Editorial: Meeting asthma challenge

Nothing to do with asthma seems to make much sense. In an age of stunning medical breakthroughs, we still do not know the cause of the lung disease, or why it is becoming increasingly prevalent here. We do, however, know that one in six New Zealanders has the disease and that it is the most common cause of hospital admissions for children; and that it costs the country an estimated $825 million each year - $125 million in pharmaceuticals, patient care and specialist services, and $700 million in lost work days, loss of healthy life and premature death. Yet such devastating statistics could not earn asthma a place on the "big 13" priorities when the New Zealand Health Strategy was unveiled in 2000. Why not?

Perhaps this low-key response reflects the characteristics of the disease, not its impact. It is usually regarded as debilitating rather than fatal. As such, it does not grab the attention like heart disease and cancer, both of which are deemed to be major health priorities. Yet as much as those diseases demand attention, asthma is clearly no less deserving. At the moment, however, asthmatics get a raw deal. The sum the Government spends on individual asthmatics, about $1000 a year, is lower than in any other Western country, according to Dr Jeff Garret, the clinical director of medicine at Middlemore Hospital.

The Government, indeed, seems intent on playing down the issue. The Minister of Health excuses an approach bordering on complacency by suggesting that asthma comes under three priorities in the New Zealand Health Strategy - in Maori and Pacific Island health, child health, and the smoking strategy. That, however, is a long way from according the disease the seriousness it merits, or of recognising the savings that could be accomplished by effective pre-emptive strikes.

It is clear that many New Zealanders have not been taught how to cope with asthma. They need access to education and instruction. It is equally apparent that, quite unfairly, sufferers are being asked to bear an unreasonable proportion of the cost to treat their condition. Thus, New Zealand admission rates to hospital for asthma are among the world's highest. Additionally, the rate is twice as high for Maori as non-Maori.

The challenge for the Government's health strategy, which places great emphasis on primary care, is obvious. Access to doctors and educators must be assured. An annual asthma check programme, similar to that provided for diabetics, seems an obvious starting point. Equally, however, it must be recognised that controlling asthma is not enough. The aim must be to find a cure. But as today's Herald series reports, asthma is not yielding its secrets easily. The prevailing wisdom is that because children in developed countries are no longer exposed to serious infection, their immune system instead generates allergies. The hunt, both here and abroad, is to manufacture a drug to treat the immune system of people with allergies or to vaccinate children to stop them becoming allergic. But at least one leading researcher is pessimistic, estimating it may be 20 to 30 years before a drug that switches off allergies becomes available.

That, in itself, represents an opportunity. The explosion of the disease in wealthier, mainly English-speaking parts of the world guarantees that the discovery of a cure will be a medical eldorado. New Zealand is at the forefront of that research. The potential reward suggests the work of its scientists should receive maximum support. And asthma control should be a top priority until the researchers' work is done.