Millions of children will fail to live up to their potential if asthma is not addressed.

MAKING ASTHMA A HEALTH PRIORITY

The asthma epidemic experienced by high-income nations over the past 30 years is now an increasing problem in low- and middle income countries as they become more urbanised. Whilst it is true that communicable diseases, such as malaria, still present a major challenge for many of these countries, non-communicable diseases, including asthma, are emerging as serious additional problems. Authorities believe that they will be responsible for tomorrow’s pandemics.

Why asthma needs to be a priority

Asthma affects millions of people worldwide

The seriousness with which asthma is viewed within the healthcare community is illustrated by the readiness with which health researchers, including pediatricians, respiratory physicians and epidemiologists, in 306 centres in 105 countries joined the ISAAC research programme to estimate the extent of the problem for children in their locality. The results of the surveys conducted by ISAAC (children) and ECRHS (adults) demonstrate that asthma is now an important non-communicable disease (NCD).

Asthma has a global impact

With millions of people in every region of the world suffering from asthma, it has become an issue of international development. WHO estimates that around 15 million disability adjusted life years (DALYs) are lost annually through this disease. Children with untreated asthma can miss much of their primary school education, which affects their future opportunities. It also impacts the productivity of the parents and relatives who must stay home to care for them, contributing to a cycle of poverty in families and communities. Asthma can also be fatal and causes an estimated 250,000 deaths annually (1 in 250 deaths worldwide).

Asthma is one of the significant NCDs

As a chronic respiratory disease (CRD), asthma is considered one of the major NCDs that have outstripped communicable diseases as the leading causes of death in the world. In 2008 NCDs were responsible for 60% of all deaths worldwide and 80% of these deaths occurred in low- and middle-income countries. Chronic respiratory diseases (CRDs) alone cause 15% of the world’s deaths.

WHO has identified CRDs, including asthma, as a priority

The burden and suffering caused by CRDs has been identified by the World Health Organization (WHO) as a priority. The WHO has also resolved that there needs to be “better surveillance to map the magnitude of CRDs and analyse their determinants with particular reference to poor and disadvantaged populations and to monitor future trends”. Thus surveillance of asthma needs to continue with simple instruments that can be widely used around the world and repeated at regular intervals, such as those used in ISAAC.

Improved asthma care makes economic sense . . .

People with poor asthma control are less able to work or look after their families, causing them considerable financial and emotional stress, and loss of productivity for the country. Poorly managed asthma places a disproportionate burden on health care systems that may already be struggling, due to increased emergency room visits, hospitalisations and inadequate or unaffordable treatments.

. . . especially in low- and middle- income countries

For people and health systems in low income countries, the cost of treating asthma has been a major obstacle that has perpetuated this cycle of suffering and wasted resources.

What needs to be done

When asthma is truly a global priority
1. Asthma will be recognised as a major global health problem.


2. Affordable, quality-assured asthma medicines will be universally accessible.


3. Correct asthma treatment will reduce suffering and poverty and increase prosperity, especially in low- and middle-income countries.


4. NCD priority actions, such as tobacco control, will be scaled-up massively and will help prevent asthma and other CRDs.


5. Surveillance of asthma will be ongoing and cover all countries in the world.


6. More asthma research will be funded, especially in low- and middle-income countries.

Invest in asthma research

Asthma research is decades behind other fields, such as cardiovascular and cancer research, and needs further investment. A key challenge is to identify environmental risk factors modifiable by public health interventions that can reduce the morbidity and severity of this increasing global problem.

Ensure that good-quality asthma drugs are affordable and accessible

Lack of access to affordable, quality-assured medicines is a major obstacle for both asthma and other NCDs. People with asthma need affordable drugs, appropriate to the severity of their asthma, including a beta-2 agonist reliever for all and an inhaled corticosteroid preventer for those with more frequent symptoms. These essential medicines, particularly inhaled steroids, are not available or affordable to patients or health services in many low- and middle-income countries, and as a consequence, people become disabled or die from asthma. The Union’s Asthma Drug Facility is an innovative initiative that has demonstrated a way to address this issue successfully, but it needs to be scaled up.

Reorganise health services for long-term treatment

The other major obstacle to effective management of asthma and other NCDs is the fact that health services are not organised for long-term management of patients with regular followup. Usually these diseases are treated only on an emergency basis. Health personnel need training and these health services need to be re-organised to handle chronic and long-term care.

Support priority interventions for NCDs

Asthma prevention and management will be aided by two of the five priority interventions for the NCD crisis – improved tobacco control and access to essential drugs. The reduction in obesity that will be achieved through a third priority of improved diets and physical activity is likely to be beneficial, as an association between obesity and asthma has been observed.

-Innes Asher, Neil Pearce, David Strachan, Nadia Aït-Khaled

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