Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Respirology. 2017 Nov;22(8):1570-1578. doi: 10.1111/resp.13123. Epub 2017 Aug 9.
New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma-related outcomes between these countries.
A web-based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web-based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year.
NZ (n = 537) and Australian (n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)-containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long-acting β -agonist (LABA) constituted 44.4% of NZ and 81.5% of Australian total ICS use (P < 0.0001). Adherence was higher with ICS/LABA than ICS-alone (P < 0.0001), and higher in NZ than in AU (P < 0.0001). ACT scores were similar (P = 0.41), with symptoms well controlled in 58.6% and 54.4% participants, respectively. More NZ participants reported non-urgent asthma reviews (56.6% vs 50.4%; P = 0.009). Similar proportions had urgent asthma visits (27.9% and 28.6%, respectively, P = 0.75).
This comparison, which included the first nationally representative data for asthma control in NZ, showed that poorly controlled asthma is common in both NZ and AU, despite subsidized ICS-containing medications. The greater use of ICS-alone in NZ relative to ICS/LABA does not appear to have compromised population-level asthma outcomes, perhaps due to better adherence in NZ. Different ICS/LABA subsidy criteria and different patient copayments may also have contributed to these findings.
新西兰（NZ）和澳大利亚（AU）的哮喘患病率相似；两国均拥有全民公共卫生系统，但补贴药物的标准不同。我们旨在探讨这两个国家之间哮喘管理和哮喘相关结局的差异。
我们于 2012 年在澳大利亚和 2013 年在新西兰开展了一项基于网络的调查，对象为当前患有哮喘且年龄≥16 岁的个体，他们是从基于网络的小组中随机抽取的，按全国人口比例分层。采用哮喘控制测试（ACT）评估症状控制情况。根据上一年报告的紧急看医生/住院就诊情况评估医疗保健的使用情况。
NZ（n=537）和澳大利亚（n=2686）参与者的年龄和性别分布相似。与澳大利亚参与者相比，更多的 NZ 参与者使用含有吸入性皮质类固醇（ICS）的药物（68.8% vs 60.9%；P=0.006），但 ICS/长效β-激动剂（LABA）构成了 NZ 参与者（44.4%）和澳大利亚参与者（81.5%）ICS 总使用量的一部分（P<0.0001）。ICS/LABA 的依从性高于 ICS 单药（P<0.0001），且 NZ 参与者的依从性高于澳大利亚参与者（P<0.0001）。ACT 评分相似（P=0.41），分别有 58.6%和 54.4%的参与者症状得到良好控制。更多的 NZ 参与者报告进行了非紧急性哮喘复查（56.6% vs 50.4%；P=0.009）。有紧急哮喘就诊的参与者比例相似（分别为 27.9%和 28.6%，P=0.75）。
本研究纳入了 NZ 全国范围内首次具有代表性的哮喘控制数据，结果表明，尽管使用了补贴的 ICS 药物，但 NZ 和 AU 两国的哮喘控制不良仍很常见。与 ICS/LABA 相比，NZ 中更广泛地使用 ICS 单药似乎并未影响人群层面的哮喘结局，这可能归因于 NZ 中更高的依从性。不同的 ICS/LABA 补贴标准和不同的患者共付额也可能促成了这些发现。
