The Finnish Asthma Program, which ran between 1994 and 2004, has long been heralded as a benchmark of success in how to improve management and reduce asthma-related health service utilization. In Australia, there were 38,792 asthma hospitalizations in 2017–18, and 80% of these were considered avoidable (J Asthma Allergy. 2021;14:797–808. doi: 10.2147/JAA.S311721). To address this issue, Asthma Australia has set a strategic objective of halving avoidable asthma presentations to hospital by 2030. This article provides an overview of the Finnish Asthma Program, including an evaluation of critical success factors, outputs, and outcomes, followed by a synthesis of these findings for relevance and applicability to the contemporary Australian context that will inform policy and practice recommendations. Early diagnosis, effective anti-inflammatory medication, guided self-management, and monitoring disease control are still the keys to mitigating asthma burden. In the spirit of the Finnish Program, the digital transformation of healthcare and social media is enabling a new kind of systematic approach, both for patients and professionals.

Background and ObjectivePeople living with asthma, their carers, clinicians and policymakers are the end-users of research and need research that address their individual healthcare needs. We aimed to understand the research priorities of end-users of asthma research. MethodsA national cross-sectional mixed-methods study was conducted. The study included an online survey that engaged patients, carers, healthcare professionals and policymakers to provide statements to free-text questions about what they would like to see answered by research to improve living with asthma on a day-to-day basis. Responses where thematically analysed followed by three online priority setting consensus workshops. ResultsThere were 593 respondents who provided 1446 text comments. Participants prioritized 10 asthma research themes which were: (1) asthma in children, (2) COVID 19 and asthma, (3) asthma care and self-management, (4) diagnosis and medication, (5) managing asthma attacks, (6) causes, prevention and features of asthma, (7) mental health, (8) asthma and ageing, (9) severe asthma, (10) asthma and other health conditions. Each theme comprises specific research questions. ConclusionThis project successfully established 10 priority research themes for asthma, reflecting the collective voice of the end-users of this research. These novel data can be used to address the documented mismatch in research prioritization between the research community and the end-users of research.

BACKGROUND: Individuals with asthma experienced severe and prolonged symptoms after the Australian 2019 to 2020 landscape fire. Many of these symptoms, such as throat irritation, occur in the upper airway. This suggests that laryngeal hypersensitivity contributes to persistent symptoms after smoke exposure.OBJECTIVE: This study examined the relationship between laryngeal hypersensitivity and symptoms, asthma control, and health impacts on individuals exposed to landscape fire smoke. METHOD: The study was a cross-sectional survey of 240 participants in asthma registries who were exposed to smoke during the 2019 to 2020 Australian fire. The survey, completed between March and May 2020, included questions about symptoms, asthma control, and health care use, as well as the Laryngeal Hypersensitivity Questionnaire. Daily concentration levels of particulate matter less than or equal to 2.5 mm in diameter were measured over the 152-day study period.RESULTS: The 49 participants with laryngeal hypersensitivity (20%) had significantly more asthma symptoms (96% vs 79%; P = .003), cough (78% vs 22%; P < .001), and throat irritation (71% vs 38%; P < .001) during the fire period compared with those without laryngeal hypersensitivity. Participants with laryngeal hypersensitivity had greater health care use (P <= .02), more time off work (P = .004), and a reduced capacity to participate in usual activities (P < .001) during the fire period, as well as poorer asthma control during the follow-up (P = .001).CONCLUSIONS: Laryngeal hypersensitivity is associated with persistent symptoms, reports of lower asthma control, and increased health care use in adults with asthma who were exposed to landscape fire smoke. Management of laryngeal hypersensitivity before, during, or immediately after landscape fire smoke exposure might reduce the symptom burden and health impact. Crown Copyright (c) 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2023;11:3107-15)

Wildfires are increasing and cause health effects. The immediate and ongoing health impacts of prolonged wildfire smoke exposure in severe asthma are unknown. This longitudinal study examined the experiences and health impacts of prolonged wildfire (bushfire) smoke exposure in adults with severe asthma during the 2019/2020 Australian bushfire period. Participants from Eastern/Southern Australia who had previously enrolled in an asthma registry completed a questionnaire survey regarding symptoms, asthma attacks, quality of life and smoke exposure mitigation during the bushfires and in the months following exposure. Daily individualized exposure to bushfire particulate matter (PM2.5) was estimated by geolocation and validated modelling. Respondents (n = 240) had a median age of 63 years, 60% were female and 92% had severe asthma. They experienced prolonged intense PM2.5 exposure (mean PM2.5 32.5 μg/m3 on 55 bushfire days). Most (83%) of the participants experienced symptoms during the bushfire period, including: breathlessness (57%); wheeze/whistling chest (53%); and cough (50%). A total of 44% required oral corticosteroid treatment for an asthma attack and 65% reported reduced capacity to participate in usual activities. About half of the participants received information/advice regarding asthma management (45%) and smoke exposure minimization strategies (52%). Most of the participants stayed indoors (88%) and kept the windows/doors shut when inside (93%), but this did not clearly mitigate the symptoms. Following the bushfire period, 65% of the participants reported persistent asthma symptoms. Monoclonal antibody use for asthma was associated with a reduced risk of persistent symptoms. Intense and prolonged PM2.5 exposure during the 2019/2020 bushfires was associated with acute and persistent symptoms among people with severe asthma. There are opportunities to improve the exposure mitigation strategies and communicate these to people with severe asthma.

The impact of bushfire, particularly on those with chronic lung diseases, is now recognized.1, 2 Individuals with asthma are among the most vulnerable groups.3 As bushfires are anticipated to be longer and more intense in many regions of the world, their adverse impact, particularly in asthmatic individuals, will impose a significant burden. Between July 2019 and March 2020, Australia experienced an unprecedented number of bushfires. At its worst, the smoke resulted in the Air Quality Index reaching more than 25 times the hazardous level in Canberra on 1 January 2020. It is estimated the bushfire smoke was responsible for more than 400 deaths, 2000 respiratory hospitalizations and 1300 presentations to the emergency department (ED) for asthma.4 In response to the unfolding public health emergency caused by this prolonged period of bushfire, Asthma Australia conducted an online survey (19 December 2019–30 January 2020) to capture the experiences of people across Australia. The survey was posted on the Asthma Australia website, and disseminated via Asthma Australia networks, social media and media articles, including an email to Asthma Australia's database of approximately 60 000 people with asthma or their carers. It included both quantitative and qualitative questions. The survey was completed by 12 152 people of which 7285 (61%) reported a history of doctor-diagnosed asthma.5 People with asthma were particularly vulnerable to the impacts of smoke exposure, with 93.6% experiencing respiratory symptoms compared to 70.2% in those without asthma (Fig. 1). People with asthma were significantly more likely to report seeking medical assistance (23.3%) and being sick more than a week (33.0%) than those without asthma (13.3% and 19.9%, respectively). Notably, people with asthma reported significantly higher rates of serious health outcomes including attending the ED (5.9%), hospitalization (2.4%) and requiring corticosteroid medication (16.3%) compared to those without asthma (1.4%, 0.6% and 2.4%, respectively). These outcomes were reported despite people with asthma being significantly more likely to take actions to reduce smoke exposure (e.g. staying inside with doors and windows shut: 85.7%; using air conditioning on the recycled setting: 55.1%; using a portable High Efficiency Particulate Air (HEPA) air cleaner in small, enclosed areas of a house: 12.3%; and using a P2/N95 face mask: 28.7%) than those without asthma (72.4%, 43.3%, 8.9% and 22.8%, respectively). Children with asthma were disproportionately impacted by the smoke exposure. Carers were more likely to report their child attended the ED or was admitted to hospital as a result of smoke exposure. The survey also found sustained exposure to bushfire smoke had significant impact on the quality of life in people with asthma. Those with asthma reported significantly reduced capacity in daily activities (65.6% in asthmatic individuals vs 47.4% in those without asthma), social engagement (e.g. needed to cancel important sporting/social engagement: 35.4% in asthmatic individuals vs 23.7% in those without asthma) and being absent from work/school (29.4% in asthmatic individuals vs 14.8% in those without asthma). People with asthma were twice as likely to experience financial stress (24.9%) compared to people without asthma (12.9%). This was due to lost or reduced income, and additional costs from extra doctors' visits, additional medication and the costs of protective equipment. One particular aim of the survey was to understand if actions taken by people with asthma during the bushfire period helped to reduce the adverse impact of smoke exposure. Despite their efforts, people with asthma who reported taking action to minimize smoke exposure both before and during bushfire season were still more likely to report respiratory symptoms, require medical attention (general practitioner visits, ED visits, hospital admission and requiring steroid medication) and experience negative impacts on their quality of life (e.g. sick for >1 week, financial stress, absent from work/school, restricted daily activities and social engagement) than those with asthma who did not take action. This is unexpected and may be related to asthma severity. Among people with asthma, those who reported taking their preventer medication daily were also more likely to report taking protective actions to reduce smoke exposure. It is possible these people had more severe asthma and therefore were more at risk of adverse respiratory outcomes during hazardous smoke exposure. In addition, the smoke was present for unprecedented periods at hazardous levels, and often out of the individual's control to minimize or avoid exposure completely despite taking protective actions. The survey findings reveal the substantial acute impact of the bushfire crisis on people with asthma. Importantly, it is likely that these catastrophic fires will have long-term health effects.2 Exposure to woodsmoke may cause long-lasting lung and airway injuries and contribute to the progression to irreversible airflow limitation.6 The findings highlight the need for effective primary and secondary preventative measures in people with asthma. Monitoring for long-term respiratory consequences is essential to quantify and qualify the extent of the impact and use this information to explore preventive measures. Public health programmes to increase awareness and preparedness for bushfires should be strengthened. Appropriate allocation of healthcare resources for respiratory care, the availability of additional services such as smoke pollution warning and advice on preventive measures before and during bushfire seasons are also warranted. In addition to preventative measures specifically for people with asthma, the impact of bushfires in this survey and others7 on people with and without asthma highlights the need for holistic national strategies to prevent and mitigate the adverse impact of bushfires. Timely and effective risk communication and education targeting environmental health literacy is needed. Authorities should improve the air quality monitoring network, including a better distribution, consistency across state borders on risk thresholds and use of temporary air quality stations where necessary. Long-term surveillance of affected communities for adverse health impacts and appropriate allocation of health care resources is also essential to support both the acute phase and mitigate the long-term impact. National policies including control of prescribed burning are needed, as are strategies to ameliorate the factors contributing to the increase in frequency and severity of catastrophic bushfires, namely, global warming. Lessons learned from the 2019–2020 bushfire crisis and these recommendations could benefit both Australia and other countries.