The walls of Bay of Islands Hospital are all too familiar for Northland mum Olivia Reti-George who is often in and out of hospital because of respiratory issues which affect her entire family.
Ms Reti-George, from Waikare, and her four kids all suffer from asthma and her 9-year-old daughter and 10-year-old son are often in hospital with bronchiectasis.
"It is a challenge living with this sickness and to make it worse we are 40 minutes away from the hospital. Nearly every three months myself and my partner are in hospital with my two kids because of it."
Statistics show more Northlanders are going to hospital for respiratory issues and more than half were Maori. Respiratory disease refers to conditions that impair the airways and lungs including asthma, bronchiectasis, bronchiolitis, pneumonia, chronic obstructive pulmonary disease (COPD), lung cancer and obstructive sleep apnoea.
Northland District Health Board (NDHB) figures show people needed to go to hospital for those conditions 2346 times last year. That was up on 2100 in 2014 - an 11 per cent increase - and 1846 in 2013. Just over half of those who went to hospital for respiratory illnesses last year were Maori and just over a third were children. Ms Reti-George said living with asthma could be restricting at times.
"It is limiting. My 9-year-old girl is not able to play sports but my son has been getting Maori rongoa which seems to be helping and he has just started playing rugby. My daughter pushes herself, she can jog but she is not able to play sports actively."
Ms Reti-George said she has had asthma for as long as she can remember and her four children have suffered from it their entire lives: "If I could take it away from them I would," she said.
Ms Reti-George said she was not sure why so many Maori in the region were going to hospital for respiratory issues but said one aspect may be poor living conditions. And she knows the difference a healthy home can make. She was living in damp and mouldy state-house but moved to a family papakainga about six years ago. The papakainga has recently been insulated and she said it made a huge difference.
"I have noticed huge changes, positive ones. My daughter coughed a lot but she has been coughing less. It's been really good."
NDHB acting chief executive Meng Cheong said the DHB had contracts with the Manaia and Te Tai Tokerau Primary Health Organisations for respiratory services.
They were focused on raising the level of competency of practice nurses in the management of patients with asthma and COPD through training and Mr Cheong said 75 nurses had completed the training in the two years since it began. Two respiratory specialist nurses provided support for patients outside the hospital known to have complex issues. They visited those patients to work with them on their plans and prevent their conditions worsening.
Other initiatives included the Healthy Housing Tai Tokerau programme, supporting low income families to insulate homes.
Emeritus Professor Sir Mason Durie of Massey University said respiratory diseases not only reflected the health status of individuals but were also a comment on the environments within which they lived, worked, and played, with poverty a breeding ground for respiratory diseases.
Addressing the problem required an approach that included highly skilled medical interventions, ready access to those services, early intervention, close links between the various components of the health sector and high levels of health literacy, he said.