We have one of the highest rates of asthma in the developed world, and asthma attacks are increasing too. There are several explanations why.
Opinion: Asthma attacks are on the rise in New Zealand, increasing by a third between 2010 and 2019. This is the finding of a national population-based study we recently published in Respiratory Medicine, showing that on average an asthma attack is being experienced by a New Zealander every 2.5 minutes.
Reassuringly, the percentage of people with asthma in New Zealand has stayed relatively stable over the last 10 years – 10 percent of New Zealanders, though the rates are higher in Māori and Pacific populations. Despite this stability, New Zealand remains one of the countries with the highest prevalence of asthma compared with developed countries such as the UK and the US. For the first time we now have data on asthma attacks across all age groups in Aotearoa New Zealand, and the results are concerning.
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The chances of someone having an asthma attack are higher now than it was 10 years ago. Asthma attacks, also known as exacerbations, are when someone experiences a sudden worsening of their asthma symptoms. You feel short of breath, your chest may feel tight, you may struggle to breathe. This can be terrifying as it can happen suddenly, and the symptoms can last for several days, leading to time off work or school. Every year, asthma costs our country over $1 billion, because of hospital care and medication and the costs incurred from not being able to go to work because you or your child has asthma.
Our research did show that hospitalisations for asthma have reduced over the last decade, even though the overall number of attacks are increasing. This suggests more of these attacks are being managed in our communities within primary care rather than by our hospitals – an important finding when it comes to healthcare planning for the next 5-10 years, given the costs associated with managing asthma attacks, and our already stretched primary healthcare system.
However, we found Māori and Pacific people had higher rates of hospitalisation than other ethnic groups, which may suggest either more uncontrolled asthma or that Māori and Pacific people may find hospitals more accessible than primary care for managing asthma attacks.
Why are we seeing this increase in asthma attacks? From our current research, we cannot know for sure, but there are several hypotheses.
Global warming and climate change
We have recently experienced the very real effects of global warming on (and under) our doorsteps, with floods and severe weather events. What may have seemed like a foreign and far-distant concept a few years ago, feels very relevant now. Global warming is already affecting our health, particularly with allergic conditions such as asthma. With warmer temperatures, the duration of the pollen season where people are exposed to potentially allergenic pollen that can trigger an attack is getting longer. Warmer temperatures encourage species that are known allergy triggers to flourish, such as ragweed, which may release pollen for longer periods each year.
Rapid changes in air temperature and humidity can also affect our asthma. Airways, like many of us, do not like sudden change. Severe weather events, like the ones we saw in January this year, can create conditions that are dangerous for people with asthma. Thunderstorm asthma, for example, occurs when pollen grains get swept up by winds, fragmented into tiny pieces by the storm and then concentrated with gusts of wind that can trigger airway tightening in the lungs.
The exact role that pollens, weather and climate change play in asthma attacks is something that we are investigating. New Zealand does not have an airborne pollen monitoring programme in place, which lags well behind other countries. Without routine monitoring, we don’t know what is happening to the levels of pollen in the air and what type of pollen we are being exposed to. Our team installed the first pollen trap this year on July 4 2023 on the roof of Auckland museum, which will help answer some pressing questions about how the timing and severity of key pollen allergens are changing in the air. Much of New Zealand may be at risk of future weather-related asthma events in the coming decades such as thunderstorm asthma so having information on how the environment is changing and the impacts on health is critical.
Cost of living
The cost of living has increased substantially since 2010, which could affect the ability of people to get the care they need, when they need it. A UK survey found one in five people with asthma reported that the high cost of living has caused life-threatening asthma attacks as they cut back on medicines, heating and food. We may be seeing a similar situation in New Zealand. Access to healthcare in New Zealand is already inequitable, with some struggling to access a doctor or necessary medication. The removal of prescription charges since July 1 2023 could go some way to addressing this disparity, though how much of a difference this makes to asthma and asthma control is yet to be revealed.
Diet and nutrition
Most of us are aware that fast foods aren’t good for our health but might not be as aware that they make us more prone to asthma attacks.
Airway inflammation – the key underlying mechanism driving asthma attacks – can increase within hours of eating food high in fats. Fast food such as burgers and chips contain high saturated fats, and sugar, which can worsen asthma symptoms. New Zealanders are spending more than a quarter of their food budgets on takeaways and restaurant meals each year, which could partly explain the increasing number of asthma attacks.
Our diet has changed markedly over the past decade. We are using more online food delivery, and spending more on takeaways and less on fruit and vegetables. With fruit and vegetable prices up 22.5 percent from this time last year, this is likely to affect rates of asthma and diet-related diseases.
It is not yet possible to know exactly which of the above hypotheses is the main driver behind the increase in asthma attacks we are seeing in the last decade. It's likely to be a mix of all of them – and other related factors.
What we do know is that if we are to keep asthmatics well, we need to ensure our primary practices – such as our GPs, nurses, and pharmacists – are equipped and ready to manage the increasing attacks we are already seeing in our communities, and likely to see more of in the near and uncertain future.
The research referred to in this paper was co-authored by Andrew Tomlin, Kebede Beyene and Jeff Harrison.
