Asthma sufferers with lower incomes have more asthma attacks, reveals leading respiratory charity on World Asthma Day

  • Almost half (47.3%) of asthma sufferers from lower income households have had more than two asthma attacks in the past 12 months
  • People from lower income band less likely to be asked about their asthma symptoms in their annual asthma review

As the coronavirus pandemic rapidly pushes more families below the poverty line1, the UK’s leading respiratory charity has revealed that asthma sufferers with lower incomes are more likely to have life-threatening asthma attacks2.

Asthma UK are calling for action to address the health inequality gap in a report that lays bare the stark differences in the quality of care between rich and poor, resulting in worse asthma outcomes for those in lower economic groups.

Asthma can affect people of all ages, genders and social backgrounds but, like all respiratory conditions including COVID-19, we see that it hits people on lower incomes hardest. The Great Asthma Divide survey, conducted in 2019, found that people from lower income backgrounds are more likely to suffer asthma attacks3.

The survey found 47.3% in the lowest income band (below £20,000) had suffered more than two asthma attacks in the past 12 months, comparing to 26.9% in the highest (over £70,000) - almost double the level of difficult-to-control asthma4.

Respondents with a lower household income also suffer from asthma symptoms more frequently[1]. Over twice as many people (24.9%) from the top income band have well controlled asthma, compared to 11.9% of those in the lowest income band in the survey. The lowest income band is the only one where over half (57.4%) of people have uncontrolled asthma5.

There is no cure for asthma and the number of people dying from the condition is at the highest level this century. On average, three people will die from asthma every day6.

This is the first time in seven years of conducting the annual survey that Asthma UK asked respondents to list their household income group. The results have revealed shocking new insights about the effect of asthma across different levels of our society.

Quality of Care

The survey offers some insights as to why such differences exist. People in the lowest income band were least likely to receive each component of a high-quality asthma review. For example, only 60.8% (of those who had an annual review) were asked about how their asthma symptoms were, compared to 69.8% of those in the highest income group. Only 50.8% of those with the lowest incomes were asked about their preventer medication, compared to 57.7% of people on highest incomes7. Without a discussion about asthma symptoms and preventer medication, people with asthma from lower incomes are being let down by GPs and asthma nurses.

There are lots of other contributing factors that drive health inequalities for people with asthma. We know that in deprived areas, air quality can be worse and poor housing increases exposure to mould, cold air and dust triggers. In England, many asthma sufferers still pay for prescriptions, which leads to some from lower income households skimping on their medication8.

Samantha Walker PhD, Director of Research and Innovation at Asthma UK, said: “Income disparities are having a major impact on asthma outcomes.

“The fact that having a lower income can lead to more life-threatening asthma attacks is a poor reflection on our society.

“It is inevitable that the economic damage from the coronavirus pandemic will push more people towards the poverty line. This World Asthma Day we want to see asthma positioned at the heart of efforts to address health inequalities.”

Going backwards

Alongside health inequalities, the report also found regional disparities in access to basic care – an asthma action plan, inhaler technique check and an annual asthma review. In some places, basic care levels are going backwards rather than forwards.

Overall, the survey found for the first time in 2019 there was no year on year improvement in access to basic care and 60.5% of people with asthma - equivalent to 3.27 million people – are still not receiving all elements of basic asthma care9.

In London, which was hit hardest by COVID-19, just 35.1% of respondents said they receive basic asthma care in comparison with a high of 43.1% in the North East and the South West10.

Of the four nations, Scotland received the lowest level of basic asthma care, with 36.3% receiving it – 3.2% percentage points below the UK level11.

Dr Andy Whittamore, Clinical Lead for Asthma UK, said: “As a practising GP I understand the pressure to cover so much in any appointment, especially an annual asthma review. When we are providing basic asthma care, healthcare professionals need to have the time to fully assess someone’s asthma and the impact that it has on people’s diverse lives.

“We also need to be able to tailor treatments and their action plan to people’s lifestyles and help them to use their medicines and seek health care at appropriate times. By doing this we can bring down the high rates of asthma attacks particularly in at risk and disadvantaged groups and reduce the burden that poorly controlled asthma has on the NHS.”

Notes to Editors

For more information or for interview requests, please contact the press team on 0207 786 4949 or mediaoffice@asthma.org.uk.

Asthma UK research conducted in April 2020 found that 20.7% of 8,000 people with asthma were worried about their financial situation due to missed work during the pandemic.

  1. Asthma UK surveyed 12,876 participants about asthma control and their household income. Read the full report: The Great Asthma Divide
  2. In the same survey2
  3. In the same survey2
  4. In the same survey2
  5. Asthma facts and statistics 
  6. In the same survey2
  7. Asthma UK has previously called for an end to asthma prescription charges
  8. In the same survey2
  9. In the same survey2
  10. In the same survey2

Kyla's story

Kyla Reddick, 23, London: I live in a highly populated area of southwest London with my three-year-old son, Malakai, who has recently been diagnosed with acute severe asthma.

When Malakai was just four months, we moved into a council flat which I hoped would provide a safe and permanent home for us as a low-income single parent family. It was not to be.

Just months after moving in, as the first winter approached, damp and mould started appearing everywhere. Many of the windows were broken or not properly aligned, making it difficult to open them for good ventilation and a cold draft would circulate throughout the flat from the gaps between the windows and the frames. In the bathroom, there’s no window, just an extractor fan that had a continuous leak.

The damp became particularly bad in the bay window area of the front room, where my son would play. The carpet and walls became sodden and black mould was spreading rapidly. It even started growing on his toys, which I had to throw away.

Over time, access to the shared washing room also became challenging. Other residents would often throw our clean clothes on the floor, which I would then have to re-wash due to Malakai’s eczema. Eventually, I had no choice but to dry our washing indoors, adding to the damp situation.

Worried about the toll the poor living conditions were taking on our health, I contacted the council, with great difficulty, on many occasions to voice my concerns. I have also requested to move several times. Three years have now passed and whilst some work has been carried out on the flat, the problems with damp and mould persist, and the impact on Malakai’s health is clear.

Just a few weeks ago, as COVID-19 was spreading throughout the country, my worst fears became a reality when Malakai was admitted to hospital for four-nights following a severe asthma attack, which could have been life-threatening. The doctors at the hospital said that mould spores from the property had likely exacerbated his symptoms, which started displaying when he was around six months old.

In the 18-months prior to that episode, Malakai had suffered nine asthma attacks, all requiring emergency care in A&E.

The first, just a year after we moved in, was truly terrifying. When the ambulance arrived with a ventilator, Malakai was distraught. He didn’t know whose arms he was in and it was as if he couldn’t see or hear. His stomach was extended, and his chest looked like it was caving in on him. I thought we were going to lose him.

Malakai was diagnosed with viral wheezing and after each attack, we were discharged from A&E with a blue reliever inhaler and spacer, steroids, pamphlet and weaning sheet. Without a proper asthma diagnosis, I wasn’t able to get a blue inhaler on prescription, so I was forced to use the ones we had left over from hospital to relieve his symptoms. I had to make the pumps last and sometimes, Malakai had to go without for weeks at a time. Once, when Malakai was particularly wheezy, I managed to get the GP to prescribe an emergency inhaler.

The most recent attack is evidence to me that Malakai’s condition is worsening as a result of where we are living. He has now been diagnosed with acute severe asthma and has been given a brown preventer inhaler. He is due to have an asthma review in early May at the hospital and I hope we can get his asthma under better control.

An asthma specialist from the hospital has written to the council outlining the dangers of Malakai’s living conditions on his health and recommended that we move into more suitable accommodation. I have not received a response from the council.

Lockdown has made the situation worse and it’s taking its toll on our mental and physical health. The severity of Malakai’s condition means that we have chosen to shield to protect him from coronavirus, but he’s now confined to a damp-ridden property 24/7 with no access to a balcony or garden for fresh air. Outside, the only play areas are a small grassy patch next to the car park or on the pavements by the roadside, where car exhaust fumes present another trigger for his symptoms.

I suffer with anxiety which has worsened since the outbreak. When you see your child fighting for their breath you wonder if they are going to be okay. I don’t ever want to get to the point where I lose my child due to the inadequacy I have been given. I feel powerless, at the mercy of the council as a tenant, and I live in fear that each day, something entirely preventable within our own home could prove fatal for my son.

I’m pleased that this report is shining a light on the heath inequalities faced by people with asthma in lower income groups and I hope it will encourage healthcare professionals, policy makers, local authorities and the government to take the action needed to redress the issues and prevent unnecessary hospital admissions and deaths.