New Zealand has some of the worst asthma rates in the developed world. The Asthma Foundation says 14 per cent of children have received medicine for asthma - more boys than girls - and 11 per cent of adults, with women more likely to be affected than men.
Its 2014 respiratory disease impact report put the cost of asthma at $800m, $155m in direct costs, and $645m in indirect costs from work days lost, disability affected life years, and mortality.
Professor Innes Asher from Auckland University, who chairs the Global Asthma Network, says that figure is probably too low, because if ignores undiagnosed and unmedicated asthma.
She says a recent Canadian study found the productivity loss from people who continued working while having asthma was significantly greater than if they had stayed home until the symptoms went away. For some people asthma is triggered by allergies, but in many cases there may be other reasons for the inflammation that are not yet understood.
There are still things that can be done to your home to reduce the risk of an attack.
The Asthma Foundation manages the Sensitive Choice initiative - sensitivechoice.com - which aims to help people identify products and services that could be better choices for people with asthma and allergies.
It started in Australia, but has been modified for New Zealand conditions.
"So many things trigger people's asthma. Everyone has different triggers. It's a matter of doing the best you can to limit it," says Taniya Scott, the foundation's business development coordinator.
Dust and pollen, intrusive fragrances, damp, cold and mould can all be triggers for asthma.
"A warm, dry and well heated home is a healthy home, and we look at lots of products that address that," Scott says.
An independent panel including allergists, GPs, and engineers looks at every product that applied for a Sensitive Choice endorsement and makes sure the information provided is accurate.
Laundry products are a particularly sensitive area. "We look at what ingredients are included. It needs to be something that caters to people with various allergies. It needs to be fragrance free because fragrances have ingredients that can create allergies on skin and also can trigger allergies.
"Sometimes things around the home are affecting us, but if it it's not severe, we may not notice it."
Flowers in the home, workplace or restaurant might look good, but they could also set some people off.
Scott says pollen is a major allergen, with some of our native species generating large amounts of pollen at certain times of the year, and it may be a reason we have one of the highest asthma rates behind the United Kingdom.
Another may be poor housing. Unlike countries where central heating is the norm, Kiwis use a range of heating strategies.
The World Health Organisation recommends a temperature in the home of 16 to 18 degrees constant, so insulation is important.
Product on the Sensitive Choice list include several vacuum cleaners and steam mops - the standard recommendation is for cleaners with HEPA or "high efficiency particulate air filters" that trap very small particles that may cause problems for allergy sufferers.
There are a range of mattresses, bed coverings and pillows which aim to cut down exposure to bacteria, mould and dust mites.
Humidifiers and air purifiers can help with a healthy home.
A steel manufacturer is included in the listed products, pointing out that steel framing for houses means no additional preservative chemical treatments, no support for mould growth and no poisonous gases or volatile organic compounds (VOCs) - which can also be found in some paints and polyurethanes.
Professor Innes Asher from Auckland University, who chairs the Global Asthma Network, says not enough is being done in New Zealand at an official level to improve asthma management.
That may be in part because it's a symptom of the socioeconomic divide, with no political will to improve the quality of the cold, damp houses that are increasing asthma rates among the poor and their children.
Improved housing would mean less time off work, more time at school, lower medicine costs.
Asher also says asthma which is well controlled imposes far less of an economic and personal burden than non-controlled asthma.
Get people using evidence-based therapies and overall health costs go down.
That means a national or local strategy to improve early detection of asthma and provide effective preventive treatment, which still isn't happening.
The Global Asthma Report 2014 made recommendations to the World Health Organisation, governments, health authorities and health professionals, which, if followed, would transform asthma globally from a burden to an inconvenience.
As part of their asthma strategy, every country needs an up-to-date approach to the diagnosis and management of wheezing in young children. If an infant presents with frequent and/or severe episodes of recurrent wheezing they should be diagnosed and managed as asthmatic, unless there is evidence to the contrary.
She says there needs to be effective policy action on known, remediable causes of asthma such as parental smoking (for children) and occupational exposures (for adults).
Guaranteed access to quality-assured essential asthma medicines is vital to improving asthma outcomes. That means inhalers that work and are affordable.
That's why the Global Asthma Network has spoken out against the proposed Trans Paci?c Partnership Agreement.
Asher says the TPPA is designed to promote the interests of the pharmaceutical industry to the great detriment of public health.
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