Changing approaches to asthma management in Australia - Effects on asthma morbidity

Asthma is an important public health issue in Australia and is responsible for significant morbidity and mortality in the community. Recognition of th e impact of asthma on the health of Australians, and the apparent failure o f new medications to reduce mortality and hospital admission rates resulted in a major review by the stakeholders in asthma care. This led to new appr oaches to asthma management based on strategic use of asthma medications an d the development of the Asthma Management Plan (AMP). The AMP drew together current understanding of asthma to develop a simple s tepwise approach to management that could be readily applied in patient man agement. The National Asthma Campaign (NAC), a coalition of the major stake holders in asthma care, was launched in 1990 to lead the dissemination of t he AMP. In association with other organisations interested in asthma care i n Australia, the NAC has developed the AMP, and co-ordinated a decade of ed ucation and advocacy about asthma that targeted doctors, health professiona ls and the general public. These activities have been successful in raising awareness about asthma in the community: However, recent research, while demonstrating the continued uptake of written asthma action plans for asthma and decrease in use of inh aled bronchodilator medications, reported a decrease in use of preventive t herapy by people with asthma. These activities have had a sustained impact on asthma-related health outcomes with mortality at the lowest level since 1960 and a decline in hospital readmission rates. This is useful informatio n because there is sound evidence that the prevalence and possibly severity of asthma in children has increased. However, review of management in prim ary care and among people who present to emergency services with acute asth ma suggest that many people continue to manage their asthma poorly. Continu ed education is needed to build on the progress that has been made. There a re opportunities to do this through efforts to integrate general practition ers into the wider health system through the formation of Divisions of Gene ral Practice. Recognition of asthma as a health priority area at a national level will help to enhance and maintain awareness of the public health imp ortance of asthma and facilitate the further development of the initiatives begun during the last decade or more.