Respiratory disease

Objectives To report patterns of asthma control, medications and healthcare utilisation in Australian adults with asthma in 2021, and assess changes since a similar survey in 2012. Study Type Cross-sectional web-based survey (February–March 2021; n=5427), compared with a similar 2012 survey (n=2686). Setting/Participants Adults (≥18years) with asthma, recruited from large web-based panels, with enrolment stratified by age group, gender and state/territory. Main Outcome Measures Asthma control test (ACT), healthcare utilisation and medications. Results Median age was 46years; 59% of participants reported female gender. Compared with 2012, fewer participants had well-controlled symptoms (ACT≥20: 2021, 48.0%; 2012, 54.4%; p<0.001), and more had very poorly controlled symptoms (ACT 5–15: 2021, 26.8%; 2012, 22.9%; p<0.001). Urgent asthma healthcare had increased (2021, 37.9%; 2012, 28.6%; odds ratio 1.53 [95% confidence interval, 1.37–1.69]; p<0.001). Inhaled corticosteroid (ICS) use in the previous year was similar (2021, 60.9%; 2012, 60.8%) but adherence was lower (p<0.001). Fewer participants had good symptom control while taking little/no ICS (2021, 33.4%; 2012, 40.1%), and more had uncontrolled symptoms with little/no ICS (2021, 38.1%; 2012, 25.6%; p<0.001); among the latter group, urgent healthcare utilisation had increased (2021, 63.5%; 2012, 41.2%; p<0.001). In 2021, 28.7% reported using oral corticosteroids for asthma in the previous year; only 42.0% of ICS users recalled their inhaler technique having been checked in the past 12months. Overuse of short-acting beta2-agonists was common: 56.3% adults obtained ≥3 inhalers in the previous year, and 10.5% obtained ≥12 inhalers. For symptom relief in the previous 4weeks, only 13.3% adults reported using an anti-inflammatory reliever (ICS–formoterol). Conclusion Our comparison of these two large nationally stratified sample surveys demonstrates significant worsening of key asthma indicators between 2012 and 2021, including worse symptom control and urgent healthcare use, but also indicates opportunities for improvement. The findings highlight an urgent need for system-wide implementation of the 2025 Australian asthma guidelines to reduce preventable morbidity. Trial Registration ACTRN12620000977976p

Helen K. Reddel, Maria R. Ampon, Leanne M. Poulos, Sharon R. Davis, Brett G. Toelle, Guy B. Marks, Taehoon Lee

The 2025 NSW RSV Prevention Program, which achieved an estimated coverage of 63% maternal vaccination and 18% for infant immunisation, led to more than 40% reduction in RSV notifications and hospitalisations among infants aged younger than 6months.

Janaki Amin, Sally L. Ellis, Christopher Lambeth, Jessica Gugusheff, Christine Selvey

Objectives To examine spatial, temporal and seasonal patterns in childhood and adolescent asthma hospitalisations across Queensland, and assess variation in hospitalisation risk by age and sex across climate regions. Design A retrospective, population-based ecological study using area-level administrative data from hospital admissions. Setting All public and private hospitals in Queensland, Australia, 1 January 2000–31 December 2019. Participants Children and adolescents aged 0–19years who were admitted to hospital with a principal diagnosis of asthma. Main Outcome Measures Age-standardised admission rates and relative risks (RRs) from spatial models; temporal patterns from time-series analysis; spatial variation from mapping; age-, sex- and climate zone-specific risks. Results Hospitalisations among children aged 0–4years declined from 48.1% (1640 admissions) in 2000 to 23.2% (721 admissions) in 2019, whereas proportions in older age groups increased. Seasonal peaks occurred in May, June and February, with male patients showing a stronger February peak and female patients maintaining higher risks into July. Hot desert regions had the highest RRs, rising from 3.73 (95% credible interval [CrI], 3.71–3.74) in 2000–2001 to 9.37 (95% CrI, 9.28–9.47) in 2009–2010, then declining to 2.37 (95% CrI, 2.37–2.38) in 2018–2019. Hot semi-arid and tropical savanna regions showed persistently elevated risks (hot semi-arid: RR, 1.86–3.75; tropical savanna: RR, 1.81–4.58). Three temporal phases were evident statewide: an early lower-risk period (2000–2002), a higher-risk period (2002–2012) and a later reduction (2012–2019), with most RRs between 0.5 and 1.5. Seasonality was strongest in hot desert zones (seasonal strength, 0.519) and weakest in tropical savanna zones (0.063). Conclusions Childhood and adolescent asthma hospitalisations in Queensland exhibit significant spatiotemporal variation, with burden shifting from younger to older children, and climate-specific risks, although observed reductions in the youngest age group may partly reflect diagnostic and hospital admission practice changes. Higher asthma risks in arid and tropical savanna regions underscore the need for geographically tailored services and planning. These findings suggest that targeted public health strategies might help reduce asthma burden in vulnerable communities.

Jialu Wang, Javier Cortes-Ramirez, Janet Davies, Wenbiao Hu

A multisectoral approach and stronger multilevel government coordination are required to address the health impacts associated with proximity to mining and exposure to toxic chemicals

Javier Cortes‐Ramirez · Ruby N Michael · Leisa‐Maree Toms · Melissa Haswell

Reducing the use of high emissions inhalers is a high priority for decarbonising health care in Australia

Luise Kazda · Alexandra L Barratt · Sean Docking · Kristen Pickles · Darlene Cox · Ross S Bailie · Kate Wylie · Katy JL Bell

A review of advancements in respiratory syncytial virus (RSV) prevention within Australia, focusing on the recent introduction of nirsevimab, a long-acting monoclonal antibody, and Abrysvo, a maternal RSV vaccine.

Sam T Barnett · Jane Tuckerman · Ian G Barr · Nigel W Crawford · Danielle F Wurzel

A discussion on the possibility and urgency of using linked maternal and child health data, with Victoria and South Australia as case studies, while there is a political window of opportunity for collaborative action

Ashleigh Shipton · Meredith O'Connor · Melissa Wake · Sharon Goldfeld · Helen Lees · Catina Adams · Kristina Edvardsson · Leesa Hooker · Jatender Mohal · Rhiannon M Pilkington · Fiona K Mensah

A 61-year-old previously healthy man presented to hospital with acute type 1 respiratory failure after five days of coryzal symptoms and a positive COVID-19 rapid antigen test

Melanie Wong · Bradley Gardiner · Rob Stirling · Golsa Adabi · Brooke Riley · Jyotika D Prasad · Gregory I Snell

Examination of the complexities of multiple organ transplant for patients with cystic fibrosis, using a hypothetical patient

Mark R Oliver · John Massie · Miranda Paraskeva · Avik Majumdar · Lynn H Gillam · Dominic JC Wilkinson

New pathways to address current inequities in Australian cystic fibrosis patients’ access to disease-modifying treatments, including in vitro cell models.

Laura K Fawcett · Shafagh A Waters · Adam Jaffe