About 52 New Zealanders die from asthma every year, a figure the Asthma Foundation says is "unacceptably high".
Asthma Hawke's Bay clinical nurse manager Jo Smiley said the service only saw a "minute" part of the Hawke's Bay population so it was hard to make a judgement for the whole region.
However, about 50 per cent of clients were self-referrals, who wanted to understand how to use their medication, and rates of adult clients were consistently higher than children.
Affordability of treatment was an issue for clients, with some unable to access GPs because they had no transport, and some sharing reliever inhalers.
Other clients did not pick up repeat prescriptions, which then expired and re-started the "snowball effect" of going back to a GP for a new prescription- with many not bothering, she said.
Ms Smiley said a respiratory initiative was due to be rolled out across the Bay on September 16, focusing on the integration of services across non-governmental organisations and primary health organisations.
"Its going to be a good sit and wait to see how the impact is. Perhaps we might have a different picture in the next year or two if this is successful."
Asthma Foundation medical adviser Dr Tristram Ingham said more asthma support was needed in schools.
"Sick asthmatic children just go quiet, staff fail to recognise the symptoms."
New Zealand has the world's second-highest asthma rates after the United Kingdom, according to 2012 statistics.
Possible reasons included high rates of house dust-mite allergens, cold, damp housing, lower breast feeding rates, higher fast-food intake/obesity, lower rates of childhood immunisation and paracetamol use in childhood, said Dr Ingham.
He said most New Zealand asthmatics were under-treated.
"People just put up with chronic symptoms.
"The mortality statistics and hospitalisations show asthma is still a serious condition and it can kill.
"We need to bust that 'she'll be right' attitude."
