Respiratory Conditions

The basics…

Respiratory conditions affect the airways, including lungs and nasal passages. These conditions can be long-lasting (chronic) or shortterm (acute). Children with these conditions have difficulty breathing, and can experience wheezing, tightness of the chest, and a cough. Common respiratory conditions may involve either difficulty exhaling (e.g. asthma, bronchiectasis, or bronchitis) or difficulty inhaling air (e.g. sinusitis or hay fever).

The cause?
Research shows that common risk factors for respiratory conditions like asthma include:

• poverty 
• mouldy, damp, or poorly heated homes
• crowded households
• unhealthy diets
• frequent or severe lower respiratory infections during childhood
• exposure to tobacco smoke and environmental air pollution
• and genetic factors.

The numbers: respiratory illness in New Zealand…

In the government’s 2019/20 Health Survey, 13.5% of children aged 2–14 years had asthma and were currently taking medication for this condition. In 2020, around 4,000 hospitalisations were for asthma and wheeze, nearly 6,500 for acute bronchiolitis, almost 3,000 were for pneumonia, and over 4,100 for acute upper respiratory infections (of multiple and unspecified sites).

The COVID effect

Hospitalisation rates for respiratory conditions in children halved in 2020 – due to the elimination of community transmission of viruses, especially influenza and RSV – through COVID control measures and corresponding changes in vaccination subsidies.

The numbers: respiratory illness in New Zealand…

Children in Aotearoa New Zealand have some of the highest rates of asthma in the world. The most recent (2022/23) NZ Health Survey (NZHS) shows that one in eight children aged 2–14 years (12.4%) and 15.5% of young people aged 15–24 years were using medication for diagnosed asthma.

Over the 5 years to the end of 2022, 42% of respiratory hospitalisations in children aged 0-19 years were for lower respiratory tract infections (including pneumonia and acute bronchiolitis).

Upper respiratory tract infections (colds, tonsillitis, laryngitis etc) made up about 29% of respiratory hospitalisations, and 27% were for asthma or wheeze.

What are we doing to help?

Here is a snapshot of some of the latest respiratory research that we are funding, to hopefully reduce the fact that respiratory conditions are the leading cause of acute admissions (i.e. brief, but serious) to hospital for children in Aotearoa New Zealand.

Helping prevent hospitalisation for wheeze

Professor Cameron Grant, University of Auckland

Professor Cameron Grant’s study is investigating whether OM-85 — a medicine that stimulates immune responses associated with defence against viral infections — could reduce recurrent respiratory tract infections and prevent wheeze in young children.

Healthcare access equity in childhood asthma in Aotearoa

Dr Emily Perelini, University of Otago

Māori and Pasifika children in Aotearoa experience higher rates of hospitalisation for asthma, however, they are less likely to receive the recommended preventive treatment (with inhaled corticosteroids or ICS).

This study aims to understand the extent of this inequity, identify barriers and enablers to appropriate care, and test a nurse-led telehealth initiative to improve access to both ICS and asthma education for children who have recently had a bad asthma attack.

Through national data analysis, qualitative feedback from whānau, and a targeted pilot in South Auckland, the project aims to reduce healthcare access barriers and ensure asthma management aligns with evidence-based guidelines. The ultimate goal is to provide better healthcare services for these communities with high needs.

Trialling shorter treatments for preschool children with asthma (STAR study)

Dr Alexandra Wallace, University of Auckland

Asthma is the most common illness of childhood, and our rates are particularly high. Children younger than 5-years-old have the highest burden of disease.

Preschool wheeze is often treated similarly to asthma in older children, with 3 days of oral steroids for moderate or severe episodes. Māori and Pasifika children have wheeze more often than other children, and are three times more likely to require hospitalisation. Some preschoolers experience recurrent wheeze and receive several courses of steroids every year.

This study was underpinned by recent evidence suggesting that preschool children with wheeze might only need 1 day of steroid medication. The researchers will compare outcomes after treatment for 1 or 3 days. If the study proves that the shorter course is safe and effective, the guidelines will be changed, to simplify treatment, and reduce the risks of side-effects.

Treating respiratory viral infections

Professor Stuart Dalzell, University of Auckland

Professor Stuart Dalziel, Cure Kids’ Chair of Child Health Research, from Starship Children’s Hospital is undertaking a project to assess the effectiveness of using a combination of adrenaline and steroids to treat children with bronchiolitis – the most common reason for New Zealand infants to be admitted to hospital.