Asthma and Coronavirus (COVID-19) Survey

The 2019/20 Coronavirus (COVID-19) pandemic is a rapidly changing global situation.

The asthma community faced significant uncertainties as the outbreak in Australia first unfolded, including the perceived increased risk of contracting COVID-19 or having a more severe illness, as well as stockpiling behaviours that affected medication supply and availability of vital asthma medication.

With this in mind Asthma Australia launched the “Asthma and COVID-19 Survey 2020” which aimed to understand the experiences of people with asthma, to inform the organisation’s public responses and advocacy, and to conduct a rapid sentiment check as the COVID-19 pandemic unfolded.

The initial survey was in market from the 9th – 30th of April and received nearly 2,000 responses from people with asthma or their carers. Following this, a smaller group of approximately 300-500 people each week have completed a pulse survey. This Pulse Survey Group helped and continues to help Asthma Australia to track how issues, impacts and sentiments are changing over the course of COVID-19.

What did people with asthma tell us?

  1. People with asthma were very anxious about COVID-19 and their level of vulnerability as a person with asthma.
    More than half of participants (54%) rated their anxiety about COVID-19 as a six or higher on a scale of 0-10. One in five people (19%) rated their anxiety at a 9 or 10. People with severe asthma or poorly controlled asthma, were more likely to be anxious about the COVID-19.There is no specific data as yet to suggest that people with asthma are at a higher risk of contracting the virus. Nor is there any evidence to suggest that people with asthma have a high risk of experiencing serious illness if they contract COVID-19. However, with a lack of definite information about their risk profile, there has been a high level of anxiety among people with asthma.
0 1 2 3 4 5 6 7 8 9 10
9% 37% 35% 19%
  1. Nearly half of people with asthma (44%) reported experiencing new or increased symptoms of depression and anxiety.Additionally, one quarter of people (25%) said feelings of anxiety, stress and depression had been triggering their asthma. The percentage of people reporting new or increased symptoms of anxiety and depression increased with decreasing asthma control, and vice versa, highlighting the known bidirectional impact between asthma and mental health.
  1. More than half of people with asthma reported they were self-isolating (67%).This means staying at home and not leaving unless it is an emergency, not going to public places (e.g. shopping centres or work) and not having visitors. Of this, only 8% of people reported they were self-isolating due to government regulations (e.g. returning from recent travel). Most people with asthma were choosing to self-isolate to protect themselves. People with severe asthma or poorly controlled asthma were more likely to report self-isolating.
  1. One quarter of people with asthma (26%) had faced challenges accessing their usual asthma medication.Additionally, 10% of people with asthma reported they did not have a 30-day supply of their asthma medication, as recommended. This was mainly due to the medication being out of stock. Participants mostly reported this being an issue for Symbicort, Flixotide and Ventolin/Salbutamol.
  1. Most people with asthma did not have well controlled asthma.People with asthma completed the Asthma Control Test as a measure of their level of asthma control. [i],[ii] Only 38% of people with asthma had well controlled asthma. This is lower than estimates from a 2015 nationally representative survey, where half of people with asthma were well controlled. [iii] People who reported they had been diagnosed with severe asthma, were more likely to have very poorly controlled asthma.
Level of Asthma control Mild-moderate asthma Severe Asthma All participants with asthma General asthma population
Well controlled (20+) 49% 22% 38% 54.7%
Not well controlled (16-19) 26% 25% 25% 22.6%
Very poorly controlled (5-15) 25% 53% 36% 22.7%
  1. People with asthma experienced changes to their usual healthcare during COVID-19.One third of people with asthma (33%) reported concern about COVID-19 exposure at health services and nearly one in 10 people (8%) reported they had been unable to see their GP in person during this period for management of an asthma flare-up or for an asthma review.Other challenges experienced by some people with asthma included not being able to perform spirometry and disruptions to regular care in a hospital setting.

How has this changed over time?

  • The general level of anxiety about COVID-19 is declining. In the most recent pulse survey (23rd – 26th June), 44% of people reported their level of anxiety was a 6 or higher on a scale of 0-10, compared to 54% in the initial survey. Only 10% of people with asthma rated their level of concern as a 9-10, compared to 22% in the initial survey.
  • While the level of anxiety has reduced, participants are still concerned about their vulnerability as a person with asthma, and what it would mean for their asthma or overall health if they were to contract the virus.
  • In the Initial Survey participants were asked if they were self-isolating or not. Self-isolation was defined as staying at home and not leaving unless for an emergency. Two thirds of people said they were self-isolating (67%). This declined to less than half at Pulse Survey 4 (44%). In Pulse Survey 5 and 6, the question gave participants a third option, of staying at home except to purchase essential items. With this option included, only 17% of people said they were self-isolating.
Are you currently self-isolating? Initial Survey Pulse Survey
1 2 3 4 5 6
Self-isolating 68% 60% 53% 52% 44% 15% 17%
Not self-isolating 32% 40% 47% 48% 56% 47% 42%
Staying at home except for essentials* n/a n/a n/a n/a n/a 38% 41%
Total 100% 100% 100% 100% 100% 100% 100%

*The option to select ‘I am staying at home except for essentials (e.g. medicine and groceries)’ was only added from Pulse Survey 5 onwards. Previously participants were asked if they were self-isolating or not.

  • The percentage of people reporting challenges accessing their asthma medication has declined. One quarter of people (26%) reported their asthma medication had been out of stock in the initial survey, compared to only 13% Pulse Survey 1. In Pulse Survey 3 only 6% of people reported they had faced challenges accessing their asthma medication.
  • The level of Asthma Control amongst participants has increased. Only 38% of people with asthma had well controlled asthma in the initial survey, this increased to 51% of participants Pulse Survey 4, which maintained in Pulse Survey 6.

The Pulse Survey has also explored challenges such as health service utilisation, mental health, and masks with participants. Key insights from each Pulse Surveys are below and will be updated each fortnight.

Pulse Survey Date Responses Insights
Pulse Survey 1 5th – 8thMay 435
  • One in five people (22%) reported avoiding going to their doctor, the emergency department or calling an ambulance for their asthma because they had concerns about contracting COVID-19 or the pressure on the health service.
  • People who avoided healthcare primarily chose to manage their health at home, with only one third (30%) using telehealth services instead.
  • Half of respondents with school-age children choose to continue to keep their child home from school or childcare (n=109).
  • Most people with asthma (62%) were not using a facemask when they left the home.
  • Only one in ten people reported using a face mask all of the time.
Pulse Survey 2 12th – 15thMay 388
  • When asked about factors contributing to feelings of worry, anxiety or depression the following factors contributed a little, somewhat or a lot;
  • Fear of contracting COVID-19
  • Fear of a relative or friend contracting COVID-19
  • Entering winter/flu season
  • Physical distancing from family/friends
  • And child attending school (for parents)
  • The most significant factor contributing to feelings of worry, anxiety or depression was coming into winter and flu season.
  • Most participants reported concern in open text responses about restrictions easing and the potential for a second wave of COVID-19
Pulse Survey 3 19th – 22ndMay 347
  • 10% of people reported they thought about or needed to see their doctor about their asthma but did not. Most people reported concerns about contracting COVID-19. Others noted a lack of time, choosing to manage their condition at home, difficulty getting an appointment or concern about the burden they would place on the health system
  • Only 6% of people reported challenges accessing their asthma medication in the previous two weeks.
Pulse Survey 4 26th – 29thMay 269
  • 51% of people had well controlled asthma.
  • One quarter of people (27%) said they had faced challenges due to their asthma symptoms being similar to COVID-19 symptoms (e.g. cough).
  • People spoke about negative attitudes from the general public if they had asthma symptoms, requiring COVID-19 testing for asthma symptoms, difficulty accessing health services and apprehension from employers about asthma symptoms.
Pulse Survey 5 9th – 12thJune 284
  • Almost one third (29%) reported they had experienced asthma symptoms or an asthma flare-up as a result of increased used of cleaning products during COVID-19.
  • People with asthma continue to report concern about their level of risk if they were to contract COVID-19.
Pulse Survey 6 23rd – 26thJune 236
  • 51% of people had well controlled asthma.
  • The number of people choosing to use a face mask outside of the home remained consistent. Although the number of people reporting to use one all of the time reduced from 10% (Pulse Survey 1) to 3%.
  • Of people who had ever used a mask or face covering, 69% said it made them harder for them to breath.
  • Most people (71%) were concerned or very concerned about using public transport.
Pulse Survey 8 22nd – 24thJune 267
  • Participants anxiety about COVID-19 has increased. 72% of participants rated their anxiety about COVID-19 as a 5 or greater (on a scale of 0-10).
  • The percentage of people with well controlled asthma was 48%, slightly lower than pulse check 6.
  • Most people who had used a telehealth service during COVID-19 were satisfied with the service. In open text comments, some participated noted their appreciation of being able to access telehealth services and other noted preference for face-to-face appointments with their health professional.
  • In the last four weeks;
    • 22% of participants reported their asthma medication had been out of stock in the last four weeks.
    • 63% of participants reported they were worried about COVID-19 exposure when visiting a health service.
    • Nearly one in five (18%) participants faced challenges accessing appointments with their GP or specialist due to COVID-19.
    • 15% of participants reported they had to be tested for COVID-19 at a health service when presenting with usual asthma symptoms

About the Survey

The initial Survey launched on 9 April and closed 30 April. It was disseminated via Asthma Australia’s networks and external partners. It received a response from 1805 people. From this original group, a weekly Pulse Survey was sent to a consenting group of approximately 900 people. The first pulse survey was disseminated on the 5th of May.

Of the 1805 people who responded to the initial survey, most were people with asthma (88%) and female (79%). The majority of participants were from Victoria (37%), followed by NSW (28%).

It’s worth noting that more than one third of people (39%)reported they had been diagnosed by a specialist as having ‘difficult, severe or brittle asthma’. This is significantly higher than population estimates of between 3 and 10%[iv], [v]Half of respondents (49%) said they had another chronic condition as well as asthma.

Image 1: Percentage of respondents by state and territory

Australia Survey

Image 2: Percentage of respondents by age and asthma status (person with asthma or carer of a person with asthma)

Chart


[i] Modified US version for use in Australia. This does not replace a full assessment from your Doctor. Asthma Control Test™ copyright, QualityMetric Incorporated 2002, 2004. All Rights Reserved. Asthma Control Test™ is a trade mark of QualityMetric Incorporated. Asthma Score is distributed by GlaxoSmithKline Australia Pty Ltd. 1061 Mountain Hwy, Boronia Victoria, 3155. ABN 47 100 162 481. www.gsk.com AUS/AST/0031/14

[ii] Development of the Asthma Control Test: A survey for assessing asthma control; Nathan RA et al, J Allergy Clin Immunol 2004;113:59-65. 2. The Asthma Control Test™ (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey; Thomas M et al, Prim Care Resp J 2009; 18(1): 41-49.

[iii] Reddel HK, Sawyer SM, Everett PW, Flood PV, Peters MJ 2015. Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population. Medical Journal of Australia 202:492–7

[iv] Hekking et al 2015, The prevalence of severe refractory asthma, J Allergy Clin Immunol; 135(4):896-902.

[v] Chung, Wenzel, Brozek, et al 2014, International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma, Eur Respir J;43(2):343-373.