Tracking asthma mortality, occupations and risk of rheumatoid arthritis, re-defining polycystic ovary syndrome and unpacking salt

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Why have asthma death rates plateaued after earlier declines?

Dr. Norman Swan 0:00

Hello and welcome to the Health Report with me, Norman Swan. Today, whether your job puts you at risk of rheumatoid arthritis? The commonest hormone problem in younger women is it being overdiagnosed? Just what should you look for on the food label when it comes to salt? And are we failing in the goal of reducing asthma deaths? Not so long ago, Australia and New Zealand had amongst the highest rates of asthma deaths in the world. They have come down, but a global survey of asthma. asthma and mortality published in The Lancet suggests efforts have so stalled. The person who wrote the accompanying editorial was Christine Jenkins of the George Institute in Sydney. Christine is professor of respiratory medicine at the University of New South Wales and the University of Sydney.

Dr. Norman Swan 0:39

Welcome back to the Health Report, just after two or three weeks, you know it's becoming a common thing.

Christine Jenkins 0:43

Thank you so much,

Dr. Norman Swan 0:44

Norman. So what are the statistics that came out in this New Ze it was a New Zealand group that did the research?

Christine Jenkins 0:49

Yes, it was, but they were actually analyzing global data from 46 countries. It's a WO uh WHO Global Mortality Database for asthma, and it comes from their civil registries, and it really tells us a lot about the spectrum of asthma deaths around the world. And in this database analysis of 46 countries, these New Zealand investigators identified that there had been a very nineteen the early nineteen nineties until around two thousand and five six and since then it appears to have plateaued very significantly and we're not making further gains at the present time in many of the those countries.

Dr. Norman Swan 1:30

Evenly distributed everywhere or just somewhere?

Christine Jenkins 1:33

No, it's patchy. Some countries have done exceptionally well. Canada has done very well. The UK has done quite well. New Zealand has done very well. Even Australia we've done very well. We've actually halved our asthma mortality rate. Although it fluctuates quite a bit. Singapore's done very well. Other countries, uh certain parts of Eastern Europe, uh South America, um The USA, for instance, have brought down their rates, but certainly have not brought them down in the last decade.

Dr. Norman Swan 2:02

So what was the cause of the fall? We'll come to the plateau in a minute.

Christine Jenkins 2:06

The cause of the fall was almost certainly the introduction of inhaled corticosteroids. So they're the anti-inflammatory preventer medications that we talk about for asthma, and they are a remarkable medication in that they only require very small doses to achieve very substantial effects in improving asthma control and preventing asthma deaths. The other thing is, of course, there were big public health campaigns driving consumer awareness. So people with asthma became aware of the fact it could be a life-threatening disease. And they actually went to their doctors as part of these campaigns. They were encouraged to do that and and to ask for an asthma action plan, for instance, or a lung function test, so their asthma could be assessed and properly treated.

Dr. Norman Swan 2:48

And the reason for the plateau? I mean th and there has been a plateau in Australia as well.

Which occupations and exposures increase the risk of rheumatoid arthritis?

Christine Jenkins 2:52

Yes, there has been a plateau in Australia, and there has been also in the UK, and as I mentioned, also the US. And there are probably many reasons for this. So, I mean, first of all, you could propose that the first drop in asthma death rates was the low hanging fruit. These were people who weren't aware that it was a potentially life threatening illness, or people who weren't taking a preventer medication, people who presented to hospital had a hospital admission, but then got onto a good track in regard to managing their asthma. These were people often not aware of how serious asthma could be or how much it was affecting their lives. And when they received the right treatment and they took their anti-inflammatory preventers, they said, wow, I can't believe I can feel this good.

Christine Jenkins 3:33

And now we have a group of people who still have perhaps an understanding that asthma's not a terribly worrying disease. They may not be aware that you can lose lung function very slowly over time, and they could have quite bad lung function and not know it.