2020, ED presentation rates decreased significantly during the nationwide lockdown from March and increased again from May. Rates for most of 2020 were lower than observed in 2019, likely due to the impact of health protection measures implemented for the pandemic (Figure 18).

Trends over time for ED presentations due to asthma (as principal diagnosis), from 2018-19 to 2021-22:
– 71,624 ED for asthma in 2018/19 (297 per 100,000 age-standardised)
– 66,199 ED for asthma in 2019/20 (270 per 100,000 age-standardised)
– 56,587 ED for asthma in 2020/21 (232 per 100,000 age-standardised)
– 59,173 ED for asthma in 2021/22 (242 per 100,000 age-standardised)

Figure 18: Emergency department presentations due to asthma, by age and sex, remoteness area and socioeconomic area, 2021–22, over time (2018–19 to 2021–22) and by month (2019 to 2022)

In 2023-2024 there were about 92,000 presentations to the Emergency Department of public hospitals with asthma.*
Specifically, 92,288 presentations with asthma were recorded across complexity level A, B and C, of which:
– about 44,000 (48%) were admitted (including admission in the emergency department, admission to another hospital ward, including a short stay unit, or admission to hospital-in-the-home)
– about 48,000 (52%) were not admitted
– 1.5% were triaged as resuscitations
– 37% were triaged as emergencies
– 48% were triaged as urgent
– 12% were triaged as semi-urgent
– <1% were triaged as non-urgent

*ED presentations included all types of visits, including Emergency presentation but also Return planned visit (e.g for Follow-up tretament, test results etc), pre-arranged admission and dead on arrival (without resuscitation attempt) (see https://meteor.aihw.gov.au/content/684942)

Note: This data differs from AIHW asthma webpage which lists ED due to asthma (asthma as the principal diagnosis)

Note: the number of admissions here is different from the hospitalisation number provided through the AIHW “Admitted Patient Care”. Admitted patient care provides a count of hospitalisations with asthma as principal diagnosis (i.e. main reason for hospitalisation)

In 2022-23 there were about 97,000 people Emergency Department presentations in public hospitals with asthma.*
Specifically, asthma 96,866 presentations were recorded across complexity level A, B and C, of which:
– about 44,000 (45%) were admitted (including admission in the emergency department, admission to another hospital ward, including a short stay unit, or admission to hospital-in-the-home)
– about 53,000 (55%) were not admitted
– 1% were triaged as rescussitations
– 36% were triaged as emergencies
– 49% were triaged as urgent
– 13% were triaged as semi-urgent
– <1% were triaged as non-urgent

*ED presentations included all types of visits, including Emergency presentation but also Return planned visit (e.g for Follow-up tretament, test results etc), pre-arranged admission and dead on arrival (without resuscitation attempt) (see https://meteor.aihw.gov.au/content/684942)

Note: This data differs from AIHW asthma webpage which lists ED due to asthma (asthma as the principal diagnosis)

Note: the number of admissions here is different from the hospitalisation number provided through the AIHW “Admitted Patient Care”. Admitted patient care provides a count of hospitalisations with asthma as principal diagnosis (i.e. main reason for hospitalisation)

AIHW report providing summary of epidemiological data in First Nations peoples with asthma (prevalence, risk factors, quality of life, burden of disease, mortality, hospitalisations, ED). This report provides a nice summary and a single reference.

Prevalence (2018-2019 National Aboriginal and Torres Strait Islander Health survey (NATSIHS):
– Around 128,000 First Nations people reported having asthma (16%), down from 18% in 2012-13, making asthma the third most prevalent long-term condition reported in 2018-19.
– higher in females (18%) compared to males (13%)
– increased with age, from 12% in children aged 0–14 to 26% in those aged 55 and over
– 1.6 times as high for boys compared with girls (aged 0–14) (14% and 8.6%, respectively)
– 2.1 times as high for females compared with males aged 55 and over (34% and 16%, respectively)
– 1.6 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (18% and 11% age-standardised prevalence respectively)
– Prevalence decreased with increasing remoteness: 19% in Major Cities, 12% in Remote areas and 7% in Very remote areas
– Prevalence by states: 25% in ACT, 23% in SA, 22% in TAS, 19% in NSW, 18% in VIC, 14% in QLD, 13% in WA, 6% in NT

Hospitalisation rates (2021-2022):
– 1,800 hospitalisations with asthma as principal diagnosis in 2021-22 (Covid pandemic year), an hospitalisation rate of 200 per 100,000; a decrease by 30% compared to 2018-19 (non Covid-pandemic year; 290 per 100,000)
– highest for females aged 45–54 (469 per 100,000) and higher for females overall compared to males (250 vs 155 per 100,000)
– 1.8 times higher for boys compared to girls aged 0-14 (318 vs 173 per 100,000)
– 2.1 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (205 vs 100 per 100,000, age-adjusted)

Emergency Departments visits (2021-2022 Non-admitted Patient Emergency Department Care database):
– 5,400 ED presentations for asthma in 2021-22 (605 per 100,000 population, decreased by 14% compared to 700 per 100,000 in 2018-19)
– Highest for females 35-44 (1,063 per 100,000) then females 45-54 (1,014 per 100,000) then boys 0-14 (883 per 100,000)
– 1.6 times higher in boys vs gilrs aged 0-14 (883 vs 558 per 100,000)
– 1.4 times higher in females vs males overall (about 710 vs 500 per 100,000)
– 2.6 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (about 600 vs 230 per 100,000; age-standardised)

Mortality (2017-2021):
– 65 deaths over the 5 years, corresponding to a mortality rate of 1.7 deaths per 100,000 population (decreasing from 2.1 per 100,000 in 2015-2019)
– Mortality rate increases with age and is 1.6 times higher in females
– Mortality rates adjusted for age structure are 1.9 times higher in First Nations people compared to non-Indigenous Australians

Burden of Disease (Australian Burden of Disease Study 2018):
– 7th leading cause of disease burden in First Nations people, contributing 3.4% to the total burden
– Burden of asthma is greater in females (4.3%) compared to males (2.5%)
– 4th leading cause of non-fatal disease burden (5.7% of total non-fatal burden)

Risk factors for First Nations people with asthma compared to those without asthma (2018–2019 NATSIHS):
– Similar likelihood to be a current daily smoker (43% vs 40%)
– More likely to be insufficiently active (93% vs 87%)
– 1.3 times more likely to live with obesity (55% vs 43%)

Quality of life (2018–2019 NATSIHS) for adult First nations people with asthma compared to those without asthma:
– 2.5 times more likely to have poor health (18% vs 7.2%)
– 1.5 times more likely to experience high or very high levels of psychological distress (42% vs 28%)
– 62% had at least one other chronic condition – the top 3 comorbidities were arthritis (51%), mental and behavioural conditions (46%), and back problems (37%)

Asthma Management in First Nations people with asthma (2018–2019 NATSIHS):
– 56% reported using asthma medication within the last 2 weeks
– 32% had a written asthma action plan (32% of those in non-remote areas vs 27% of those in remote areas)

See table below.

See tables below.

In 2021-2022 more than 77,000 presentations to the Emergency Department with asthma, of which 40% were admitted, and less than 1% were triaged as non-urgent.*
Specifically, 77,150 presentations with asthma were recorded across complexity level A, B and C, of which: (ref 1)
– 31,039 (40%) were admitted
– 46,111 (60%) were not admitted
– 986 (13%) were triaged as resuscitations
– 24,441 (32%) were triaged as emergencies
– 38,797 (50%) were triaged as urgent
– 12,305 (16%) were triaged as semi-urgent
– 621 (below 1%) were triaged as non-urgent

*ED presentations included all types of visits, including Emergency presentation but also Return planned visit (e.g for Follow-up tretament, test results etc), pre-arranged admission and dead on arrival (without resuscitation attempt) (see https://meteor.aihw.gov.au/content/684942)

In 2021-22 there were 59,200 ED due to asthma (with asthma as principal diagnosis), a rate of about 240 presentations per 100,000 population. This included, by age:
– about 26,500 ED for asthma in children 0-14 (9,825 in girls and 16,673 in boys) (ref 2)

In 2020-21, there were 8.8 million emergency department presentations (for any conditions), with young children 0-4 years and people aged 65 years or over having the highest rates of presentations.
Available data tables for download:
– Emergency department care 2020-21 data table: ED presentation by public hospital peer group, state and territory, age group and sex, triage category, remoteness, socioeconomic status, type of visit, principal diagnosis (including respiratory diseases but not specific to asthma), admission status, waiting time, length of stay etc.
– Emergency department multilevel data: percentages of patients seen on time, seen within 4 hours, time in ED and presentations.

The bushfires that swept across Australia in 2019–2020 resulted in 33 deaths, destruction of over 3,000 houses and millions of hectares. Bushfire smoke exposure was significantly associated with an increased risk of respiratory morbidity. Nationally, hospitalisation rates increased for asthma and COPD coinciding with increased bushfire activity during the 2019–20 bushfire season. For asthma, the highest increase was 36% in the week beginning 12 January 2020 (2.4 per 100,000 persons) compared to the previous 5-year average (1.7 per 100,000 persons).
For Emergency Department presentations, asthma saw the highest increase of 44% in the week beginning 12 January 2020 (4.7 per 100,000 persons compared to the previous bushfire season (3.3 per 100,000 persons).

Extract from AIHW Chronic respiratory conditions report:

COVID‑19 impact on chronic respiratory conditions

The COVID‑19 pandemic had substantial impacts on hospital activity generally. The range of social, economic, business and travel restrictions, including restrictions on, or suspension of, some hospital services, and associated measures in other healthcare services to support physical distancing in Australia, resulted in an overall decrease in hospital activity between 2019–20 and 2020–21. As a result, the hospitalisation rates for asthma and COPD in these years were the lowest recorded in the last 10 years (AIHW 2022a).

For more information on how the pandemic has affected the population’s health in the context of longer-term trends, see ‘Changes in the health of Australians during the COVID‑19 period’ in Australia’s health 2022: data insights.

Emergency department presentations for asthma and COPD were also affected by the pandemic, decreasing from March (when the national lockdown started) to May 2020 (from 26 to 11 and 39 to 28 presentations per 100,000 population, respectively).

In June 2020, emergency department presentations increased again as restrictions began to ease across the country (to 19 presentations per 100,000 population for asthma and to 33 presentations per 100,000 population for COPD) (Figure 9).

During the COVID‑19 pandemic (as at 31 October 2022), chronic respiratory conditions were certified as a pre-existing condition in 18% of the deaths with a chronic condition mentioned, the third highest of all chronic conditions (ABS 2022)

Death rates due to all respiratory diseases combined also showed a substantial fall in 2020, with rates particularly low for females and during the winter months compared with previous years, though rates have increased since (Figure 10).

While the long-term impact of COVID‑19 on the respiratory system is still being assessed, evidence shows that COVID‑19 does not directly impact the risk of increasing asthma severity and vice versa (Lee et al. 2020; Lieberman-Cribbin et al. 2020; Mather et al. 2021). However, there is increasing evidence showing that COPD patients with COVID‑19 have greater risk of mortality, severity of infection and higher likelihood of requiring Intensive Care Unit (ICU) support than those without COPD (Cazzola et al. 2021; Clark et al. 2021; Wells 2021).

For more information, see ‘The impact of a new disease: COVID‑19 from 2020, 2021 and into 2022’ in Australia’s health 2022: data insights.

A study of asthma exacerbation emergency department visits in Brisbane suggests that the risk of childhood asthma exacerbations increases within a few hours of air pollution exposure in children aged 0-14, with the risk increasing within the same hour of exposure to O3, and 4 hours after exposure to NO2.
In the study, there was also an association between exposure to PM2.5 and PM10 in some age groups, with children aged 0-4 being more vulnerable to PM10 but less vulnerable to NO2 compared to school-aged children (5-14 years).

A small Australian study indicated that amongst patients attending ED more than once within a year for asthma, one third of recurring ED visits could have been avoided, particularly for patients with mild and moderate asthma

In 2016/17 more than 70,000 people with asthma (74,034) presented to the Emergency Department.

Can also find in this data Asthma Action Plans, time of school, ED visits, # times asthma interfered with daily activities, types of medication taken, GP visits.

Repeat emergency department presentations are associated with increasing risk of future hospitalisation.

After adjusting for age, sex, and CTAS (triage scale), ED visit count was an independent predictor of asthma hospitalization. Compared to children with no previous ED visits, the risk of future hospitalization in children with one previous visit and those with two or more visits was 2.9 and 4.4 times higher, respectively.

An Australian and New Zealand study reported asthma as the 4th most frequent diagnosis in ED visits by children. The most frequent diagnoses were acute gastroenteritis, acute viral illness and acute upper respiratory tract infection. Among those aged 0–18 years, asthma represented 3.5% of all ED presentations in 2004.

Asthma ED visits increase at higher PM2.5 concentrations, with children more susceptible to the impacts than adults. ED visits due to PM2.5 were higher during the warm season.