It is time to control asthma

Shobha Shukla :
This is the sub theme of this year’s (2014) World Asthma Day (WAD), which was first celebrated in 1998 in conjunction with the first World Asthma Meeting in Barcelona. It is an annual event aimed at improving asthma awareness, diagnosis, treatment, and, ultimately, control and is organised by the Global Initiative for Asthma (GINA) on the first Tuesday of May. The main theme of WAD 2014 continues to be ‘You Can Control Your Asthma.’
Asthma is a common chronic Non-Communicable Disease (NCD), affecting more than 300 million people worldwide. It is the most common NCD among children and a major public health problem in developed as well as developing countries. In Western Europe as a whole, asthma incidence has doubled over the last ten years; USA has seen an increase of over 60 per cent since the early 1980s; while 8 per cent of the Swiss population suffers from asthma as against only 2 per cent some 25-30 years ago.
However, most asthma-related deaths occur in low- and lower-middle income countries as most cases of asthma go undiagnosed, untreated or mismanaged. Asthma affects all age groups but often starts in childhood. It is characterised by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. This condition is due to inflammation of the air passages in the lungs. In an asthma attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs.
Although asthma cannot be cured, it can be treated and managed effectively. The severity of asthma can be reduced dramatically, and the person’s quality of life significantly improved. Untreated or mismanaged asthma causes unnecessary suffering and disability, putting a significant economic burden on poor families as well as huge financial drain on struggling health systems.
Worldwide, the economic costs associated with asthma are estimated to exceed those of TB and HIV/AIDS combined. For example, annual asthma care costs (direct and indirect) exceed US$6 billion in the USA and are nearly US$460 million in Australia; while Britain spends about US$1.8 billion on health care for asthma and because of days lost through illness.
Asthma control is the focus of the GINA Global Strategy for Asthma Management and Prevention, a comprehensive and practical resource about how to diagnose, assess, and manage asthma. A revised version of this report is being launched on World Asthma Day 2014. “Scientific understanding of what asthma control means and how to achieve it has evolved significantly in recent years,” said Mark FitzGerald, MD, Chair of the GINA Board of Directors. “We need a practical strategy for implementing this knowledge to inform patient care worldwide, and that is what GINA aims to provide.”
India has an estimated 15-20 million people living with asthma and roughly a prevalence of 10 per cent to 15 per cent in 5-11 year old children. In an interview given to CNS, Dr Surya Kant, Head, Department of Pulmonary Medicine, King George Medical University, rued that incidence of asthma is on the rise, mostly due to rapid industrialisation, modernisation and urbanisation and changing life styles. He busted many myths around the disease – “There is still very poor awareness about asthma.
The first myth is that an asthma patient has to lead a compromised life. But asthma, if managed properly, does not interfere with the quality of life. Many sports persons and many of our cinema heroes are living with asthma. An asthma patient is as fit as any other healthy human being and can take part in all sports and activities. This message needs to go across to the public.
Secondly, people think that one gets into the habit of using an inhaler. But we must remember that habit is different from addiction. So one may get habituated to an inhaler but cannot get addicted to it. Using an inhaler is same as the habit of brushing our teeth, taking bath, eating breakfast, etc. The ideal treatment for asthma is still the inhalation therapy, which is targeted delivery of very small doses of the medicine directly to the lungs. If your bronchial tubes were weak, use an inhaler, same as you would use spectacles if your eyes were weak. This has no side effects even in long term.”
Dr Chiang Chen-Yuan, Director, Department of Lung Health and NCDs at the International Union Against Tuberculosis and Lung Disease (the Union) cited the low affordability of essential asthma medicines as one of the main barriers in providing proper asthma care in low- and middle-income countries. He told Citizen News Service (CNS) that “Asthma Drug Facility has demonstrated that it is possible to provide essential asthma medicines at affordable price in low- and middle-income countries. Governments should raise sufficient funds, reduce the reliance on direct payments to finance services, and improve efficiency and equity in order to achieve universal health coverage. Meanwhile, the revolving drug fund of asthma may help maintain an uninterrupted supply of essential asthma medicines, which has been demonstrated in Benin.”
However, Dr Chen felt that medicines alone would not help solve the problem. He said, “Patients who present themselves to health care facilities may not be diagnosed, and those who are diagnosed may not be managed properly. Health care providers need to be trained to provide standard case management of asthma. Asthma projects, piloted by the Union in Benin, China, El Salvador and Sudan, have demonstrated that training of health workers in the use of inhaled corticosteroids, for long term management of asthma, result in proper asthma control, and reduce emergency hospitalisation. Countries where asthma patients still have poor access to proper asthma care should adopt this strategy piloted by The Union and partners to reduce suffering and to improve the quality of life of asthma patients.”
Dr Karen Bissell, Consultant at The Union shared with CNS that, “Following important meetings at the United Nations in 2011, countries have been preparing strategies to prevent and manage NCDs, including asthma. However, many health services are finding it a challenge to introduce asthma management into the general health services. Many are still struggling to access quality-assured essential asthma medicines that are affordable for their populations.”
So, according to Dr Bissell, there is a need at the global level to increase the commitment of governments and donors to invest in asthma as a means of reducing poverty; implement standardised and effective management of asthma within primary health care and general health services; make essential quality-assured asthma medicines available and affordable for people in low- and middle-income countries; monitor and evaluate quality of care and gain more accurate global estimates about its epidemiological and financial burden. n