A community based assessment of asthma prevalence, management strategies, compliance and treatment perspectives amongst young adults in Melbourne, Australia

Morbidity and mortality from asthma has increased world-wide over past decades despite advances in management. Australia leads the world in asthma prevalence with associated high mortality statistics (approximately 800 deaths annually). As part of the 1992-93 European Community Respiratory Health Survey (ECRHS) we assessed asthma prevalence, drug therapy, compliance and treatment perceptions amongst 4500 young adults in Melbourne, Australia. From the first phase of the ECRHS, a random subsample of 1642 subjects (aged 20-45 years) and a further subsample of 433 symptomatic subjects were invited to complete a detailed respiratory questionnaire. Of these 2075 young adults, 757 (n=553 - random, n=204 - symptomatic) completed the questionnaire in the laboratory and a further 119 by telephone interview (42% response rate). Prevalence: Current asthma was reported by 9.7% of respondents in the ECRHS first phase. Of the 'enriched' second phase cohort, a history of physician confirmed asthma was reported by 227 (26%); 143 (63%) of these had current asthma as defined by an attack within the past year (Group I) and 84 (37%) had not (Gp II). Treatment: Of the asthmatics in phase II, 215 (95%) had been prescribed treatment for their asthma. Inhaled corticosteroid (ICS) use in the past 1 year was reported by 85 (37%) subjects. Current asthmatics (Group I) were more likely to have used ICS (n=65, 45%) in the last year than those with no history of recent attacks (Group II; n=20, 24%). B-agonists had been used by 161 (71%), antihistamines by 67 (29.5%), oral methylxanthines by 17 (7%) and oral steroids by 5 (2%) subjects within the past year. 41 (18%) subjects had received immunotherapy for allergies. Compliance: 93 (43%) subjects reported taking treatment as prescribed all of the time, 50 (23%) most of the time, 70 (33%) some of the time and 2 (1%) none of the time. Compliance was not significantly different between Gp. I and Gp. II subjects. Perception: 148 (62%) believed it was "bad" to take regular preventative treatment and 92 (62%) of these had suffered an attack within the past year. Of the 153 (67%) subjects who only took treatment when necessary for attacks of breathlessness, 80 (52%) took treatment at the onset of the attack but 73 (48%) waited until symptoms became severe. Conclusion: Asthma patient perception and treatment compliance continues to be poor despite national education campaigns. Anti-inflammatory agents remain neglected even in those with current symptoms