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• the rate of hospitalisations decreased, from around 165 to 120 per 100,000 population (age-standardised rate: 169 in 2014-15 to 123 in 2023-24)
• the proportion of overnight hospitalisations decreased from 69% to 65%, while the average length of overnight stays remained relatively stable over the period, and was 2.6 days in 2023–24 (Figure 2).
• It should be noted that the rate of hospitalisations over the past few years has been affected by the COVID‑19 pandemic.

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):

Descriptive analysis of PBS dispensing data between 1 January 2019 and 30 November 2023, based on UK estimates of emissions per inhaler.

Findings:

• 14.4 million PBS-subsidised inhalers dispensed in 2019, increasing to 15.5 million in 2023, primarily caused by an increas in high-emission inhalers (8.2 million to 9.2 million)
• estimated emissions increased from 217 510 t to 246 934 t CO₂e
• 56.9% of dispensed inhalers were high emission in 2019 vs 59.5% in 2023
• each year, high-emission inhalers accounted for about 98% of total PBS-subsidised inhaler-related emissions
• emissions were the greatest for SABA inhalers (98% in high emissions inhalers, 57% of all inhaler-related emissions) and combined ICS/LABA (49% in high-emission inhalers, 34% of all inhaler-related emissions)

PBS-subsidised inhaler dispensing rates were:

• higher in non-metropolitan than metropolitan areas(but emissions were higher in metropolitan areas due to a larger number of inhalers dispensed).
• higest in Tasmania (693 per 1000 population in 2023) then South Australia (632 per 1000) and lowest in the Northern Territory (355 per 1000 population) and Western Australia (383 per 1000 population)
• higher for females than males (proportion of high emission inhalers also higher for females)

The proportions of high emissions inhalers dispensed were largest in South Australia (63–65%) and the Northern Territory (59–64%) and smallest in the Australian Capital Territory (53–57%) and Western Australia (52–56%).

The age group dispensed the largest proportion of PBS‐subsidised inhalers were people aged 60–79 years (43–45% of all PBS‐subsidised inhalers dispensed; high emissions inhalers, 50–54%).

Note: study was limited by the omission of over the counter sales (for SABA) and some missing data.

A UK prospective study (conducted in 2020-2021) including 2100 people with asthma (that had had a vaccine booster in the past) reported that getting a COVID-19 infection increased the risk of asthma exacerbation by:

• 5 fold for any asthma flare-up (adjusted OR 5.11 (4.19 to 6.24) for booster within 12 months and 5.60 (2.98 to 10.53) for booster over 12 months ago)
• 6 to 9 folds for severe asthma flare-ups (requiring OCS, ED visit or hospitalisation), depending on the time since the booster was received , although the difference in risk between under and over 12 months was not statistically significant: adjusted OR 6.59 (4.70 to 9.22) for booster within 12 months and 9.20 (3.56 to 23.78) for booster over 12 months ago
• these results were adjusted/controlled for asthma treatment level (severity) and history of past flare-ups, amongst other potential confounders.

This study indicates that having a COVID infection continues to increase the risk of asthma flare-up in people with asthma, independently of asthma severity and asthma exacerbation history.

While the results suggest that longer time since vaccination increases the risk of severe asthma exacerbation, the difference was not statistically significant (confidence intervals overlap) and this requires further investigation.

Study using previously published predictions for all sources PM2.5 and NO2 and models to estimate traffic-related air pollution (TRAP) in 2015.

Results:

• an estimated 3684 (95 % CI, 3051–4350) premature deaths were attributable to air pollution from all sources
• 51 % (95 % CI, 19 %–86 %) of these (more than 1,800 premature deaths) were linked to TRAP.

These estimates are lower than previous estimates of 11,000 annual deaths from TRAP by the University of Melbourne (2023) although this study was not peer-reviewed and published.

Conclusion: Air pollution remains a significant contributor to mortality in Australia. Reducing exposure, particularly from TRAP, could yield substantial public health benefits. Policies promoting cleaner transport modes offer a promising avenue for rapid improvement.

In 2023-2024, the expenditure for asthma was an estimated $1.28 billion spent on the treatment and management of asthma (out of $180.4 billion total spending on disease and injury and $98 billion spent on chronic conditions, and $5.77 billion spent on respiratory disease in 2023-2024), making asthma the third most costly respiratory condition (after COPD and upper respiratory conditions).(ref 1)

This is an increase from $1,192 million in 2022-23 and $852 million in 2020-21 (ref 2, 3)

The 1.3 billion spent on asthma represents:(ref 4)

• 0.7% of health system expenditure allocated by disease
• 22% of all respiratory condition expenditure

Asthma expenditure repartition: (ref 4)

• about 20% of asthma expenditure was spent on children under 15 years
• 58% was spent on females , 42% on males, and 0.3% was unattributed to any sex
• spending per case was higher for females vs males ($440 vs $390 per case)
• almost half (43%) of asthma spending was attributed to the PBS ($180 per case), followed by general practitioner services, 16% of asthma spending ($68 per case)

Asthma expenditure in 2023-24 included (ref1):

• $549 million spent on pharmaceuticals
• $210 million spent on GP
• $166 million spent on public hospital admissions
• $146 million spent on public hospital EDs
• $104 million spent on public hospital outpatient services

Asthma spending breakdown (Fig 5, ref 4):

Asthma expenditure was spent as follows: (ref 4)

• 61% ($780.8 million) on Primary healthcare, which is about 2.2 times the primary healthcare proportion average spent for all disease groups: this included 43% spent on PBS benefits, which is 3.6 times higher than the proportion of PBS spending for all diseases groups (12%)
• 33% for Hospital services (1.9 times lower that the 63% hospital proportion average for all disease groups), however the ED proportion was especially large for asthma (11%), 2.2 times higher than the average for all disease groups (5%)
• referred medical services (5.8%) was lower than the average proportion for all disease group (9.0%)

Trends over time (ref 4):

• asthma expenditure has increased from $0.7 billion to $1.3 billion between 2013-14 and 2023-24 (in current prices – unadjusted for inflation)
• after adjusting for inflation, real expenditure on asthma grew $261 million (constant prices) between 2013-14 and 2023-24
• after adjusting for inflation, average health spending on asthma per case remained stable between 2015–16 ($415) and 2023–24 ($420)

Burden of disease summary (Fig 8, ref 1):

Spending on asthma by jurisdictions (ref 1):

• ACT: $25.04 million
• NSW: $402.83 million
• NT: $12.78 million
• QLD: $254.19 million
• SA: $94.56 million
• TAS: $31.84 million
• VIC: $335.08 million
• WA: $126.12 million

In 2024, there were 478 deaths with asthma as underlying cause in Australia, including 322 females and 156 males (see table below) (ref 1):
* Asthma deaths were nearly identical to the previous year (480 deaths in 2023; 329 females and 151 males)*** (ref 1), with a return to pre-pandemic level after seeing a reduction in 2021 due to pandemic measures resulting in fewer respiratory infections (ref 1, 2)
* However, over the last 35 years, asthma deaths have halved, from 964 deaths in 1989 (ref 2)

Deaths increased by 28% in males aged 75+ since 2023 (18% of all deaths) (ref 3)

Deaths increased by 16% for females aged 75+ (50% of all deaths) (ref 3)

*** Note that ABS numbers were updated in this release for previous years with 480 deaths in 2023 and 474 deaths in 2022, compared to 474 deaths in 2023 according to previous ABS release and Asthma Australia infographic.

The age-standardised death rate in 2024 was 1.3 deaths per 100,000 people (1.5 for females and 0.9 for males) which remains similar to before the pandemic. (ref 1)

There were 3,864 years of potential life lost due to asthma in 2024 (1,964 years in males and 1,847 years in females). (ref 1)

Looking at asthma as a contributing factor at death (not underlying/principal cause of death), there were 2,395 deaths in 2024 in which asthma was a contributing factor (1,475 females and 920 males) (ref 1)

Asthma deaths by state/territory and sex 2023 (ref 1)

Graphs from NAC infographic (ref 3):

Worldwide incidence of asthma readmission is up to 40% (ref 1, intro).

NSW (ref 1,3)

A retrospective longitudinal study looking at 48,217 asthma hospitalisations in children aged 2-17 years reported that over 1 in 5 children hospitalised for asthma in NSW between 2007 and 2022 were readmitted for asthma within a year, costing an average AU$2593 per readmission. (ref 1)

The study included all children born in NSW between 2005 and 2015 who had at least one asthma hospitalisation across NSW between 2007 and 2022.

Findings (ref 1):

• 21.6% of children were readmitted to hospital due to asthma within 12 months
• readmitted children were younger than non-readmitted ones (mean age 3.8 vs 4.37) with 81% of readmitted children being aged 2-4 years (vs 65% of non-readmitted)
• overall incidence rate for the first asthma readmission within the 12 months was 23.8 per 100 person-years (95% CI 22.6 to 25.1)
• the incidence rate of asthma readmission was twice as high in children 2-4 years and went down with age up to the age group (28.7 per 100 person-years for 2-4 yo; 14.7 for 5-9 yo; 11.2 for 10-14 yo) but then increased again in older adolescents (18.0 per 100 person-years in 15-17 yo)
• the readmission incidence rate was highest in the first month following hospitalisation

• readmission incidence rate was higher in the more disadvantaged areas and major cities, implying socioeconomic disparities with higher population density, traffic congestion, and environmental pollution

• First readmission cost on average AU$2593 in direct medical cost per episode,  but increased with age up to 10-14yo: lowest cost in children 2-4 yo (AU$2867 per episode) and highest cost in children 10-14 yo (AU$4392 per episode).
• the medical cost of first asthma readmissions within 12 months was AU$ 15.6million.

Possible reasons:

• Hospital discharge without proper disease management, guideline-discordant asthma care, lack of education including reviewing inhaler technique and adequate counselling during discharge have been demonstrated to influence the risk of asthma readmission within the first few months of index hospitalisation
• Causal factors for higher readmission rate in younger children may include the high incidence of respiratory infections, particularly viral infections, environmental triggers such as environmental tobacco smoke, secondary smoking at home, traffic-related air pollution, moulds at home, dust-mite allergens, food allergens and inhalant allergens are causal risk factors for asthma readmissions among young children.

The same study/data was used to identify risk factors for these asthma readmissions (ref 3).

This second publication reported: (ref 3)

• 22% were readmitted within a year: 18% of these readmitted within 30 days (early readmission) and 82% readmitted after 30 days (late readmission)
• Most readmitted children were aged between 2 and 4 (77% of early readmissions, 81.5% of late readmissions)

Risk factors for early readmissions:(ref 3)

• children’s age 2–4 years (adjusted Relative Risk (adjusted risk ratio 1.71)
• No older siblings (1.26)
• Length of stay ≥ 2 days (1.42)
• Intensive care unit admission (2.27)
• Underlying chronic comorbidities and/or congenital anomalies (1.27)
• Admissions related to allergies or eczema (1.54)

Risk factors for late readmissions:(ref 3)

• Children’s age 2–4 years (1.93) – nearly twice as likely!
• No older siblings (1.09)
• Residence in the most socio‐economically disadvantaged areas (1.16)
• Residence in major cities (1.20)
• Index admission during spring (1.16) or summer (1.10)
• Length of stay ≥ 2 days (1.21)
• Admissions related to allergies or eczema (1.40)

VIC (ref 2)

A smaller study was conducted in VIC across 3 hospitals for 767 children 3-18 years hospitalised for asthma between 2017 and 2018. The study found that 34.3% of children were radmitted within 12 months, 69% of them being aged 3-5 yo.(ref 2)

note: the NSW data is stronger evidence as it is a population-based large study in NSW and included longer follow-up.

A systematic review and meta-analysis looking at the link between air pollutants and incidence of asthma in adults.

Findings:

• 7% increased risk of developing adult asthma per 5 ug/m3 increase in particulate matter (PM2.5) exposure (pooled risk ratio 1.07 [95% CI 1.01 to 1.13], based on 9 studies)
• 11% increase in risk of developing asthma per 10 ug/m3 increase in nitrogen dioxide (NO2) (pooled risk ratio 1.11 [1.03 to 1.20], based on 9 studies)
• No significant association between ozone (O3) and developing asthma (pooled risk ratio 1.04 [0.79 to 1.36]), based on 4 studies)

Note: due to high variations between studies (heterogeneity), results should be interpreted with caution and further research is needed.

According to the Global Burden of Disease study 2021, a systematic review and meta-analysis including data from 389 sources for asthma reported that in 2021 there was:

• an estimated 260 million people with asthma worldwide
• forecast to reach 275 million people having asthma in 2050
• age standardised prevalence: 3340 per 100,000 in 2021, a 40% decrease compared to 1990 (5568 per 100,000), and expected to remain stable between 2021 and 2050.

Modifiable risk factors were responsible for 30% of the global asthma DALY burden, particularly high BMI in high-socio-demograhic (SDI) index settings, and occupational asthmagens in low SDI settings.

Asthma hospitalisations 2023 – 2024 (AIHW)
In 2023 – 2024, there were 31,994 hospitalisations with asthma as principal diagnosis.(ref 1)
This is very small increase compared to the previous year (31,107 hospitalisations in 2022-2023), a substantial increase compared to years affected by COVID-19 restrictions (e.g. about 25,500 in 2021-22) but remains below pre-pandemic level (about 37,000 in 2018-19).(ref 2)

Children under 15 accounted for 43% of all asthma hospitalisations.(ref 1)

In 2023-2024, 90% of asthma hospitalisations were potentially preventable.(ref1, 3)

*PPH: Potentially Preventable Hospitalisations (hospitalisations for asthma in people 4 years and over).

According to AIHW asthma webpage (ref 4), in 2023-24 there were:

• 32,000 hospitalisations with a principal diagnosis of asthma, representing 0.3% of all hospitalisations in Australia, and 119 hospitalisations per 100,000 population. Children 0-14 yo made up 43% of these hospitalisations (about 13,600 admissions)
• 65% of asthma hospitalisations were overnight stays, with an average length of 2.6 days
• the median age for asthma hospitalisations was 23
• When counting asthma hospitalisations as principal or additional diagnosis (any diagnosis), there were about 47,200 hospitalisations (0.4% of all hospitalisations)
• First Nations: 2,3000 hospitalisations due to asthma in First nations people, a rate of 220 per 100,000, which after adjustement for age, was 1.8 times higher than non-Indigenous Australians

Hospitalisation rates (ref 4):

• 119 per 100,000 (all ages, principal diagnosis)
• Highest among children aged 5-9 (around 405 per 100,000)
• boys aged 0–4, 5–9, and 10–14 had higher rates of hospitalisation than girls of the same age. For example, boys aged 0–4 were 1.8 times as likely as girls of the same age to be admitted to hospital

In 2023-2024, there were 28,778 potentially preventable hospitalisations (PPH) due to asthma. (ref 1).

This is similar to the year before with 28,238 PPH in 2022-2023, compared to 22,985 in 2021-2022 (a year with pandemic measures), and 32,558 in 2018-2019 before the COVID pandemic. (ref 2)

Note: Asthma PPH are all hospitalisations with asthma as principal diagnosis in people aged 4 and over.

Asthma PPH by jurisdiction (2023-24)

Asthma PPH rate (per 1,000 people) by Indigenous status and state or territory of residence, 2023-2024 (ref 3)

(c) Includes other territories, overseas residents and unknown state of residence.

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.

A literature review (ref 1) published in 2025 summarising evidence on the burden of RSV in adults with asthma or COPD highlighted that:

• A population-based study in New Zealand reported that the adjusted risk of RSV hospitalisation increased by 6.7; 7.6 and 8.2 folds in people with asthma aged 18-49; 50-64 and 65-80 respectively, compared to people without asthma.(ref 1, 2)
• Two studies reported that 49-65% of patients 60 years and older with asthma hospitalised with RSV experienced asthma exacerbations.(ref 1)

Abstract

Refer to the publication for information on:

• history of OCS use
• the need for an OCS stewardship
• How OCS are use, why and at what dose
• How to minimise exposure
• guidelines recommendations
• current use of OCS in asthma  (evidence or overuse or over-reliance)
• Harm from OCS use (risk with short-term and long-term use, adrenal insufficiency, cumulative risk)
• perspectives from people with asthma
• Principles of prevention of overuse
• harm reduction strategies
• Core principles of OCS stewardship in asthma

Download a copy here: Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand – PMC

AIHW data shows that in 2023, asthma was the 19th leading cause of potentially avoidable deaths for females aged under 75, with 119 deaths or 0.5% of all deaths (crude mortality rate 1.0 per 100,000; ages standardised mortality rate 0.8 per 100,000).

The leading cause for females was breast cancer with 1,667 deaths or 7.4% of all deaths (crude rate 13.6; age standardised rate 13.6 per 100,000).

Asthma was not listed in the top 20 leading causes of potentially avoidable deaths for males, nor for males and females combined.

Potentially avoidable deaths are deaths among people younger than 75 due to conditions that could have been prevented within the present health care system, through individualised care and/or treatable through existing primary or hospital care. Potentially avoidable deaths serve as an indicator of the health of Australians and the performance of the healthcare system

According to the National Health Survey 2022, over 1 in four Australians 23.9% had Allergic Rhinitis (AR or hay fever) in 2022:

You can access AR prevalence for each state/territory in the data downloads, Tables 28 to 35, from 2001 to 2022

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)

Data collected from AIHW:

• Ref 1 – asthma hospitalisations: AIHW Principal diagnosis data cubes [Internet]. Separation statistics by principle diagnosis. https://www.aihw.gov.au/reports/hospitals/principal-diagnosis-data-cubes/contents/data-cubes => open data cube Separation statistics by principal diagnosis for each year; navigate to tab 5-char PDx counts summary and add Sum of Separations for J45 and J46, tab 5-char PDx counts Data for age-specific hospitalisation counts)
• Ref 2 – asthma potentially preventable hospitalisations (PPH): AIHW. Admitted patients. https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients#more-data => Download data table, chapter 8, Admitted patient care 2020–21 or 2021-22, 8 Safety and quality of the health systems, Tab S8.2. https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients#more-data
• Note: PPH are all hospitalisations with asthma as principle diagnosis in people aged 4 and over. Ref: AIHW. METEOR. National Healthcare Agreement: PI 18–Selected potentially preventable hospitalisations, 2021. (https://meteor.aihw.gov.au/content/725793)

Hospitalisations (ref 1), PPH (ref 2) and Hosp. rate (ref 3) 2016-2017 to 2020-23:

* Hospitalisation counts potentially affected by Covid pandemic measures

Hospitalisation rates 2011-12 to 2021-22 (age standardised, principal diagnosis, per 100,000 population) – ref 3, Fig 15

This is a great resource if you required detailed breakdown within your state or territory to support grant applications or relevant government submissions.
You can choose for the data to be broken down by Local Government Areas (LGAs), Population Health Areas (PHAs) or Public Health Networks (PHNs).

Note that previously PHIDU modelled data from the National Health Survey (NHS), currently prevalence is only available based on the Census 2021 data. AIHW and ABS recommend to rely on NHS prevalence data rather than Census when available.

How to access the data:
– go to https://phidu.torrens.edu.au/social-health-atlases/maps
– Select the breakdown you would like (PHA, PHN, LGA)
– Once the map is opened, click ‘select data’ on the left and select the indicator of interest, e.g.:

Long-term conditions (Census), by conditions (several age groups available) => select asthma in drop-down menu

Admissions by principle diagnosis 2020/21 (male, female or persons) => select asthma

Potentially Preventable Hospitalisations by Chronic Conditions 2020/21 => select asthma

Make sure you include the type of map (PHN, LGA etc), indicator (e.g. asthma prevalence Census 2021) and date in your reference!

E.g. Hospitalisations for asthma as principal diagnosis in 2020/21, at PHN level: https://phidu.torrens.edu.au/current/maps/sha-aust/phn_pha_single_map/atlas.html 

Previous releases of the PHIDU including NHS 2017/2018 prevalence data (2021 release) can also be accessed at: https://phidu.torrens.edu.au/social-health-atlases/data-archive/data-archive-social-health-atlases-of-australia

According to AIHW, the prevalence of asthma has remained relatively stable (after adjusting for age structures over time) since 2001, at 12% in 2001 and 11% in 2022.(ref 1)

Previously, AIHW stated that the age-standardised asthma prevalence (based on National health Survey) is increasing (up to 2017-2018). (ref 2, 20 Jul 2022, not available online anymore)

TSANZ has published a position statement advocating for the use of DPI or soft-mist inhalers, as ‘green inhalers’. It is a good resource for deep understanding of the carbon footprint of inhalers, current practices/context and their impact. Some facts include:
– Over 8 millions of pMDIs were dispensed in Australia in 2022
– Percentage of inhaler doses delivered by pMDI exceeds 80% in Australia, United States and United Kingdom
– One person changing from MDI to DPI preventer is similar to changing from a petrol to a hybrid car, or going from meat-eater to vegetarian, over a full year.
– Research and development is also underway to commercialise MDIs with low-emission propellants, with carbon footprint almost 10 times smaller
– Two thirds of inhaler related greenhouse gas emissions are related to high reliever use, which could be decreased by better preventer adherence and asthma control.

The statement includes strategies to mitigate the impact, including Prescribing strategies (including the use of AIR therapy) and Recycling and reuse.

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)

According to self-reported data from the NHS 2022, amongst people with asthma aged 18 and over:
– 19% reported that asthma interfered with daily activities 2 or more times in the past 4 weeks (vs 23% in 2017-18), including going to school or work, playing with friends, exercising, getting around places etc.
– 8.8% experienced very high level of psychological distress in the past 4 weeks compared to 11% in 2017-18
– 9.4% considered themselves to be in poor health compared to 7.6% in 2017-18.

Analysis of PBS data shows that in 2022-2023:

Preventer use: amongst people aged 50 and under who were dispensed at least one preventer in 12 months (note: people over 50 may have used a preventer for COPD):
– 31% were considered to have good adherence to their preventer (dispensed a preventer 3 or more times in a year)
– adherence increased from 24% in 15-24 yo to 39% in 45-50 yo
– adherence was slightly higher for males (33%) vs females (29%)
The proportion of people with good adherence has slightly dropped since 2017-2018 (33%), apart from spikes in 2019-2020 and 2020-2021 related to bushfires and COVID pandemic.

Biologic use: amongst people aged 50 and under who were dispensed biologics 3 or more times in the year:
– 70% were considered to have good adherence (dispensed a biologic 6 or more times in the year)
– good adherence was more common in females (71%) vs males (67%)
– good adherence was highest in people 45-50 and lowest in people 25-34 years of age.
The proportion of people with good adherence to biologics has remained stable since 2018-2019 (72%) overall, with a small downward trend for people aged 34 and under.
Between 2018-2019 and 2022-2023, the number of people dispensed at least once biologic in the year has more than tripled, from 810 to 2,900 people.

Analysis of PBS data shows that in 2022-2023, 27% of people aged 40 and under (and dispensed at least one reliever during the year) were considered to have poor asthma control based on their use of reliver medication (dispensed reliever medicine 3 or more times in a year) – progress compared to 29% in 2017-2018. It was:
– 31% in people aged 35-40, higher than for all other age groups
– 29% in males vs 26% in females
Rates have remained similar since 2017-2018 apart from spikes in 2019-2020 and 2020-2021 related to bushfires and COVID-19 pandemic.

Note: since previous reporting by AIHW, the scope of reliever medication has expanded to include SABA and also budesonide-formoterol 50-200mcg, resulting in data changes across all years. Budesonide-formoterol can also be used as a preventer.

In 2022-2023, the expenditure for asthma was an estimated $1,192 million spent on the treatment and management of asthma (out of $172 billion total health expenditure in 2022-2023), making asthma the third most costly respiratory disease after COPD and Upper respiratory conditions.

Asthma expenditure included:
– $378M in hospital expenditure (public ED, admitted and outpatient + private hospital services) with $150M spent on public hospital admissions and $125M spent on public hospital ED
– $742M in primary care (incl. allied health and other services, dental expenditure, GP, and PBS expenditure), making asthma the most costly respiratory disease for primary health care: this includes $186M for GP services and $534M in PBS/medication expenditure, ranking first respiratory disease for both
– $72M in referred medical services, ranking second most costly respiratory disease: $48M was spent on Specialist services.

A Victorian retrospective pharmacy-based database search of all inpatient inhaler dispensing from 1 July 2022 to 30 June 2023 at The Royal Melbourne Hospital.
Findings:
– 9,246 inhalers were dispensed in a year, of which 79% were MDIs and accounted for 99% of the total inhaler carbon footprint
– Salbutamol MDI (51%), ipratropium MDI (12.5%) and budesonide/formoterol MDIs (8%) were the most frequently dispensed inhalers, accounting for 71.5% of total inhalers dispensed
– Tiotropium respimat (406 inhalers) and budesonide-formoterol DPI (379 inhalers) were the most frequently dispensed SMI/DPIs but accounted for only 4.39% and 4.01% of dispensed inhalers respectively
– the Carbon footprint of MDIs used for asthma and COPD at the hospital was equivalent to providing electricity to 50 homes for a year.
Conclusion: the environmental impact of inhaler choice should be considered in decision-making around prescribing

Lung foundation Australia carried out a survey involving more than 3,300 adult participants in 2024 to better understand barriers to adult vaccination, and information and support needs.

Participants:

• Over 3,300 adults
• 41% had a lung disease (of which, 57% had asthma, 65% had an additional chronic condition and 26% had more than one lung disease)
• 79% women, 20% men, 1% gender diverse

Findings:

• 87% agreeing that adult vaccinations improve the health of the population
• 85% agreed that it’s important for adults to receive all vaccinations recommended for them
• 83% supported setting national adult vaccination coverage targets
• 86% supported increased government investment in vaccination support and information
• Top barriers to receiving vaccination: 1st out-of pocket cost; 2^nd don’t know which vaccines are free; 3^rd don’t know which vaccine to get or when
• 3 in 4 (75%) contracted either COVID-19, influenza, pneumococcal disease, whooping cough or respiratory syncytial virus in the last two years: for 1 in 5, this infection had a major impact on their lung health.
• 45% of 18-49yo did not know which vaccines are free
• 42% of 18-49yo did not know which vaccines to get and when

The report/LFA recommends and advocates for:

• Implementing adult vaccination targets
• Recognise Australians living with a lung disease as a priority population for vaccination
• Vaccination awareness campaigns and community education
• Support primary care to better meet vaccination needs
• Free vaccinations for all clinically recommended vaccines on the NIP

Read the report to find out more including for specific respiratory conditions/vaccines.

A small qualitative study in NSW and VIC interviewed 32 adults with severe asthma, currently treated, and reported that timely severe asthma diagnosis in Australia appears to be hampered by an absence of a clear referral process, lack of general practitioner (GP) knowledge of additional treatment options, under-utilisation of pharmacists, and multiple specialists treating patient comorbidities.
Read publication for further details.

Risk factors – Asthma Burden of Disease (AIHW 2024)
Risk factors attributable burden of asthma: the Burden of Disease study estimated that in 2024:
– 36% of asthma total burden was due/attributed to all risk factors combined
– 24% was due/attributed to being overweight (including obesity)
– 7% was due/attributed to tobacco use
– 5% was due/attributed to occupational exposures and hazards
Air pollution, although not directly linked to asthma burden, was linked to other respiratory conditions and was estimated to contribute 7.5% to the burden of Chronic Obstructive Pulmonary Disease.

Information from the burden of Disease study 2024:(ref 1)

In 2024, Asthma was the 10th leading contributor to the total burden of disease in Australia with a disability-adjusted life years (DALY) rate of 5.35 per 1,000 population (143,782 DALY, crude number), similar to 2023
– After adjustment for age structure, asthma was the 8th leading cause of total burden, with an age-standardised DALY rate of 5.3 DALY per 1,000, similar to 2023 (8th) but up from 9th in 2018 and 2015, and 10th in 2011 and 2003, with an increase by 8.5% in the last 21 years (from 4.9 per 1,000 in 2003; 4.4 in 2011; 5.0 in 2015; 5.2 in 2018; 5.3 in 2023 and 5.3 in 2024)
– 5.7% of the total asthma burden was fatal, 94.3% was non-fatal

By gender:
– Asthma ranked 6th in females of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 5.7 DALY per 1,000, up from 7th in 2018 and a 4.3% increase since 2003, but unchanged compared to 2023
– Asthma ranked 10th in males of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 4.9 DALY per 1,000, down from 9th in 2018 and a 13.5% increase since 2003, but unchanged compared to 2023

By age groups (age-specific DALY per 1,000), asthma ranked as leading cause of total burden of disease:
– Under 5 year-olds (0-4): 5th in females ( accounting for 2.9% of total burden) and in males (3.4% of total burden)
– under 1 year-olds: ranking 25th overall (24th in males, not in top 25 for females)
– 1-4 year-olds: ranking 1st in boys, girls and overall
– 5-9 year-olds: 1st in females, 2nd in males after Autism spectrum disorder, ranking 1st overall
– 10-14 year-olds: 2nd in females, 2nd in males and 2nd overall
– 5-14 year olds: 1st in females (accounting for 10.7% of burden) and 2nd in males (accounting for 12.8% of burden)
– 15-19 year-olds: 6th in females, 5th in males, 4th overall
– 20-24 year-olds: 5th in females, 8th in males, 6th overall
– 25-44 year olds: 4th in females (accounting for 4.7% of burden), not in the top 5 for males
For asthma burden for other age groups, see Fig 3.4 (Rank by number) on AIHW web report.

Note: to compare epidemiological data, it is usually preferred to use age-standardised statistics to ensure the differences are not caused by variations in age structure and an ageing population, unless the data is for specific age ranges in which case “crude” age-specific statistics are used.

Figure 3.5: Disease- or injury-specific summary of disease burden in Australia: Asthma

Risk factors attributable burden of asthma: it was estimated that in 2024
– 36% of asthma total burden was due/attributed to all risk factors combined
– 24% was due/attributed to being overweight (including obesity)
– 7% was due/attributed to tobacco use
– 5% was due/attributed to occupational exposures and hazards
Air pollution, although not directly linked to asthma burden, was linked to other respiratory conditions and was estimated to contribute 7.5% to the burden of Chronic Obstructive Pulmonary Disease.

Additional information reported in AIHW Asthma webpage: (ref 2)

In 2024, asthma accounted for:

• 2.5% of total disease burden (DALY), 4.3% of non-fatal burden (YLD) and 0.3% of fatal burden (YLL)
• within the respiratory disease group, it accounted for 35% of total disease burden, 51% of non-fatal burden and 5.3% of fatal burden

The rate of burden from asthma was higher in females vs males (1.2 times higher with 5.8 vs 4.9 DALY per 100,000 population)

Trends over time:

The age-adjusted rate of burden due to asthma increased between 2003 and 2024 from 4.9 to 5.3 DALY per 100,000. The increase was driven by non-fatal burden.

Age-standardised DALY rates due to asthma, 2003 to 2024:

A study in 668 adults asthma patients looked at the carbon footprint of inhalers and found that as needed budesonide-formoterol DPI (e.g. Symbicort) resulted in:
– 95.8% less carbon emission than as-needed salbutamol pMDI (e.g. Ventolin)
– 93.6% less carbon emission than maintenance budesonide DPI + as-needed salbutamol pMDI

Note: this is a rather small study.

A study including 236K participants with poorly controlled asthma in the UK reported that poorly controlled asthma results in:
– 3 times the carbon emissions of well-controlled asthma (on average)
– Excess was largely driven (90%) by inappropriate use of SABA.

Researchers analysed the carbon footprint of inhaled medications in Europe using 2020 European sales data, and estimated the emissions of different treatment regimens on Global Initiative for Asthma (GINA) step 2.
Findings:
– There is potential to reduce the carbon footprint of inhaled medications by 85% if DPIs are preferred over pMDIs.
– For moderate asthma, as-needed ICS/LABA had a substantially lower annual carbon footprint (0.8 kg CO2e) than the more traditional maintenance ICS + as-needed SABA (2.9 kg CO2e)
– Emissions from pMDIs in the EU were estimated to be 4.0 megatons of carbon dioxide equivalent (MT CO2e) which could be reduced to 0.6 MT CO2e if DPIs were used instead

Ecological study using data from the Census 2021 (self-reported asthma prevalence in 4,6 million aged 0-14) for spatial clustering using statistical area level 2 (SA2, a ‘suburb’ within cities and catchments of rural areas, population around 3000 to 25000) and statistical modelling. The study reported that: (ref 1)
– 6.27% overall (average) childhood asthma prevalence in these geographical areas, ranging from 0 to 16.5%
– 465 areas (suburbs) were hotspots (they had a prevalence above the average 6.27% and were surrounded by areas with similar prevalence) , representing 20% of all areas
– NSW had the most hotspots (39%) followed by VIC (21%), QLD (18%) and TAS (11%)
– More than 60% of hotspots were in socio-economically disadvantaged areas
– Higher asthma prevalence in areas of areas of SE disadvantage vs advantage (10% higher, PR=1.10)
– Higher asthma prevalence in areas with high proportions of First Nations people (13% higher, PR=1.13)
– Hotspots mostly observed in regional or remote areas of New South Wales, Victoria, Queensland, and Tasmania

Concl/Discussion: Childhood asthma variation was found to be associated with area-level sociodemographic features, such as social deprivation and Indigenous density. These findings can be attributed to environmental features including socioeconomic deprivation, race or ethnicity, pollen, dust, exhaust pollutants, air pollution, violence, or crime, as well as limited access to healthcare because the majority of specialised paediatric asthma services are located in tertiary metropolitan hospitals.

Note/Limitations: ecological studies can demonstrate associations rather than causal relationships, and parent-reported data may not be reliable due to reporting bias.

23 Hotspot Regions

The hotspot suburbs with high asthma childhood prevalence were identified in 23 SA4 areas (regions/shires, mostly with a population over 100,000) listed below: (ref 1 and 3)

Note: reference 3 is a Data on File ( UNSW Asthma hotspots – Childhood-Asthma-Clusters-Data-by-suburb-SA2-with-electorates .xlsx) provided by UNSW and can’t be shared without approval from UNSW.

Refer to attached file (Ref 3) for detail of hotspot suburbs (SA2s) included in each region (SA4).

Reproduced from Ref 4:

UNSW data – Asthma Hotspots in WA and NT (ref 5):

UNSW data on file – asthma hotspots WA – email J Khan 20 Jan 2026.pdf

UNSW team shared with AA that 4 hotspot suburbs (SA2) out of 465 were located in WA, and none were located in NT:

Note that most areas in WA exhibited relatively low asthma prevalence. This pattern may reflect a combination of low population density, and the potential for underdiagnosis, particularly in remote communities.

The National Aboriginal and Torres Strait Islander Health Survey for the financial year 2022-2023  reported:
• 16.6% has asthma, up from 15.7% in 2018-2019 (note that the difference between 2018-2019 and 2022-2023 was not statistically significant)
• Asthma was the second most prevalent selected chronic condition after mental and behavioural conditions
• By remoteness: 18.2% of people living in non-remote areas had asthma, compared to 8.1% of people living in remote areas (the difference was statistically significant)
• Around two in four people (49%) had one or more selected chronic conditions in 2022–2023, up from 46% in 2018–2019.
• 29% of people aged 15 years and over smoked daily (excluding e-cigarettes or vaping devices), down from 37% in 2018–2019.

In 2023, there were 474 deaths with asthma as underlying cause in Australia, including 325 females and 149 males (see table below) (ref 1):
* Women over 75 are the most at risk, with 43% of asthma deaths in this age group in 2023 (Ref 2,3)
* Asthma deaths were nearly identical to last year, with a return to pre-pandemic level after seeing a reduction in 2021 due to pandemic measures resulting in fewer respiratory infections (ref 3)
* However, over the last 35 years, asthma deaths have halved, from 964 deaths in 1989 (ref 3)

The age-standardised death rate in 2023 was 1.4 deaths per 100,000 people (1.7 for females and 1.0 for males) which remains similar to before the pandemic. (ref 1)

Asthma deaths by state/territory and sex 2023 (ref 1)

NAC infographic (ref 2)

According the AIHW Asthma webpage updated on 17 Feb 2026:(ref 4)

480 people died from asthma (underlying cause) in 2023, with a death rate (not adjusted for age) of 1.8 deaths per 100,000 population.

Mortality rates:

• increased with age (highest in people 75+ at 13.2 per 100,000)
• was higher in females vs males, with a difference more pronounced in people 75+
• changed little over time
• was 3.4 times higher in First Nations people after adjusting for age (31 deaths in 2023, crude rate 3 per 100,000)

A population-based study in WA analysing hospital admissions in Perth in 2015-2017 and smoke exposure using a model tracking PM2.5 levels during 1700 bushfires and burn offs found that following exposure to high PM2.5 (12.60 mcg/m3 or higher) there was:
– 16% (RR 1.16, 95% CI 1.00 to 1.35) increase in hospital admissions on the same day as exposure
– 93% increase in asthma hospitalisations the next day (lag of 1 day) for children
– 52% increase in asthma hospitalisations on a lag of 3 days in low socio-economic groups.

Analysis of PBS data indicates that:

• 33% of people 50 and under being dispensed a preventer were dispensed at least 3 preventers within 12 months (overuse) in 2021-2022, compared to 36% in 2020-2021, 35% in 2019-2020, 34% in 2018-2019 and 34% in 2017-2018, and has therefore remained quite stable since 2017-2018 despite a spike in 2020-2021 that may be related to COVID-19 panic buying and bushfires in 2019-2020.
• by age groups, the proportion of reliever overuse (3 or more reliever dispensed within a year) in 2021-2022 was: 29.3% in 0-14 yo; 25.3% in 15-24 yo; 30.5% in 25-34 yo, 35.4% in 35-44 yo and 41.0% in 45-50 yo

This indicates that in 2021-2022, at least 2 in 3 people 50 and under using a preventer did not use it regularly.

Fig.12 Proportion of people aged 50 and under dispensed at least one preventer medicine, who were dispensed preventer medicines 3 or more times within 12 months, by age and sex, 2017–2018 to 2021–2022

Analysis of PBS data indicates that:

• 18% of people 40 and under being dispensed a reliever were dispensed at least 3 relievers within 12 months (overuse) in 2021-2022, compared to 19% in 2020-2021, 18% in 2019-2020, 16% in 2018-2019 and 17% in 2017-2018, and has therefore remained quite stable since 2017-2018 despite a spike in 2020-2021 that may be related to COVID-19 panic buying and bushfires in 2019-2020.
• by age groups, the proportion of reliever overuse (3 or more reliever dispensed within a year) in 2021-2022 was: 10.1% in 0-14 yo; 18.3% in 15-24 yo; 22.3% in 25-34 yo and 26.3% in 35-40 yo

Fig.11:Proportion of people aged 40 and under dispensed at least one reliever, who were dispensed relievers 3 or more times within 12 months, by age and sex, 2017–18 to 2021–22

Prevalence data based on the National Health Survey 2022 indicated that:
– about 1.8 million (65%) of people living with asthma also had one or more chronic condition
– the top three comorbidities were: mental and behavioural conditions (41%), back problems (25%) and arthritis (23%)

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)

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)

A Cross-sectional survey of 6048 adult Australians with current asthma in the community (conducted in Feb-March 2021 during Covid measures) found that:
– 21.7% had difficult-to-treat asthma (DTTA)
– 85.4% of the participants with DTTA had at least 1 other chronic condition (comorbidity)

Note: DTTA was defined as severe asthma and/or poor asthma control and/or urgent asthma healthcare in previous 12 months despite medium-high dose ICS/LABA.

Asthma hospitalisations 2022 – 2023 (AIHW)
In 2022 – 2023, there were 31,107 hospitalisations with asthma as principal diagnosis.(ref 1)
This is an increase compared to years affected by COVID-19 restrictions (e.g. about 25,500 in 2021-22) but remains below pre-pandemic level (about 37,000 in 2018-19).(ref 2)

Children under 15 accounted for 43% of all asthma hospitalisations.(ref 1)

*PPH: Potentially Preventable Hospitalisations, defined as hospitalisations with asthma as principal diagnosis in people aged 4 years and over.

In 2022-23, there were 28,238 potentially preventable hospitalisations (PPH) due to asthma. (ref 1) This represents 91% of all hospitalisations with asthma as principal diagnosis in 2022-23. (ref 1 and 2)

This compares to 22,985 the year before (2021/22, year with pandemic measures), and 32,558 in 2018/19 before the COVID pandemic. (ref 3)

Note: Asthma PPH are all hospitalisations with asthma as principal diagnosis in people aged 4 and over.

According to a cross-sectional survey of 6048 adult Australians with current asthma in the community (conducted in Feb-March 2021 during Covid measures), 21.7% of adults with asthma had difficult-to-treat asthma (DTTA) in 2021, of which:
– 50.4% had very poorly controlled asthma
– 36.2% were current smokers
– 85.4% had at least 1 additional chronic condition
61.4% of those with DTTA had at least 1 urgent GP visit in the last 12 months (compared to 27.5% in non-DTTA people; 4.8 times more likely).
41.9% of those with DTTA had at least 1 ED visit in the last 12 months (compared to 17.9% in non-DTTA; 3.8 times more likely).

The prevalence of DTTA was higher is areas of greater socioeconomic disadvantage, where participants were also less likely to have received biologic therapy in the previous three months.

DTTA was defined as severe asthma and/or poor asthma control and/or urgent asthma healthcare in previous 12 months despite medium-high dose ICS/LABA.
Note: the survey was conducted during COVID measures which may have impacted healthcare utilisation.

Tas specific data for public hospital, hospitalisations, saved in file

Tas – PHN resource – community health profiles

Tas specific data

According to AIHW asthma report 2024 (ref 1), the peaks for asthma hospitalisations generally occur for children:

• in late summer (February): the peak in February is related to respiratory infections spreading with return to school and childcare after the summer break, and possibly a lower use of preventer medicines during the summer break
• in autumn (May)
• One-off natural events occurring on a seasonal basis like bushfires and thunderstorms can also impact asthma hospitalisations

2020 was an exception to this general trend, with a large decrease in hospitalisations in April and May for all age groups, due to COVID measures and lockdowns.

Figure 16: Monthly variation in hospitalisations due to asthma, by age group, 2017 to 2021 (ref 1)

Refer to Fig 16 on AIHW website to obtain exact hospitalisation rates per months and age groups.

People with asthma are more likely to report a poor quality of life. This is more pronounced among people with severe or poorly controlled asthma.

Asthma is one of the most common chronic conditions in Australia, with prevalence and mortality rates that are high by international comparisons

New research using geographical modelling of the 2021 Census data to map the prevalence of asthma in children aged 5-14 reported:
– On average, childhood asthma prevalence was 7.9%, 8.2%, 8.5%, and 7.6% in Sydney, Melbourne, Brisbane, and Perth, respectively (intra-city special variation)
– prevalence ranged between 6 and 12% between least and most affected locations in each city (intra-city special variation)
– 66% of this intracity variation was attributed to the following covariates in Australian-born non-Indigenous children: climatic and environmental factors (30%), outdoor air pollution (19%), Socio-economic status (51%)

AIHW report where you can find time series of OCS prescriptions for respiratory conditions, by SA4 geographical areas.

Select Dashboard, PBS prescription data. Also provides comparative data at the state and national level.

The Overview of Aboriginal and Torres Strait Islander health status 2023 (Overview) aims to provide a comprehensive outline of the current health status of Aboriginal and Torres Strait Islander people.
This includes: information about the social and cultural context , social determinants, the structure of the population, and measures of population health including births, deaths and hospitalisations, cultural indicators including language, selected health conditions (incl. asthma) and risk/protective factors.
Information is provided for states and territories, Indigenous Regions and remoteness, and for demographics such as sex and age, when the information is available and appropriate.

Provides the most up-to-date information available on the targets and indicators in the National Agreement on Closing the Gap (the Agreement).

Not asthma-specific

Letter to the Editor, emphasising latest data/findings on childhood asthma in Australia including:
Facts:
– High prevalence (8.5% for children 0-14)
– Leading cause of burden of disease
– Hospital admissions have decreased in the last decade
– About 1 in 10 children dispensed SABA (e.g. Ventolin) through the PBS (as opposed as over the counter) have poor asthma control
– Only one in three (29%) children that have been dispensed a preventer used it regularly
– Overreliance on SABAs (reliever) and underuse of ICS are an enduring problem in childhood asthma, as these indicators have not improved in the last 5 years
– 1 in 3 hospitalised children is readmitted within 12 months for asthma (compared to 1 in 5 a decade ago) — Note: this is from a study looking at children admitted in 2017-18
– only 16.2% of children admitted to the hospital due to asthma were prescribed ICS before admission, and of those who were not on a preventer at the time of admission only 12.2% were commenced during the admission
– only 25.6% of children admitted to the hospital with asthma received asthma education and only one‐third of children had an assessment of their inhaler technique during their admission
– several studies from across Australia highlight guideline‐ discordant care across many settings (including pediatricians), which is a known risk factor for hospital readmission

Barriers:
A lack of standardized management and asthma action plans, inadequate systems to allow for timely follow‐up with GPs, inadequate asthma education for parents/carers, and lack of integrated asthma care between GPs and hospitals7 are some of the barriers to optimal asthma management in Australian children.

What is needed:
Multidimensional interventions have been shown to improve asthma control and reduce hospitalization, including asthma self‐management education, home environmental assessment regarding potential asthma triggers and supporting families to deliver asthma care at home, care coordination between primary and tertiary care, and school involvement to support the administration of asthma medications.

Research estimates that wood heater smoke in Australia is linked to 558-1555 earlier than expected deaths each year, and halving the number of wood heaters in Australia would create health benefits of between $AUD 1.61 billion to $AUD 1.93 billion per year.

Note: The data visualisation tool in this study shows estimated wood heater pollution-related health impacts across Australia. Using this tool you can explore the estimates by State/Territory, by Greater Capital City Statistical Area, or by Statistical Area Level 4. The tool also enables you to select what estimates to display: wood heater emissions (WHE) (kg/year), population-weighted WHE-fine particulate matter (PM2.5) concentrations, the number of earlier than expected deaths, or deaths per 100,000 people.

The Visualisation tool can be accessed at https://safeair.org.au/data-visualisation-wood-heater-pollution-mortality-in-australia/

Wood heater emissions (2015)

Earlier than expected deaths due to wood heater emissions (2015)

Earlier than expected deaths per 100,000 people due to wood heater emissions (2015)

Healthcare sector emissions in Australia 2023,
– Australia is ranked eleventh highest in the world in terms of the nation’s health care sector position with respect to its per capita greenhouse gas emissions
– In 2020, Australia’s total emissions were 28.9 Mt, which includes emissions from a range of greenhouse gases that are emitted directly by the health sector, and emissions resulting from the demand of goods and services for running health care operations.
– there has been a 30% increase in total emissions in 2020 and a 28% increase in per capita emissions from 878.3 kg per capita in 2019 to 1125.2 kg per capita in 2020, compared to 2019.

PM2.5 air pollution in Australian cities between 2000 and 2023, MJA-Lancet Countdown report 2023
– The average city exposure in Australia has generally declined over time but has major fluctuations as a result of bushfires and dust storms
– Some states experience significant seasonal variations — due to the dry season in the Northern Territory and the use of wood heaters in the cooler southern regions
– The annual average PM2.5 concentrations in Australian cities were lower than in cities from many other countries (which can be as high as 35 μg/m3 annual average) but are still above the latest WHO annual air quality guideline of 5 μg/m3 but mostly below the Australian advisory reporting standard of 8 μg/m3

Increasing exposure to bushfires in Australia
After the 2019–20 Black Summer bushfires, Australians have been exposed to lower bushfire danger conditions. Nevertheless, the overall trend shows an increase over time in the exposure to very high or extremely high bushfire danger, with average annual exposure in the past ten years (2013–2022) considerably increasing to 33.6 days per person from 27.5 days per person in the previous ten years (2003–2012).

In Australia and New Zealand, research has shown that more than a third of severe asthma patients used toxic cumulative doses of OCS in just one year, with further escalation within 2 years.

Data from the Australiasian Severe Asthma Registry between 2013 and 2021 shows that, amongst 924 patients with severe asthma in Australia and new Zealand:
– 23% were taking maintenance OCS at baseline
– 26% were taking biologics at baseline, benefitting from biologics
– 44% received over 500mg cumulative OCS within a year
– 32% received over 1000mg cumulative OCS within a year
– an additional 10% reached 500mg OCS within 2 years
– an additional 9% reached 1000mg OCS within 2 years
– People exceeding the OCS thresholds had poor asthma control
– 12% were identified as potentially benefitting from biologics, of whom only 23% commenced biologics within 12 months

Conclusion: toxic cumulative doses of OCS were reached in just one year in more than a third of severe asthma patients, with further escalation within 2 years.

article that summarises the use of biologics in severe asthma, and includes a table describing the 4 biologics used in Australia and their clinical requirements.

Note: The term potentially preventable hospitalisation (PPH) does not mean that a patient admitted for that condition did not need to be hospitalised at the time of admission. Rather the hospitalisation could have potentially been prevented through the provision of appropriate preventative health interventions and early disease management in primary care and community-based care settings (including by general practitioners, medical specialists, dentists, nurses and allied health professionals). PPH rates are indicators of the effectiveness of non-hospital care.

PPH are available to download from AIHW’s Admitted Patient Care,  chapter 8, Tab S8.2 for each corresponding year.

– RSV vaccination is new, and has not been considered yet with the Australian Asthma Handbook guidelines.
– ATAGI recommends a single dose of Arexvy RSV vaccine for: (ref 1)
* all adults aged 75 and over
* Aboriginal and Torres Strait Islander peoples aged 60-74
* adults aged 60-74 with a medical condition increasing their risk of severe disease due to RSV, including severe asthma (defined as requiring frequent medical consultations or the use of multiple medicines)
– Arexvy can be co-administered with other vaccines, although this may increase mild-to-moderate adverse events.
– The need for further doses in the future has not yet been established. Recommendations on the need for subsequent doses will be provided when evidence is available.
– Abrysvo, another RSV vaccine, has been registered with the TGA in March 2024 for use in pregnant women and in adults 60 and over, however it is not available in Australia yet (as of 14 May 2024) (ref 2)

To protect infants/young children:(ref 2)
– monoclonal antibodies against RSV are currently available in Australia to immunise young infants and children up to 2 years. These are only available through certain states/territories programs (WA, QLD and NSW are funding nirsevimab for infants, see reference 2 for specifics of the programs)
– a RSV vaccine to immunise pregnant women: Abrysvo was registered by the TGA in March 2024 for use in pregnant women, however it is not available yet (as of 14 May 2024)

– About 128,000 RSV lab-confirmed cases were notified in 2023, with the highest numbers in NSW (46,533; rate 90 per 100,000), QLD (28,787; rate 85 per 100,000) and VIC (25,232; rate 25 per 100,000)
– notifications were the highest in quarter 2 2023: 15K cases in Q1; 57K in Q2; 43K in Q3; 13K in Q4
– highest number of notifications in children 0-4 (64K) then 5-9 year olds (7k) and people aged 85+

– so far 32k notifications in Quarter 1 which far exceeds the 15K notified in Q1 2023
– 37,002 cases up to 9/04/2023

– RSV is a virus transmitted by respiratory secretions, and commonly causes upper and lower respiratory tract infection. Repeated infections are common throughout life because natural infection does not confer long-lasting immunity.
– in adults, RSV usually causes upper respiratory tract infection symptoms (cough, sore throat, nasal congestion etc). Lower respiratory tract infection can also cause wheezing and breathing difficulty.
– in children, the first RSV infection usually occurs by 2 years of age.
– The highest burden of RSV disease is among very young children and elderly people.
– RSV is the leading cause of hospitalisation due to lower respiratory tract infection and bronchiolitis in infants aged under 6 months. Most hospitlisations occur in children that are otherwise healthy.
– Hospitalisation rates decline with age after early childhood, then increase again from 50 to 65 years of age.
– Aboriginal and Torres Strait Islander adults have an increased risk of severe disease and hospitalisation due to RSV.

In childhood:
According to the Australian Asthma Handbook: (ref 1)
– severe respiratory viral infections during infancy, including with respiratory syncytial virus (RSV) and rhinovirus, are a risk factor associated with childhood asthma
– early life lower respiratory tract infections with RSV or Rhinovirus are strongly associated with allergic asthma in childhood.
– it is estimated that the attributable risk of asthma due to RSV is 13-22% in children 5 years and under, 11-27% in children 5-11 and 32% in children 12 and over. (This means that 13-22% of asthma occuring in 0-5 yo is thought to be due to RSV infection, etc)

In adulthood:
– Some medical conditions are associated with an increased risk of complications from RSV disease, including COPD and severe asthma (defined as requiring frequent medical consultations or multiple medicines). (ref 2)
– Older adults (particularly aged over 65), people with heart and lung disease, or people with weakened immune system are at higher risk of complication and hospitalisation. They may develop pneumonia, worsening asthma or COPD and congestive heart failure. (ref 3)
– adults that get an RSV infection typically have mild cold-like symptoms, however they may also develop a lung infection or pneumonia. RSV can also sometimes lead to worsening asthma, COPD and congestive heart failure.(ref 3, 4)

Flu season 2024:
– So far this year, there have been 30,457 notifications of laboratory confirmed influenza reported to the NNDSS in the year to 3 April: ACT 420; NSW 12,382; NT 271; QLD 8,305; SA 1,747; TAS 219; VIC 5,367; WA 1,746 (ref 1)
– compared to previous years, there has been a high number of lab-confirmed influenza cases reported in January, February and March 2024. (ref 1)
– Latest statistics from quarter 1 of 2024 show an increase by 29% in laboratory-confirmed cases of Influenza in Australia, compared to the same period in 2023. (ref 2)
– as of 18 March 2024, national influenza statistics suggest we could be facing our second consecutive early influenza season. The Immunisation Coalition urges all Australians that now is the best time to get your influenza vaccination in preparation for the upcoming influenza season.(ref 2)

Note: cumulative notfications can be accessed live at: https://nindss.health.gov.au/pbi-dashboard/. As of 9/04/2024, there were 33,313 cases of influenza notified. the dashboard also provides age-specific numbers. Of these 33K cases, 9,165 (27.5%) were in children aged under 15. So far, children 0-9 are the age groups with the highest number of notifications. (ref 3)

In adults, the peak period of severe viral-associated flare-ups occurs in the winter.

In children, asthma hospitalisations tend to peak in February, most likely due to respiratory infections associated with return to school and childcare after the summer break.

Management of viral infections/cold and asthma:
– ensure instructions about managing asthma at the onset of a cold are described in an Asthma Action Plan
– some patients with asthma may be sensitive to aspirin and/or NSAIDs (e.g. ibuprofen): do not take aspirin or NSAIDS if you have experienced runny nose or wheezing within 1-2 hours of taking these medications in the past. Taking these could worsen your asthma symptoms.

According to the Australian Asthma Handbook:
– Viral respiratory infections are the most common trigger for asthma flare-ups, including serious acute asthma requiring hospital admission
– Reliever medicines may not be as effective during colds
– Children with both allergy and asthma have more severe and long-lasting virus-induced symptoms (both cold symptoms and asthma symptoms) than Children with asthma but no allergy
– people with asthma and allergies are at higher risk of asthma hospitalisation than those without allergies
– In practice, it is not feasible to avoid colds or influenza. Colds and influenza are spread by multiple routes, including airborne transmission of small and large droplets generated by talking and coughing, and transfer by fingers from contaminated items to the nose or eyes.
– People with asthma should avoid crowded and enclosed spaces, particularly where there are people with colds.

Flu season 2023:
– The 2023 influenza season was characterised by an early peak and longer duration, but overall lower clinical severity and societal impact, than many pre-COVID-19 pandemic influenza seasons
– vaccination coverage was low overall in 2023, especially in children, and severe
presentations to sentinel hospitals in children were reported throughout the season
– there were 252,296 notifications of laboratory-confirmed influenza cases, 376 influenza associated deaths (median age 76 years); and 3,696 sentinel hospital admissions
– Children aged 05–09 years had the highest influenza notification rates followed by children aged 0–04 years. The notification rate was lowest among adults aged 70–74 years.
– Influenza vaccine coverage rates were lower in 2023 (at 32% overall) than in 2022 (39%), and lower overall in First Nations peoples (24%).
– vaccine coverage in children was low (21% in under 5 yo)
– 72% of hospitalisations reported by sentinel hospitals were in children under 16 (although sentinel admissions may overestimate hospital admissions nationwide for children under 16)

Immunisation recommendations from the National Immunisation Handbook: (updated 15 March 2024).
– Yearly influenza vaccination is recommended for all people aged 6 months and over (children and adults)
– influenza vaccination is funded on the NIP (free of charge) for:
* children 6 months to under 5 years
* people aged 65 years and over
* First nations people (aged 6 months and over)
* pregnant women
* people with certain medical conditions aged 6 months and over: this includes people with severe asthma (defined as requiring frequent medical consultations or the use of multiple medicines)

Immunisation recommendations from the Australian Asthma Handbook
– influenza vaccination reduces the risk of influenza, however the level of protection it confers against asthma flare-ups is uncertain (ref 1)
– patients with severe asthma (defined as having frequent hospitalisations and requiring multiple asthma medicines) should keep their influenza vaccination up to date. Other adults with asthma should follow national immunisation guidelines and be informed of the potential benefits of flu vaccination. (ref 2)
– the flu vaccine is free of charge for people with severe asthma (defined as requiring frequent medical consultations OR the use of multiple medications) (ref 2)

According to the Australian Asthma Handbook:
– Viral infections are the most common trigger for asthma flare-ups, including serious acute asthma requiring hospital admission
– influenza is spread by multiple routes, including airborne transmission of small and large droplets generated by talking and coughing, and transfer by fingers from contaminated items to the nose or eyes.

In 2020, Australia ranked 4th OECD country (out of 29 countries) with the highest rate of asthma hospitalisations in people aged 15+ (42 per 100,000), decreased from 71 per 100,000 in 2011. The average asthma hospitalisation rate was just 23 per 100,000.

To compare the rates of asthma hospitalisations between OECD countries (2018 and prior), download the primary care table and g to tabs AA1.1 and AA1.2. The data is from the National Hospital Morbidity Database

Editorial article in the Lancet providing statements/ references for:
– 70% of total annual deaths in the world are estimated to be due to climate sensitive diseases
– climate is the biggest health threat facing humanity
– Australia is on the frontline of of the climate change catastrophe
• Australia and its citizens lead all other regions of the world in per capita greenhouse gas emissions from our energy sector, with, on average, each of us contributing significantly to the changing climate and the death and disease it is causing.
• Australia’s health care sector has the eleventh highest per capita greenhouse gas emissions in the world.

Age-standardised asthma hospitalisation rate in 2021-2022 in First Nations people vs other Australians, by jurisdictions:
– for Aboriginal and Torres Strait Islander people: 1.6 per 1,000 in NSW; 1.3 in VIC; 2.1 in QLD; 2.2 in WA; 2.0 in SA; 0.7 in TAS; 2.1 in ACT; 3.4 in NT, Nationally 2.0 per 1,000 (Table 10A.71)
– for other Australians (incl when indigenous status is not stated): 0.8 per 1,000 in NSW; 0.9 in VIC; 1.1 in QLD; 0.5 in WA; 1.0 in SA; 1.3 in TAS; 0.6 in ACT; 0.2 in NT, Nationally 0.9 per 1,000 (Table 10A.71)

In 2022, 17.6% of people with a mental illness had asthma; 9.0% of people without a mental illness had asthma; and 11.5% of all people had asthma in Australia. Therefore, people with a mental illness where nearly twice as likely to have asthma than those without a mental illness. (proportions by states/territories and data for previous years are also available in Table 13A.58)

According to the Australian Government Productivity Commission, in 2022 the proportion of people with asthma that had a written asthma action plan was:
– By age group Nationally: 72% of 0-14 yo; 39% of 15-24 yo; 20% of 25-44 yo; 27% of 45-64 yo; 27% of 65+ yo; 35% all ages combined (age-standardised)
– By age group and jurisdiction (states/territories): download table 10A.46

Note: same data published in 2024 and 2026 reports (ref 1 and 2)

AS: Age-standardised

* Estimate has a relative standard error (RSE) between 25% and 50% and should be used with caution.

In 2019, Australia ranked 9th OECD country with the highest age-standardised rate of asthma hospital admissions in adults (people aged 15+), with 63 admissions per 100,000 population.

(Note: the OECD page has been removed)

According to the Census 2021, 3.6% of humanitarian entrants reported having asthma, a rate equal to other permanent migrants but 60% lower than the rest of the Australian population.

According to the NHS 2022, amongst adults (18+) with asthma in 2022:
– 1 in 7 (14.1%) were smoking daily
– 1 in 3 (32.2%) were ex-smokers
– 51.7% had never smoked (compared to 66.5% of people without any selected chronic condition)

In 2020-2021, the expenditure for asthma was an estimated $852 million, coming third for respiratory diseases after other respiratory diseases and upper respiratory diseases.
Asthma was the respiratory condition with the highest expenditure in primary care, with $631 million spent in 2020-2021, the fourth respiratory condition for expenditure in hospitals ($180M), and the thrid respiratory condition for expenditure in Referred medical services ($41M).

Expenditure for asthma is also available by age and sex on Figure 9:

According to the National Health Survey 2022, amongst people with asthma in 2022:
– Just under half (48.7%) of children used asthma medication in the prior 2 weeks, compared to more than 3 in 5 (63.5%) of adults
– 1 in 3 (33.9%) people with asthma used daily medication in the prior 2 weeks
– 2 in 5 (39.1%) did not take medication in the prior two weeks

According to the ABS, based on the National Health Survey 2022: (ref 1)
– Almost 1 in 3 (32.1%) people with asthma had a written action plan
– 2 in 3 (67.2%) children with asthma had a written action plan
– only 1 in 4 (24.5%) adults with asthma had a written action plan

According to AIHW, also based on the National Health Survey 2022: (ref 2)

• 32% of people with asthma had a written asthma action plan (Figure 10). This was similar to 2017–18 (31%).
• Over two-thirds (71%) of children aged 0-14 had an asthma action plan in 2022, a higher proportion than all other age groups. This is likely due to schools and childcare facilities requiring that children with asthma have a health care provider issued-asthma action plan
• According to the 2018–19 NATSIHS, 32% of First Nations people had a written asthma action plan, with those living in Non-remote areas more likely to have a plan compared with those living in Remote areas (32% and 27%, respectively)

In 2022, there were 467 deaths with asthma as underlying cause. Compared to previous years, there was:
Number of deaths:
– a 31.5% increase in number of deaths compared to 2021 (355 deaths), as 2021 saw a reduction in deaths due to COVID public health measures resulting in fewer respiratory infections and asthma flare-ups. Asthma flare-ups have now returned to pre-pandemic levels. (Ref 1, 2,3)
– compared to the average number of deaths before the pandemic (2016 to 2019), 2022 saw a 6% increase in asthma deaths (Ref 1)
– important variations between states: QLD and SA sawg more than 80% increase compared to 2021, and 21% and 15% increase respectively compared to pre-pandemic average (2016-2019); WA saw a 19% increase compared to pre-pandemic years (2016-19);
NSW saw a small increase (6%) compared to 2021, and 9% decrease compared to before the pandemic (2016-19) (ref 1; see table on right side)

Age-standardised death rates (better indicator for trends over time): Ref 4
– At 1.3 deaths per 100,000 people, the asthma death rate in 2022 was 30% higher than in 2021, however it remained similar compared to before the pandemic (2018-2019), but higher than in 2021 (1.0 per 100,000)
– variations by jurisdictions: SA fared the worse with 1.8 deaths per 100,000 people, a 80% increase compared to 2021 and a 16% increase compared to before the pandemic (2018-19), followed by QLD with 13% increase compared to 2018-19. NSW and VIC saw a decrease in death rates compared to before the pandemic, at 10% and 4% decrease respectively.

See AA internal presentation: https://asthmafoundation.sharepoint.com/:p:/s/RPA/EZFxO08aJJ5JgIz0I2II7CUBYMjuh8vZDgrccUJDgEQIxg?e=4bgUsl

Asthma Deaths 2022 compared to previous years, National and by jurisdiction

Asthma Deaths rates (age standardised) 2022 compared to previous years, National and by jurisdiction

Revised data (published by ABS in 2024, updated in library 13 Nov 2024):
In 2022, there were 473 deaths with asthma as underlying cause of death, including 303 females and 170 males. (ref 5)

Data published in 2023:

In 2022, there were 467 deaths with asthma as underlying cause in Australia, including 299 females and 168 males (see table below) (ref 1):
* Women over 75 are the most at risk, with 45% of asthma deaths in this age group in 2022 (Ref 2,3)
* Asthma deaths in males was the highest in the last 10 years, up from 109 in 2021 to 168 in 2022 (Ref 2).
* The mortality rate for respiratory conditions in 2022 was 42.5 per 100,000, an increase by 8.4% compared to 2021, but remaining lower than before 2020. (ref 4)

The age-standardised death rate in 2022 was 1.3 deaths per 100,000,(ref 1) which remains similar to before the pandemic.

Asthma mortality by state/territory and sex in 2022 (ref 1)

See Infographic below from NAC (Ref 3). Note that this compares 2022 to 2021 ONLY, when respiratory infections and asthma flare-ups had decreased markedly due to COVID public health measures.

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)

– People born in Australia compared to overseas:12.4% vs 7.3% in 2022 (ref 3); 12.6% compared to 6.0% in 2020-2021 (ref 1)
– People who lived in Inner Regional areas are more likely than those who lived in Outer Regional and Remote areas to have asthma (13.1% compared to 9.2% in 2020-2021, ref 1)
– People living in the Outer regional and remote areas compared to Major cities (aged standardised rate 13% vs 11% in 2017-2018, 1.2 times more likely, ref 2)
– People with a profound or severe core activity limitation are almost three times more likely than those with no disability to have asthma (23.3% and 8.2% in 2020-2021, ref 1); while people with a disability were more likely to have asthma than those without in 2022 (17.0% vs 8.0%; ref 3)
– Aboriginal and Torres Strait Islanders compared to non-Indigenous Australians (ref 1 and 2)
– People living in areas of most disadvantage were more likely to have asthma than those living in areas of least disadvantage: 13.2% vs 10.2% in 2022(ref3 )
– people living in the lowest socioeconomic areas compared to highest socioeconomic areas (aged-standardised rate 13% vs 10% in 2017-2018, 1.3 times more likely, ref 2)

Note: Data first entered in March 2022 then updated in May 2022 and January 2024.

According the National Health Survey 2022 (conducted with face-to-face interviews, the same methodology as the 2017-18 NHS), it is estimated that:
• Just under 2.8 million (2,754,100 people or 10.8%) Australians had asthma in 2022, including about 386,000 children aged under 15
• the prevalence of asthma has remained steady over the last 10 years (from 10.2% in 2011-12 to 10.8% in 2022)
• Females are more likely to have asthma (12.2%) compared to males (9.4%)
• In children aged 0-14, boys are more likely to have asthma (10.1%) than girls (6.2%) – overall 8.2%
• Age-specific prevalence is provided below: note that the difference between males and females is only statistically significant in those aged 0-14; 35-44 and 55-64 (95% CI do not cross)
• prevalence by jurisdiction (states/territories)

AIHW has a website specifically for Aboriginal and Torres Strait Islander people, providing statistics by geographical areas, including:
– A Closing the Gap dashboard: access regional statistics related to the 17 socioeconomic targets
– Regional Overview Dashboard: data down to the LGA level, including socioeconomic and health data (including asthma prevalence based on Census 2021)
– Service map: search for health and medical services available for each region

Prevalence data based on the National Health Survey 2020-2021 indicated that: (ref1)
– Asthma is the fourth most commonly reported chronic condition at 10.7% of the population (9.4% in males and 12% in females), after mental or behavioural conditions (20%); back problems (16%) and arthritis (12%) (amongst the 9 selected chronic conditions reported in the survey)
– 20% of Australians had 2 or more chronic conditions in 2017-18 (23% of females vs 18% of males), becoming 51% of people aged 65+

According to the National health Survey 2020-2021, 78% of people aged 45 and over who currently have asthma also reported having one of the 9 selected chronic conditions. Specifically, in 2020-2021, among people aged 45 and over that have asthma: (ref 2)
– 42% had arthritis (compared with 26% among people without asthma)
– 33% had back problems (compared with 23% among people without asthma)
– 31% had heart, stroke, and vascular disease (compared with 22% among people without asthma)
– 20% had mental and behavioural conditions (compared with 11% among people without asthma)
– 14% had COPD (compared with 1.9% among people without asthma)
– 13% had osteoporosis or osteopenia (compared with 7.6% among people without asthma)

In 2020-2021, the expenditure for asthma was an estimated $852 million was spent on the treatment and management of asthma, representing 0.6% of total health system expenditure and 19% of expenditure for all respiratory conditions. Specifically:
– Primary care represented 74% of asthma expenditure, about 2.7 times the average portion of primary care for other conditions, and with PBS expenditure in asthma representing more than half (53%) of asthma expenditure (4.7 times the proportion for other conditions)
– hospital services accounted for 21% of asthma expenditure (3 times lower than other conditions), with ED representing 6.23% of asthma expenditure (1.5 times higher proportion than other conditions)
– referred services accounted for 4.8% of asthma expenditure, with Specialist referrals representing 3.4% of asthma expenditure
Asthma accounted for 2.6% of the total (all-cause) PBS expenditure, 1.4% of total GP expenditure, 0.9% of public hospital ED expenditure, 0.5% of specialist services and 0.5% of public hospital outpatient services

In 2023, Asthma was the 10th leading contributor to the total burden of disease in Australia with a disability-adjusted life years (DALY) rate of 5.34 per 1,000 population (141,621 DALY, crude number).
– After adjustement for age structure, asthma was the 8th leading cause of total burden, with an age-standardised DALY rate of 5.3 DALY per 1,000, up from 9th in 2018 and 2015, and 10th in 2011 and 2003, an increase by 8.4% in the last 20 years (from 4.9 per 1,000 in 2003; 4.4 in 2011; 5.0 in 2015; 5.2 in 2018 and 5.3 in 2023)
– 5.7% of the total asthma burden was fatal, 94.3% was non-fatal

By gender:
– Asthma ranked 6th in females of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 5.7 DALY per 1,000, up from 7th in 2018 and a 4.1% increase since 2003
– Asthma ranked 10th in males of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 4.9 DALY per 1,000, down from 9th in 2018 and a 13.8% increase since 2003

By age groups (age-specific DALY per 1,000), asthma ranked as leading cause of total burden of disease:
– Under 5 year-olds (0-4): 5th in females ( accounting for 3% of total burden) and in males (3.5% of total burden), ranking 5th overall — however, ranking 1st in boys, girls and overall for the age group 1-4
– 5-14 year-olds: 1st in females (11.1% of total burden) and 2nd in males (12.8% of total burden) after Autism spectrum disorder, ranking 1st overall
– 15-24 year-olds: 5th in females (5.1% of total burden) and in males (4.7% of total burden), ranking 4th overall
– 25-44 year-olds: 4th in females (4.7% of total burden) and 9th in males (5th overall)
– In 45-64 year-olds: 8th in females and 15th in males (12th overall)
– In 65-84 year-olds: 17th in females and beyond 20th in males (20th overall)
– In 85 year-olds and older: beyond 20th for females, males and overall

Note: to compare epidemiological data, it is usually preferred to use age-standardised statistics to ensure the differences are not caused by variations in age structure and an ageing population, unless the data is for specific age ranges in which case “crude” age-specific statistics are used.

* The age-standardised rate of asthma hospitalisations for children aged 0–14 decreased overall, falling from 491 per 100,000 population in 2011–2012 to 225 per 100,000 population in 2021–2022

* The age-standardised rate of asthma hospitalisations for those aged 15 and over was relatively stable, fluctuating between 93 per 100,000 in 2011–2012 and 70 per 100,000 population in 2021–2022, peaking at 112 separations per 100,000 in 2016–2017 (after adjusting for age structure).

* the rate of hospitalisations has been affected by the Covid pandemic over the past few years.

Note: to obtain hospitalisation counts or rates for specific years, refer to Fig 15 and 16 in AIHW webreport and scroll over the dots on the graph, the actual values will appear.

In 2021-2022, a year affected by Covid-129 pandemic measures, there were:
– 1,800 hospitalisations with asthma as principal diagnosis in First Nations people, an hospitalisation rate of 200 per 100,000 population; a decrease by 30% compared to 2018-2019 (non Covid-pandemic year; 290 per 100,000)
– highest asthma hospitalisation rates 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 asthma hospitalisation rates for boys compared to girls aged 0-14 (318 vs 173 per 100,000)
– 2.1 times higher hospitalisation rates in First Nations people compared to non-Indigenous Australians after adjusting for age structure (205 vs 100 per 100,000, age-standardised)

Over the 5-year period 2017-2021 (including years of COVID-pandemic measures), there were:
– 65 deaths due to asthma in First Nations people, corresponding to a mortality rate of 1.7 deaths per 100,000 population (decreasing from 2.1 per 100,000 in 2015-19)
– Mortality rate increases with age and is 1.6 times higher in females
– After adjusting for age, First Nations people were 1.9 times more likely to die due to asthma compared to non-Indigenous Australians

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)

This provides:
– review of the impact of Landscape Fire Smoke (LFS) exposure
– greater impact on vulnerable groups, particularly older people, pregnant woman and Aboriginal and Torres Strait Islander peoples
– development of asthma on the background of risk factors
– advice for asthma management, smoke mitigation strategies and access to air quality information, that should be implemented during periods of LFS

This report rated air quality for 36 sites around Australia. The results ranged from half-a-star to four-and-a-half stars, with an average of two-and-a-half stars. One of the common reasons for reduced ratings was the influence of landscape fires, especially the Black Summer bushfires of 2019-2020, and annual savannah burning in the Top End of the Northern Territory. These caused multiple elevated pollution days and drove long-term trends. Another contributor in many locations was seasonal pollution from wood heater emissions.

This report highlights a wide variation in air quality around the country, and provides air quality rating by states for various sites (urban and regional), and the plausible reasons for the trends in air quality (bushfires, wood heaters etc). There is considerable potential for interventions to protect health and improve air quality.

This report explains why the effects of air pollution are so far reaching and, equally, why coordinated action to make air safer is one of the best investments in Australian health.
The report by the Centre for Safe Air includes evidence and information about the health effect of poor air quality, including on asthma.

In 2018, almost two-thirds (64%) of the fatal burden among Aboriginal and Torres Strait Islander (First Nations) people was classified as avoidable (preventable), compared to 54% in non-Indigenous Australians.
There were:
– 486 AYLL (avoidable years of life lost) (1.2 AYLL per 1,000 population) due to asthma in females under 75
– 303 AYLL (0.7 per 1,000) due to asthma in males under 75
– 789 AYLL (1.0 per 1,000) due to asthma in persons under 75
You can find further details (e.g. the stats per age group) in the data download on the AIHW website.

According to the National Health Survey for the 2018-2019 financial year:
Thirty-two per cent (32%) of Indigenous Australians had a written asthma action plan in 2018–2019, with those living in Non-remote areas were more likely to have a plan compared with those living in Remote areas (32% compared with 27%).

According to the National Health Survey for the 2020-2021 financial year:
– about 34% of people with self-reported asthma across all ages had a written action plan
– Over two-thirds (69%) of children under under years of age had a written action plan
– less than a quarter (23%) of people aged 75 years and over had a written action plan
– across all ages, women are more likely than men to have an AAP

Note: the NHS 2020-21 was conducted differently (online) due to the Covid pandemic and should not be compared to other years.

See tables below.

See table below.

Report/Information paper by the Lung Foundation that discusses the results from their national survey (2196 responses) about the experiences of Australians throughout the COVID-19 pandemic and the impact of ongoing COVID-19 symptoms, particularly for the lung disease community. This report outlines the following:
– Experience of Australians through the pandemic
– Experience of Australians living with a lung disease or other chronic condition
– Experience of carers
– Healthcare access
– Mental health
– Immunisation
– The view of Australians on disease prevention, the future and government trust
– Recommendations

Snapshot of primary care in the ACT

COVID measures: lockdowns and travel restrictions until end of 2021, returning to normal in early 2022, all compulsory public health restrictions ceased by September 2022

Hospitalisations (in public hospitals) in 2021/22- pandemic year:
* In 2021/2022, there were over 25,000 hospitalisations for asthma (in public and private hospitals), of which more than 10,000 (42%) were in children aged under 15.(ref 1)
*90% of asthma hospitalisations were considered potentially preventable.(ref 1, 2) — scroll down to PPH by states and territory table

* there were about 25,500 hospitalisations with asthma as principal diagnosis in 2021-22 (hospitalisation rate of 99 per 100,000 population, or 101.5 per 100,000 when age-standardised), representing 0.2% of all hospitalisations in Australia (ref 3)

By age groups: (see graph below)
* most of asthma hospitalisations were in children aged 0-9 (ref 3)
* children aged 0–14 had a markedly higher hospitalisation rate than people aged 15 and over (225 vs 70 per 100,000 population) (ref 3)
* boys aged 0–14 were 1.6 times as likely as girls of the same age to be admitted to hospital for asthma (ref 3)
*in people aged 15 and over, females were 2.4 times as likely as males to be admitted to hospital for asthma (ref 3)

For potentially preventable hospitalisations by states, see: AIHW. Admitted patient care 2021-22. Table S8.2. https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients

For potentially preventable hospitalisations counts, rates and average length of stay at the National, PHN and SA3 level, download data table from https://www.aihw.gov.au/reports/primary-health-care/potentially-preventable-hospitalisations-2020-22/data (ref 4)

Graph available at https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma (Ref 3, accessed 8 Oct 2024):

Note: first entry on 13/07/2023; last update on 8/10/2024

Over the 3 years period of 2019 to 2021, asthma was:
– the 18th leading cause of death for children aged 1-14 (16 deaths; 1.3% of all deaths; 0.1 deaths per 100,000 children of that age)
– the 19th leading cause of death for boys aged 1-14 (8 deaths; 1.1% of all deaths; 0.1 deaths per 100,000 boys of that age)
– the 16th leading cause of death for girls aged 1-14 (8 deaths; 1.5% of all deaths; 0.1 deaths per 100,000 girls of that age)

– the 19th leading cause of death for young people aged 15-24 (18 deaths; 0.5% of all deaths; 0.2 deaths per 100,000 children of that age)
– not in the top 20 leading causes of death for boys aged 15-24
– the 16th leading cause of death for girls aged 15-24 (10 deaths; 1.0% of all deaths; 0.2 deaths per 100,000 girls of that age)

Most common associated causes of deaths for asthma during 2019-2021:
– ranking first: Influenza and/or pneumonia were associated with 25% of deaths due to asthma
– ranking second: COPD was associated with 23% of deaths due to asthma
– ranking third: heart failure and complications and ill-defined heart disease, associated with 20% of deaths due to asthma

A Meta-analysis of observational studies totaling more than 5 millions subject reported strong or very strong associations of the following comorbidities in people with asthma, compared to people without asthma:
– Allergic rhinitis (OR 4.24, 95% CI 3.82–4.71)
– allergic conjunctivitis (OR 2.63, 95% CI 2.22–3.11)
– bronchiectasis (OR 4.89, 95% CI 4.48–5.34)
– hypertensive cardiomyopathy (OR 4.24, 95% CI 2.06–8.90)
– nasal congestion (OR 3.30, 95% CI 2.96–3.67)
– COPD (OR 6.23, 95% CI 4.43–8.77)
– chronic respiratory diseases (OR 12.85, 95% CI 10.14–16.29)

The associations were stronger for severe asthma patients, and also included comorbidities like:
– panic attacks (OR 3.16)
– phobia (OR 3.56)
– bipolar disorders (OR 6.16)
– hypertension (OR 3.35)

Note: Odds Ratios (OR) represent the relative risk of having the comorbidity, i.e OR=4.24 means that people with asthma are 4.24 times more likely to have allergic rhinitis than people without asthma.

A study conducted between July 2018 and February 2020 estimated that the cost of poorly controlled asthma to the healthcare system was over $AU4,600 per person per year.
Specifically, a study by the Woolcock Institute and George Institute, based on 341 participants 18 years old or older with poorly controlled asthma (ACQ score of at least 1.5) recruited through community pharmacies in NSW, Tasmania and WA, looked at real data from Medicare and PBS to calculate the actual yearly cost of asthma to the health system. The study found $AU386 adjusted monthly healthcare expenditure per participant ($4,632 per year), increasing by:
– $4 for each year increase in age
– $201 for being unemployed
– $35 per one unit change in worsening quality of life
– $171 for being diagnosed with depression and anxiety

Asthma Australia internal report on Air pollutants, including what they are, their health impact and Australian standards
(Note that this report was finalised in January 2022, national standards may need to be updated)

accessible here: https://asthmafoundation.sharepoint.com/:w:/s/RPA/ER_83-TCXSNNo-Uea4SJOfcBui-dibb4J63DN2GJh5nJ5g?e=weJ6ay

–This is an internal report, for internal use only–

Based on the Census 2021 data:
* People born in Australia had a higher prevalence of asthma (10.3% crude prevalence; 10.5%, age standardised) than people born in any other country
* People born in Australia, English-speaking and European countries generally had higher prevalence of asthma, arthritis, cancer, lung conditions and mental health conditions
* For people born overseas, the (age-standardised) prevalence of asthma increased with time since arrival in Australia, from 2.72% for 0-5 years to 4.14% for 6-10 years; 4.99% for 11-15 years and 7.20% for more than 15 years
* People who spoke English had a higher (age-standardised) prevalence of asthma (10.29%) than any other language except Auslan (15.17%), Maori (New Zealand, 14.63%), Sign languages (nfd, 14.49%), Gaelic (12.36%), Maltese (10.49%) and Welsh (10.38%)
* The (age standardised) prevalence of asthma decreased with decreasing level of proficiency in English

Figures are displayed below. Factors can be combined (e.g. time since arrival and proficiency in English)

Top 5 are anglo-saxon cultural background!

Age-standardised asthma prevalence by language used at home:

reference for % population speaking this language: Australian Bureau of Statistics. Cultural diversity: Census [Internet]. Canberra: ABS; 2021 [cited 2023 June 16]. Available from: https://www.abs.gov.au/statistics/people/people-and-communities/cultural-diversity-census/latest-release.

In 2018-2019, among Aboriginal and Torres Strait Islander people with asthma that had symptoms in the last 12 months:
– 31.6% had an Asthma Action Plan
– 56.1% had used medications in the last 2 weeks

Between 2017 and 2019, Aboriginal and Torres Strait Islander people were 80% more likelly to be hospitalised for asthma than other Australians, with an age standardised asthma hospitalisation rate of 2.7 per 1,000 people, and an asthma hospitalisation rate ratio of 1.8 (rate difference 1.2 per 1,000) compared to non-Indigenous Australians.
Specifically, the age standardised asthma hospitalisation rates and rate ratios were:
– for males: 1.9 hospitalisations per 1,000 population (rate ratio 1.4 so 40% higher compared to non-Indigenous Australians)
– for females: 3.5 hospitalisations per 1,000 population (rate ratio 2.2 so 120% higher compared to non-Indigenous Australians)

By age groups, the asthma hospitalisation rates for 2017-2019 were:
– under 1 yo: 0.3 per 1,000 (vs 0.2 per 1,000 in non-Indigenous, rate ratio 1.7) – 70% higher
– 1-4 yo: 7.1 per 1,000 (vs 6.2 per 1,000 in non-Indigenous, rate ratio 1.2) – 20% higher
– 5-14 yo: 3.0 per 1,000 (vs 2.8 per 1,000 in non-Indigenous, rate ratio 1.2) – 10% higher
– 15-24 yo: 1.6 per 1,000 (vs 0.9 per 1,000 in non-Indigenous, rate ratio 1.8) – 80% higher
– 25-34: 2.1 per 1,000 (vs 0.7 per 1,000 in non-Indigenous, rate ratio 3.1) – 310% higher
– 35-44 yo: 2.9 per 1,000 (vs 0.9 per 1,000 in non-Indigenous, rate ratio 3.1) – 310% higher
– 45-54 yo: 3.1 per 1,000 (vs 1.0 per 1,000 in non-Indigenous, rate ratio 3.1) – 310% higher
– 55-64 yo: 2.6 per 1,000 (vs 1.0 per 1,000 in non-Indigenous, rate ratio 2.5) – 250% higher
– 65 and over: 2.2 per 1,000 (vs 1.5 per 1,000 in non-Indigenous, rate ratio 1.5) – 150% higher

The age-standardised mortality rate due to asthma among Aboriginal and Torres Strait Islander people was 2.5 times as high as among other Australians in 2015-2019 (3.7 compared with 1.5 per 100,000 population over the 2015-2019 period). By gender, it was 2.7 vs 1.1 per 1,000 (2.5 times higher) in males, and 4.4 vs 1.8 per 1,000 (2.4 times higher) in females.
Note: the deaths were reported in NSW, QLD, WA, SA and NT only as these jurisdictions had adequate levels of Indigenous identification in mortality data.

More than 1 in 5 people with asthma using high-dose ICS/LABA regularly (filling at least 2 prescriptions within 6 months) received a dose of OCS sufficient to cover 2 exacerbations or more within those 6 months.
A recent study analysing prescription medications dispensed by about 82% of community pharmacies in Australia reported that:
– 22% of patients with difficult to treat asthma (defined as filling at least 2 prescriptions of high-dose ICS/LABA in 6 months) received sufficient OCS to cover at least 2 exacerbations within 6 months
– 10% of patients with difficult to treat asthma (defined as filling at least 2 prescriptions of high-dose ICS/LABA) received 1000mg or more OCS within 6 months
– 13% of patients with difficult to treat asthma (defined as filling at least 4 prescriptions of high-dose ICS/LABA; stringent analysis) received 1000mg or more OCS within 6 months

Geographical areas: Heat maps SA3 areas
Refer to Table 1 and Figure 3, map A for proportion of difficult to treat asthma, map B for proportion of difficult to treat asthma receiving 2 OCS scripts or more within 6 months, and map C for proportion of OCS above 1000mg within 6 months.

Difficult to treat asthma (defined as at least 2 prescriptions for high-dose ICS/LABA in 6 months):
– SA3 regions with the highest proportions of difficult to treat asthma were located more frequently in WA (22/36) followed by NT (2/9), VIC (14/66), TAS (2/15) and NSW (9/95)
– region with highest proportion (48%) was in WA, followed by a region on NSW (43%)

Uncontrolled asthma among difficult to treat asthma (prescription of enough OCS within 6 months to treat 2 exacerbations):
– SA3 regions with the highest proportions of uncontrolled asthma were located more frequently in SA (7/28) followed by TAS (3/15), VIC (9/66), QLD (5/82) and NSW (5/95)
– region with highest proportion of uncontrolled asthma (67%) was in NSW

1000mg OCS or more within 6 months among difficult to treat asthma:
– in 29 SA3 regions, 13% to 34% of patients with difficult to treat asthma were prescribed 1000mg OCS or more within 6 months. Most of them located in the Eastern half of Australia
– highest rate (34%) was in a region in NSW
– lowest rate (3%) was in a region in NT

A. Proportions of difficult to treat asthma (2 or more high-dose ICS/LABA in 6 months)

B. Proportions of uncontrolled asthma (OCS prescription sufficient for 2 or more exacerbations in 6 months) among difficult to treat asthma
C. Proportions receiving 1000mg or more OCS within 6 months among difficult to treat asthma

Epidemiological study based on PBS data, providing useful statistics on OCS use in asthma in Australia.

Long-term longitudinal study by David Price demonstrating increased cumulative risk at 1000mg OCS cumulative use.

Powerpoint presentation to PAC on Oral Corticosteroids Stewardship, March 2022.

See presentation link: https://asthmafoundation.sharepoint.com/:p:/s/RPA/EY2QXo10ODtFoxIDMknRRpUBBMUZdoZowRz3KyOone7dGw?e=ZRBUaV

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.

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)

Asthma was the 8th leading contributor to the total burden of disease in Australia in 2022, with a disability-adjusted life years (DALY) age-standardised rate of 5.2 per 1,000 population (138,048 DALY) compared to 9th in 2018 and 10th in 2003. This represents a 7.8% change since 2003. In, 2022, 5.9% of the asthma burden was fatal (8,087 years of life lost), and 94.1% was non-fatal (129,954 years lived with disability). Asthma contributed 2.5% to the total burden in Australia.

By sex and age groups, asthma ranked (age-specific DALY rates):
– 5th leading cause of total burden for children under 5 boys (3.5% of total burden) and girls (3.0% of total burden)
– 1st leading cause of total burden in children 5-14 for boys (14.2% contribution) and girls (11.7% contribution)
– 5th leading cause for boys (4.9% contribution) and 4th leading cause for girls (6.2% contribution) aged 15-24
– 4th leading cause for girls aged 25-44 (4.9% contribution)

In 2019-2020, the expenditure for asthma by area of expenditure (allied health, GP, imaging, pathology, medications private hospital, public hospital, specialist services) can be found by downloading the data table, and opening the tab Table 5.
The total expenditure for asthma was about $900 million, and including:
* $219M for hospitals (ranking fourth among respiratory diseases) – hospital admissions (public and private), ED and outpatient clinics (for public only)
* $639M for primary healthcare (ranking first among respiratory diseases) – includes GP, allied health, pharmaceuticals and dental
* $42M for referred medical services (ranking fourth among respiratory diseases) – includes specialists, medical imaging and pathology

specifically:
* 161.6 million in GP services
* 28.2 million in Specialist services
* 455.0 million in medications (PBS)
* 12.8 million in private hospital services
* 67.4 million in public hospital emergency department
* 84.1 million in public hospital admissions
* 54.8 million in public hospital outpatient services

In 2021, during the COVID-19 pandemic, there were 351 deaths ( 107 males, 244 females) due to asthma in Australia, with an age-standardised death rate of 1.0 per 100,000 population (0.7 for males, 1.3 for females).
There were 2941 years of potential life lost.

By state and territories, there were: 136 deaths in NSW, 78 deaths in VIC, 51 deaths in QLD, 26 deaths in SA, 34 deaths in WA, 12 deaths in TAS, 6 deaths in NT, 8 deaths in ACT.

The mortality rate for respiratory diseases was 39.1 per 100,000, the second lowest on record after 2020. The influenza mortality rate was the lowest on record, with only 2 people dying from the flu.

The age-standardised hospitalisation rate for asthma fluctuated during the last 11 years, with the highest rate at 183 per 100,000 population in 2009–2010 and the lowest at 130 per 100,000 population in 2019-2020.

Note: 2019-2020 was a COVID pandemic year, with restrictions starting on 28 March 2020.

Cohort study of people aged up to 18 years old hospitalised for asthma during 2005-2018 in NSW, Australia, looking at school performance.
Findings:

• young males hospitalised with asthma had a 13% and 15% higher risk of not achieving the national minimum standard for numeracy and reading respectively, a 51% higher risk of not completing year 10, and around 20% higher risk of not completing year 11 or 12, compared to peers.
• Young females with asthma presented no difference in achieving national minimum standard in numeracy and reading, but a 21% higher risk of not completing year 11 and a 33% higher risk of not completing year 12.

Conclusions: Educational attainment is worse for young people hospitalized with asthma compared to matched peers. Early intervention and strategies for better management of asthma symptoms may enhance academic performance for students.

The Census 2021 data was released, including a question on whether people had asthma. The ABS media release reported:(ref 1)
– Asthma was the third most reported long-term condition, with 2,068,020 people reporting having asthma
– Asthma is the most commonly reported health condition for 0–14 year olds, with a notable difference between male children with 7.4%reporting asthma compared to 5.3% of female children.

Note: ABS recommends to use the National Health Survey rather than the Census as definite and correct source for national prevalence rates.

PHIDU maps: (ref 2)

The Public Health Information Development Unit has mapped the results from the ABS Census 2021, including asthma prevalence.
Note that when available, particularly for national or state prevalence, data from the National Health Survey is more reliable and preferred over the Census data.
Prevalence is reported as age-standardised rates (the ABS reports crude rates).

Data can be visualised for ages 0-14, 15+ or all-ages, and by states and territories, Local Government Areas (LGAs), Population Health Areas (PHAs) or Public Health Networks (PHNs) here: https://phidu.torrens.edu.au/social-health-atlases/maps#2021-census-population-health-areas  

Longitudinal study examined the experiences and health impacts of prolonged wildfire (bushfire) smoke exposure in adults with severe asthma during the 2019-2020 Australian bushfire period.

Multicentre cohort study by the Murdoch Children’s Research Institute following-up for 12 months 767 children aged 3–18 years admitted to hospital for asthma in Victoria in 2017-2018.
Results:
– About one third (34.3 %) were readmitted to hospital for asthma, (those aged 3-5 years accounting for 69.2 per cent): 20.6 % were readmitted once and 13.7 % had two or more readmissions in 12 months.
– children were 57% more likely to be readmitted when their general practitioners did not adhere to recommended asthma management guidelines
– almost 75% were discharged without a preventer and more than 80% did not have a follow-up appointment at the hospital
– Over a third hadn’t had a review of inhaler technique
Conclusion: Hospital readmissions among Australian children with asthma are increasing (compared to a decade ago when about 1 in 5 were readmitted), and the study highlights the gaps in children’s asthma care throughout their care journey such as reviewing their baseline asthma control, inhaler technique and asthma medication, lack of booked follow-up arrangements before discharge, and guideline discordant care.

see MCRI website: https://www.mcri.edu.au/news-stories/hospital-readmissions-for-asthma-on-the-rise-among-children

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.

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).

Disadvantaged areas:
Report by the Jesuit Social Services, that measures as 37 indicators of disadvantage across every community in each state and territory. Dropping off the Edge 2021 shows that disadvantage is concentrated in a small and disproportionate number of communities in each
state and territory.
The report provides data for each state including maps of disadvantaged areas.

According the National Health Survey for 2020-2021 (a year impacted by the Covid pandemic), it is estimated that:
• Just under 2.7 million (10.7%) Australians had asthma in 2020-21 (ref 1)
• Females were more likely than males to have asthma (12.0% compared to 9.4%) (ref 1)
• The rate of asthma was similar in boys and girls aged 0-14 years (9.5% and 7.9%) (ref 1)
• 411,000 children aged 0-14 have asthma (8.7%) (ref 2)
Note: due to Covid restrictions, data for the NHS 2020/21 was self-reported online rather than via interviews, and with a low response rate. Therefore it is less representative compared to previous NHS and comparisons with previous reports are limited (see Australian Institute of Health and Welfare (2022) Chronic respiratory conditions, AIHW, Australian Government, accessed 20 July 2022. https://www.aihw.gov.au/reports/australias-health/chronic-respiratory-conditions for details).

* In 2020/2021, there were nearly 25,000 hospitalisations for asthma (in public and private hospitals), of which more than 10,000 (43%) were in children aged under 15.(ref 1, 5)
Nearly 90% of asthma hospitalisations (89.3%) were considered potentially preventable.(ref 1, 2)

* The age-standardised hospitalisation rate for asthma for all ages combined was 100 per 100,000 population. It was markedly higher in chidren 0-14 (225 per 100,000) compared to people aged 15 and over (68 per 100,000). (ref 5)

* For age-specific hospitalisation rates, SEE FIGURE 14 from reference 5
Boys aged 0-14 were 1.6x as likely as girls to be hospitalised for asthma, while females 15 and over were 2.3x as likely as males to be hospitalised for asthma. (ref 5)

* Note that for hospitalisations due to all causes, following steady annual growth of 3.3% between 2014–15 and 2018–19, and a dip of 2.8% in 2019–20, hospitalisations increased by 6.3% nationally in 2020–21. This saw hospitalisations returning the trend to pre-pandemic years, and can be largely attributed to the easing of restrictions following the first waves of the COVID pandemic. (ref 3)

* A study conducted in two major hospital in Sydney also reported a 50-70% decrease in paediatric asthma hospitalisations during lockdown periods in 2020-21, stating potential explanations may be a reduction in respiratory infections, better outdoor air quality combined with less outdoor activities, and patients opting for telehealth appointments rather than hospital visits by fear of contracting COVID. (ref 4)

*For hospitalisations by PHN, see indicator 9, AIHW. Asthma. Data. Data tables: Asthma 2023. Table 9.1. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma/data (ref 6)

First entry date: 19/07/2022; last update 13/02/2024

The age-standardised mortality rate due to asthma among Aboriginal and Torres Strait Islander people was 2.2 times as high as among other Australians in 2014-2018 (3.4 compared with 1.5 per 100,000 population).

The prevalence of asthma was about twice as high for Aboriginal and Torres Strait Islander people living in non-remote areas (17%) compared with those living in remote areas (9%) in 2018-19.

This internal data report discussed prevalence, mortality, burden of disease, gap, remoteness, risk factors, demographic considerations, in relation to:
– Aboriginal and Torres Strait Islander Health (in general)
– asthma
– respiratory conditions

Provides comprehensive epidemiological information, as well as key facts.

Report: https://asthmafoundation.sharepoint.com/:w:/s/RPA/EZVD72ep5AZPpgs1RXRvDu4BTuP0TRYeYGIIfyT7wh94Gw?e=ZN7RMn

Summary Presentation: https://asthmafoundation.sharepoint.com/:w:/s/RPA/EZVD72ep5AZPpgs1RXRvDu4BTuP0TRYeYGIIfyT7wh94Gw?e=ZN7RMn

These resources are for internal use only, please do not distribute the report and presentation externally.

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).

key messages:
* People with asthma face no greater risk of becoming infected with COVID.(2)
* People with well-controlled asthma are not at greater risk of severe illness, going to hospital or dying from COVID, however people with severe or uncontrolled asthma (e.g. have needed oral corticosteroids or were hospitalised in the last 12 months) are. (1-6)

Key Guidelines:
– Australian Asthma Handbook, v2.2, COVID webpage (ref 1)
– GINA COVID guidance (ref 2)
– Severe asthma toolkit: Clinical recommendations for COVID-19 in Severe Asthma + several infographics for people with severe asthma (ref 3)

Infographics can be accessed here: https://toolkit.severeasthma.org.au/resources/infographics/

In 2015-2016, asthma cost the health system an estimated $770 million – 19% of disease expenditure for respiratory conditions and 0.7% of total disease expenditure. This expenditure consisted of:
* $204 million for hospitals (27% of total expenditure on asthma)
* $163 million for non-hospital medical services (21%)
* $383 million for pharmaceuticals (50%)

In 2018-2019, the expenditure for asthma by area of expenditure (allied health, GP, imaging, pathology, medications private hospital, public hospital, specialist services) can be found by downloading the data table, and opening the tab Table 5.
The total expenditure for asthma was about 798.6 million, and includes about:
* 148.4 million in GP services
* 28.5 million in Specialist services
* 350.8 million in medications (PBS)
* 13.3 million in private hospital services
* 66.9 million in public hospital emergency department
* 88.3 million in public hospital admissions
* 66.1 million in public hospital outpatient services

MORTALITY:
– Adults with asthma have a similar risk of dying from COVID compared with people without asthma.(1)
– when hospitalised for COVID, People with severe asthma (16yo +) are more likely to die than people without asthma (adjusted Hazard Ratio 1.96; 95% CI 1.25-3.08).(2)
– In a Scottish study, the risk of death from COVID was increased in asthmatic patients with a 2-year history of 3 course or more of oral corticosteroids (adjusted HR 1.39) or asthma hospitalisation (adjusted HR 1.84) compared to patients without asthma. (3, supplementary material table S7)

– In a large national cohort study in England:(4)
– increased risk of COVID death in Adults with asthma prescribed medium and high ICS (adjusted HRs 1.18 and 1.36 respectively) compared to adults without asthma, but no significant increase in people with asthma prescribed low ICS.
– increased risk of COVID death in adults with asthma prescribed 0 (adjusted HR 1.10), 1 (adjusted HR 1.20), 2 or more (adjusted HR 1.60) courses of OCS in the year prior to the pandemic compared to adults without asthma.
Concl: People with asthma who recently required higher ICS dosage-based therapies (ie, have more severe disease) or who experience one or more exacerbations per year (ie, have poorly-controlled asthma) as measured by OCS prescriptions, are potentially at increased risk of death from COVID (particularly those that required 2 or more courses of OCS).(4)

HOSPITALISATION:
– Adult patients with a history of asthma attack requiring oral corticosteroids (OCS) or hospitalisation are at increased risk of COVID hospitalisation, compared to patients without asthma. (1) Specifically:
– patients with a history of one or more asthma attacks in the last 2 years, defined as receiving one or more course of oral corticosteroids, had an adjusted HR between 1.30 (one course) and 1.54 (3 or more courses). (1)
– patients hospitalised for asthma in the last 2 years were about 3 times more likelly to be hospitalised for COVID than patients without asthma (adjusted HR 3.01), although this was calculated based on a small group of patients (201 patients with asthma hospitalisation). (1)

– in a Scottish study, children aged 5-17 years with uncontrolled asthma (defined as hospital admission or oral corticosteroids prescription in the last 2 years) had at increased risk of hospital admission for COVID, with a risk increased by at least 6-fold for those with a history of asthma hospitalisation, and at leat 3-fold for those with a history of at least 2 courses of OCS in the last 2 years. The rate of hospitalisation was higher in children with poorly controlled asthma compared to those with well-controled asthma or no asthma.(2)

– in a large national cohort study in England in adults and children aged 12-17 years old:(3)
– adults with asthma prescribed medium and high ICS had an elevated risk of COVID hospitalisation (fully adjusted HRs 1.53 and 1.52 respectively) compared to people without asthma.
– adults with asthma had a significantly higher risk of COVID hospitalisation, with those prescribed 2 or more courses of OCS in the year prior to the pandemic having an adjusted HR of COVID-19 hospitalisation of 1.94 compared to adults without asthma. => Nearly twice as likelly to be hospitalised for COVID
– children (12-17 yo) with asthma had a greater risk of hospitalisation compared to children without asthma, and was the greatest for children prescribed 1 (HR 2.58) or 2 or more (HR 3.80) courses of OCS in the year prior to the pandemic. => children prescribed OCS were more than twice as likelly to be hospitalised than children without asthma (nearly four times for children prescribed 2 or more courses).
Concl: People with asthma who recently required higher ICS dosage-based therapies (ie, have more severe disease) or who experience one or more exacerbations per year (ie, have poorly-controlled asthma) as measured by OCS prescriptions, are potentially at increased risk of hospitalisation (particularly those that required 2 or more courses of OCS).(3)

PHIDU dataset of potentially preventable hospitalisations from 2012/13 – 2016/17 by Public Health Areas:

http://phidu.torrens.edu.au/social-health-atlases/topic-atlas/pph#potentially-preventable-hospitalisations-atlas-data

Note: data for prior releases, including NHS asthma prevalence data, is available at: https://phidu.torrens.edu.au/social-health-atlases/data-archive/data-archive-social-health-atlases-of-australia

In 2018-2019, the Health System spent an estimated $287 per case due to Asthma, less than other respiratory conditions including upper respiratory conditions and COPD.

According to the National Health Survey for the 2020-2021 financial year:
– One in three people with asthma (34.9%) used asthma-related medication daily
– Just under half (48.8%) of children under 18 years of age used asthma-related medication in the two weeks prior to the survey
– More than three in five (63.2%) people aged 18 years and over used asthma-related medication in two weeks prior to the survey
– One in three (34.9%) people of all ages used medication to help manage symptoms daily and two in five (39.8%) did not take medication in the two weeks prior to survey.

Note: NHS 2020-21 should not be compared to other years as it was conducted differently (online) due to the Covid pandemic.

According to the National Health Survey for the 2020-2021 financial year, an estimated:
– One in three people with asthma (34.6%) had a written action plan
– More than three in five (65.9%) children under 18 years of age had a written action plan
– More than one in four (27.1%) people aged 18 years and over had a written action plan
– Women aged 18 years and over were more likely than men to have a written action plan (32.7% compared to 20.2%).

CRITICAL CARE:
– When hospitalised for COVID, people with asthma are more likely to receive critical care than people without underlying respiratory condition. (1)(2)
– There is an indication, although not statistically significant, that PWA have an increased risk of hopitalisation and critical care (ICU admission and ventilator use) compared to people without asthma.(3)
– Adults with asthma that have a history of asthma attack in the preceding 2 years (defined as two or more courses of oral corticosteroids (OCS), or at least one previous asthma hospitalisation) have an increased risk of ICU admission or death, compared with COVID patients without asthma (adjusted HR between 1.44 and 1.27 for history of OCS; adjusted HR = 2.24 for history of asthma hospitalisation, compared to patients without asthma). Suplementary material (table S7): the risk of ICU admission was higher in patients with a history of one or more course of OCS (adjusted HR 1.23 to 1.89) and in patients with a history of asthma hospitalisation (adjusted HR 3.48) compared to patients without asthma. (4)

in hospitalised (severe COVID) patients: (1)
A large prospective cohort study reported that amongst patients hospitalised with COVID, asthmatic patients aged 50 and over that used ICS within 2 weeks before hospitalisation were 14% less likely to die than patients without chronic respiratory conditions.

About 1 in 4 people with asthma using preventer medicines receive potentially toxic cumulative doses of OCS (over 5 years). Half of those using high-dose ICS preventers and potentially toxic doses of OCS are not using their preventer regularly. (ref 1)

In Australia, amongst people with asthma aged 12 and over that were prescribed inhaled corticosteroids: (ref 1)
– 52% used OCS between 2014 and 2018
– 28% received 1000mg or more prednisoline-equivalent during the 5-year period
– 10% of those using high dose ICS/LABA preventer during 2018 received 1000mg prednisolone equivalent or more over the 12-month period, with half of them (50%) using their preventer infrequently and therefore inadequately
– 5.5% of those using ICS alone or low-moderate dose ICS/LABA preventer during 2018 received 1000mg prednisolone equivalent or more over the 12-month period, with 68% of them using their preventer infrequently and therefore inadequently
– OCS were prescribed in 2018 mostly by GPs (76%), followed by non-specialists (19%) and respiratory specialists (5.5%)

Fig from position paper (Blakey et al, ref 2)

OCS stewardship represents the careful and responsible management of OCS prescribing, aiming to:
– prevent harm, by reducing exacerbations and therefore OCS use
– minimise harm, by reducing dose and treatment duration when OCS are required

A cumulative dose of just 1000mg prednisolone (or equivalent) over a lifetime is enough to significantly increase the risk of most adverse events in adults. This lifetime exposure toxic threshold can be reach in just 4 typical courses of OCS for asthma exacerbations. (ref 1,2)

A cumulative dose as low as 500 mg prednisolone (or equivalent) has been associated with a significant increased risk of adverse outcomes. (ref 2,3)

Steroids-related side effects are associated with both short-term use and long-term use of OCS (ref 1), and affect all parts of the body:

Importantly, the risk of emergency department visit, hospitalisation and death increases with increasing exposure to OCS. (ref 1,2)

OCS are frequently used in asthma in both acute (flare-ups) and chronic disease (severe asthma), despite the emergence of new treatments. OCS prescribing remains embedded in patient care.

Long-term or maintenance OCS is used in 20-60% of uncontrolled or severe asthma.

OCS inappropriate use frequently occurs in people with mild-moderate asthma that is poorly controlled due to poor adherence to or underuse of inhaled corticosteroid (ICS) therapy.

Download a copy here: Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand – PMC

2021 Report:

Some insights on tobacco (and e-cigarette) use and impact are available, including: (ref1)
– Tobacco is the leading cause of preventable burden in Australia: 8.6% of the total burden of disease and injury in 2018
– Tobacco contributed in 2018 to the burden of 39% of respiratory diseases
– Tobacco use is the leading cause of cancer in Australia (44% of cancer burden)
– In 2019, people living in remote and very remote areas were more likely to smoke daily (19.6%) than people living in Inner regional areas (13.4%) and Major cities (9.7%)
– E-cigarette use: in 2019, around 2 in 5 (39%) current smokers had used e-cigarettes in the lifetime, compared to 31% in 2016
There are several Tobacco infographic factsheets available

2025 report (ref 2) is available: https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/tobacco

– Tobacco is the second leading cause of preventable burden in Australia: 7.6% of the total burden of disease and injury in 2024
– Tobacco contributed in 2024 to 71% of the burden of COPD
– Tobacco contributed to 73% of the burden of lung cancer

Article in the Australian Journal of General Practice summarising the increased risk of asthma associated with gas cooking, how to recognise the clinical implications in children and adults with asthma, and how to advocate for them.
Some reported facts: (please refer to article for exact references)
– 65% of houses in Australia use gas for cooking or heating
– The most important gas-related health effects are due to nitrogen dioxide (NO2) and carbon monoxide (CO)
– an estimated 30% of the risk of asthma for a child with current asthma living in a home with a gas stove comes from the stove
– across the community in Australia, 12% of childhood asthma is attributable to the use of gas stoves
– the risk of persistent asthma was also increased in Tasmanian aged 43-53 years living with gas heating and cooking, with OR 2.64 (1.22–5.70)
– questions about indoor gas exposure should be part of asthma review, and strategies discussed to reduce exposure

A group of international scientists have published in Science proposed standards and recommendations for Indoor Air Quality for public buildings.

Asthma is significantly associated with an increased risk of lung cancer, with a hazard ratio of 1.34 (34% greater risk).
Note: this was a prospective cohort study based on UK biobank data in ABOUT 478 000 patients aged 37-73 years, recruited between 2006 and 2010 and followed up until 2019.

Asthma was the 9th leading contributor to the total burden of disease in Australia in 2018, with a disability-adjusted life years (DALY) rate of 5.2 per 1,000 population, compared to 10th in 2003. Asthma was the 4th leading cause of non-fatal disease burden in 2018 (from 5th in 2003). The equivalent of 130,886 years of healthy life were lost due to asthma in 2018, including 123,315 of these due to years lived with a disability.

Asthma was the leading cause of total burden in children aged 5-14, contributing to 14% and 11% of the total burden in boys and girls, respectively. It was the leading cause of non-fatal burden for children aged under 5.

By age groups, asthma’s total burden of disease ranked: 5th in children aged under 5; 1st in all children aged 5-14 (1st in males and 2nd in females); 5th in males and 4th in females aged 15-24; 8th in males and 4th in females aged 25-44; 10th in males and 6th in females aged 45-54; 10th in females aged 55-64; higher than 10th in males aged over 54 and females aged over 64. (see Fig 2.6 and 2.7 for DALY rates and proportions)

By age groups, asthma’s non-fatal burden of disease ranked: 1st in children aged under 5; 1st in males and 2nd in females aged 5-14; 3rd in males and 4th in females aged 15-24; 6th in males and 4th in females aged 25-44; 5th in both males and females aged 45-54; 8th in males and 6th in females aged 55-64; 8th in females aged 65-74; higher than 10th in males aged over 64 and females aged over 74.

Asthma was the 10th leading cause of fatal burden in males and 7th in females aged 5-14.

Note that the report also contains data specific to states, remoteness and socioeconomic groups.

HealthStats NSW: interactive tool providing NSW-specific population health data

GINA International guidelines recommendations1:
– Advise patients to continue taking their prescribed asthma medicines, including ICS and biological therapies
– Avoid the use of nebulizers where possible, due to the risk of viral transmission
– COVID vaccination is recommended for people with asthma
– Consider giving biological therapies on a different day from COVID vaccination

– It was estimated that about 8% of adult COVID-positive patients have asthma1
– Adults with asthma are 17% less likely to contract COVID than non-asthmatic patients (risk ratio=0.83, p=0.01)1
– Global Initiative for Asthma (International guidelines) states that patients with asthma are not at increased risk of acquiring COVID-19, or of severe COVID-192

– PM2.5: 5 μg/m3 Annual average; 15 μg/m3 24-hour average
– PM10: 15 μg/m3 Annual average; 45 μg/m3 24-hour average
– O3: 60 μg/m3 Peak season average; 100 μg/m3 8-hour average
– NO2: 10 μg/m3 Annual average; 25 μg/m3 24-hour average
– SO2: 40 μg/m3 24-hour average
– CO: 4 mg/m3 24-hour average

PHN and National/Regional/Metropolitan healthcare services: (ref 1)
– The percentage of people who saw a GP in 2020-2021 was higher is regional areas (87%) compared with Metropolitan areas (84%), however people in metropolitan areas had a higher number of GP services on average compared to regional areas.1
– AIHW report1 provides 2020-2021 (and earlier) data on the use of non-hospital Medicare-subsidised services, such as GP, allied health, specialist, diagnostic imaging, and nursing and Aboriginal health workers, by PHN (primary health network). The data is also provide by PHN group (National, Regional, Metropolitan), and stratified by service type including “Asthma Cycle of Care PIP” and demographic group (age and gender).

To access the data, use the link provided in the Source field, navigate to the Data tab and download the Excel table for the year of interest.

2022-2023: The same report can be accessed for 2022-2023 however asthma cycle of care have been discontinued and are therefore not relevant anymore. (ref 2)

According to the South Australian Population Health Survey, which defines asthma as “diagnosed and experienced symptoms/treatment in the last 12 months”:
– 14.5% of South Australian adults reported having asthma in 2020, changed from 14.8% in 2018 and 13.8% in 2019.1
– 11.4% of South Australian children reported asthma in 2020, reduced from 14.9% in 2019 but similar to 9.9% in 2018.2
– 43.9% of South Australian adults with asthma were obese, compared to 32.8% in the entire SA population.1
Note: refer to Table 22 in adults report and Table 15 in Children report for incidence by gender, age, socio-economic index, education and household income); and Table 23 for incidence by risk factors (BMI, Vegetable and Fruit consumption, Physical activity, alcohol, smoking)

Based on the National Aboriginal and Torres Strait Islander Survey 2018-2019

15.7% Indigenous Australians reported having asthma in 2018-2019: 13.4% of males and 15.7% of females (ref 1)

An estimated 128,000 Aboriginal and Torres Strait Islander people had asthma in 2018-2019 (16%), with a higher rate among females (18%) compared with males (13%). The prevalence of asthma among Indigenous Australians was was 1.6 times as high as non-Indigenous Australians after adjusting for difference in age structure, and the difference is more marked for older adults. (ref 4)

Asthma was the third most prevalent chronic condition in Aboriginal and Torres Strait Islander people. (ref 3)

Asthma was the most commonly self-reported long-term respiratory condition in 2018-2019 in Aboriginal and Torres Strait Islander people. (ref 1)

Prevalence by age groups: 11.5% of 0-14 yo; 13.8% of 15-24 yo; 15% of 25-34 yo; 17% of 35-44 yo; 20.8% of 45-54 yo; 25.8% of 55+ yo reported having asthma (ref 1 or ref 2)

Prevalence by jurisdictions: 18.6% in NSW; 18.0% in VIC; 13.7% in QLD; 12.6% in WA; 22.7% in SA; 21.9% in TAS; 25.3% in ACT; and 6.2% in NT (ref 2). Note: these statistics are also available stratified by remote/non-remote status in Table D1.04.20

In 2012–13, 18% of Aboriginal and Torres Strait Islander Australians had asthma (an estimated 111,900 people), with a higher rate among females (20%) compared with males (15%).
The prevalence of asthma was almost twice as high among Indigenous Australians compared with non-Indigenous Australians (a rate ratio of 1.9) after adjusting for difference in age structure.

In 2017-2018, only one third of Australian have a written Asthma Action Plan (32.3%, age-standardised)
– 65.9% of children aged 0-14 years old (age-standardised)
– 24.8% of people over 15 years and over (age-standardised) (ref 1)

Nationally in 2017-2018, the age-standardised proportion of people with asthma reporting that they have a written asthma action plan was 32.3 per cent (figure 10.6b), compared to 28.4 per cent in 2014-2015. In all jurisdictions, the proportion was higher for children aged 0–14 years than for other age groups (table 10A.46). Proportions for each states are also available. (ref 2)

Interpret NT data with caution as it excludes discrete Indigenous communities and very remote areas, which comprise around 29% of population

Note that this data is age-standardised.

Certain populations have a higher mortality rate, including:
– people residing in outer regional, remote and very remote areas, compared to major cities and inner regional areas
– people residing in the lowest socioeconomic area compared to highest socioeconomic areas
– Aboriginal and Torres Strait Islander people compared to non-indigenous Australians (2.2x as high as non-indigenous in the 2014-2018 period)

PPH for asthma (and other chronic conditions) between 2012-2013 and 2017-2018 by:
– National, state/territory, PHN and SA3
– Gender
– Age group and life stage
– Indigenous/non Indigenous
– Seasons
– SES area and remoteness

PPH per 100,000 included (crude rate).

Download the Excel table at https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisa/data-1 and then sort/filter according to your area of interest.

PPH rate (National)

PPH by Indigenous status

PPH by season

PPH 2017/2018 by age group, socio-economic status and remoteness:

In 2017-2018 more than 80% of these were potentially preventable through the provision of appropriate preventive health interventions and early disease management in primary care settings. (ref 1 and 2)
(note that there were 32,720 PPH (ref 1) out of 38,792 hospitalisations for asthma (ref 2), therefore 84% of hospitalisations were potentially preventable/avoidable)

In 2017-2018 there were nearly 39,000 hospitalisations for asthma. The rate of hospitalisations for asthma was 158 per 100,000 population.

Nearly half (44%) of these were for children aged 0-14 years old, giving asthma an age profile of hospitalisation much younger compared to hospitalisations for all causes.

The age-standardised rate of hospitalistions for asthma in children aged 0-14years old has decreased overall during the last decade, falling from 542 per 100,000 population in 2009–2010 to 363 per 100,000 population in 2017–2018.

In 2017-18, about one in nine Australians had been diagnosed with asthma (11% or total population, approximately 2.7 million people), based on self-reported data from the 2017–2018 Australian Bureau of Statistics (ABS) National Health Survey (NHS) (Ref 1)

See tables (ref 1) and graph (ref 2) below for prevalence by age, gender and jurisdiction.

Note:  the data refers to self-reported asthma (diagnosed by doctor or nurse), collected during the National Health Survey 2017-2018 financial year.
– select ‘data downloads’ from menu to retrieve the data cubes for more detailed information. This includes by state/territory, population characteristics and health risk factors.
Select ‘past and future releases’ for historic prevalence data
National Health Survey is conducted every 3 years.

Prevalence 2017-18 by age and sex: AIHW (entry date 29 July 2022).

To get actual prevalence rate for each stratum, go to the AIHW webpage, Fig 2 and hover our mouse over the bar of interest.

According to the Australian Burden of Disease Study 2018, asthma was, in First Nations people: (ref 1)
– 7th leading cause of disease burden in First Nations people, contributing 3.4% to the total burden (crude rate, NOT age-standardised)
– Burden of asthma was 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)

Comment: Note important variation between age-standardised (below) and crude (above) burden of disease ranking for First Nations people, due to the differences in age structure between First Nations (younger population) and non-Indigenous Australians.

Key findings from the Australian Burden of Disease Study (ABDS) 2018 also include:
– Asthma ranked 11th in 2018 as leading specific cause of total burden (age-standardised, fatal and non-fatal burden) in First Nations people, compared to 17th in 2003 and 13th in 2011, an increase of 36.4% compared to 2003. (ref 2,3)
– In Aboriginal and Torres Strait Islander children aged 5-14 years old, asthma was the third leading cause of total burden of disease in 2018, contributing 8.7% to the total burden.(ref 4)
– the aged-standardised DALY (disability-adjusted life years) rate for asthma was 11.4 DALY per 1,000 people in 2018 compared to 8.3 in 2003 (ref 2)
– Asthma was the leading cause of respiratory disease burden among Aboriginal and Torres Strait Islander people aged under 45 in 2018 (contributing 80% of respiratory burden).(ref 4)
– Respiratory diseases contributed to 7% of total burden (DALY) in 2018 for both indigenous and non-indigenous Australians (ref 2)
– the gap in (all-cause) total burden has narrowed between indigenous and non-indigenous Australian between 2003 and 2018, with 49% of the burden of disease in indigenous Australian being preventable in 2018 (ref 2)
– gap: the contribution of asthma to total burden of disease in 2018 was 2.2 times higher for Aboriginal and Torres Strait Islander people compared to other Australians, with a difference of 6.3 years lost to premature death or living with an illness or injury. (ref 4)
– gap: asthma contributed 1.6% to the burden of disease difference between Aboriginal and Torres Strait Islander people and other Australian in males, and 4.1% in females in 2018. (ref 4)
– the risk factors contributing to the most (all-cause) burden of disease in 2018 were tobacco use (12%), alcohol use (10%), overweight (9.7%), illicit drug use (6.9%) and dietary factors (6.2%) (ref 2)

Causes of death report is released each year in September. Asthma related deaths are shown under the ICD codes J45 and J46 (Asthma & Status Asthmaticus). It provides a breakdown by state/territory and gender, but not age. Download tables in data download section to access deaths where asthma was an underlying cause.

Some totals may not equal the sum of their component parts. This is because data cell with small values are randomly assigned to protect confidentiality.

In 2018 there were 389 deaths due to asthma in Australia, with an age-standardised rate of 1.2 per 100,000 population.

In 2019 there were 436 deaths due to asthma in Australia, with an age-standardised rate of 1.3 per 100,000 population.

In 2020 there were 417 deaths ( 143 males, 274 females) due to asthma in Australia, with an age-standardised rate of 1.3 per 100,000 population.(ref 1)
Approximately 400 people die each year due to asthma. (ref 1, 2, 3)