Vision of the Global Asthma Network: A world where no-one suffers from asthma.

Mission of the Global Asthma Network:

To prevent asthma and improve asthma care globally with a focus on low- and middle-income countries.

The network will achieve this through enhanced surveillance, research, capacity building, and access to effective asthma care, including quality-assured essential medicines.

Aspirations of the Global Asthma Network

Strive for a world where no-one suffers from asthma

Be the asthma surveillance hub for the world

Raise the profile of asthma as a non-communicable disease

Stimulate and encourage capacity building in low- and middle-income countries

Promote access to appropriate management of asthma

Research ways of reducing the burden of asthma

Values of the Global Asthma Network

Empowerment

Solidarity

Independence

Quality

Accountability

The Global Asthma Report 2014

Asthma has puzzled and confused physicians from the time of Hippocrates to the present day.
Targets of the Global Asthma Network

Figure 1: Targets of the Global Asthma Network

Global Asthma Network participating centres, August 2014

Figure 2: Global Asthma Network participating centres, August 2014

Closing the world data gaps for asthma in children and adults will be a key activity of the Global Asthma Network.

GLOBAL ASTHMA NETWORK

The Global Asthma Network (GAN) has grown out of the International Study of Asthma and Allergies in Childhood (ISAAC) and the International Union Against Tuberculosis and Lung Disease (The Union). It aims to reduce asthma suffering by improving asthma care globally with a focus on low- and middle-income countries. GAN will achieve this through undertaking global surveys of asthma in children and adults, research, capacity building, improving access to effective asthma management and care, including quality-assured essential medicines, and through regular advocacy activities.

GAN plays a crucial role in collecting asthma data on adults and children globally; this data is not being obtained by any other group. In 2012 the leader of the World Health Organization (WHO), Dr Margaret Chan, said

“Accurate assessment of the global, regional and country health situation and trends is critical for evidence-based decision making in public health…. The real need is to close the data gaps, especially in low-and middle-income countries”.

For asthma this is exactly what GAN is doing – closing the data gaps.

GAN was established in 2012 to improve asthma care globally (www.globalasthmanetwork.org). GAN is a new collaboration between individuals from ISAAC - isaac.auckland.ac.nz/ (now wound up) and The Union - www.theunion.org.

GAN is building on the work achieved by the ISAAC programme (1991-2012), which has an impressive track record of undertaking surveys which have contributed extensive data on asthma and allergies in children, monitoring these diseases over time, and researching possible causes. GAN is operating on the same principles used in ISAAC of collaborative and systematic application of standardised methodologies able to be used in all settings in the world. In addition to asthma in children, GAN will study asthma in adults. Surveys will be conducted and repeated as resources allow.

GAN is led by an 11-member international Steering Group responsible for developing and overseeing its work programme. Long-term targets have been developed (Figure 1). The GAN Data Centre is located in Auckland, New Zealand. The Data Centre leads the surveys, communicates methodologies, analyses data, oversees publications, and develops and maintains the GAN website.

Methods

GAN welcomes participation from centres in all countries in the world. In August 2014 there were 276 centres in 119 countries that had expressed an interest in participating in GAN (Figure 2).

Principal Investigators in each centre complete surveys about asthma in their centre and country. Surveys are of two types: on-line surveys of GAN Principal Investigators about specific topics, and questionnaire surveys undertaken through schools. High participation rates are sought in all surveys. In 2013/14, GAN surveys of the first type were completed, on national asthma strategies, asthma management guidelines and access to quality-assured, affordable asthma medicines; the findings are summarised in Chapters 8, 9 and 10.

Surveys of the second type are planned to start in 2015. Each centre will be invited to undertake a survey using the GAN protocol and questionnaires. Two age groups of children will be involved (13-14 year olds and 6-7 year olds), as well as parents/caregivers of each child. The adolescents and the parents of the children will be asked to complete questionnaires based on ISAAC, including additional questions on asthma management and the environment; for the adults, questions will be based on the European Community Respiratory Health Survey.

Participants will be selected from randomly sampled schools within a specified geographical area (or all schools) around each study centre. Within each country at least one urban and one rural centre will be sought so that the different influences of these environments on asthma can be explored. A sample size of 3000 per age group per centre will be used to give sufficient power to detect differences in the severity of asthma. For smaller populations, such as a small island nation, all pupils (and their parents/caregivers) of the age group will be selected. Tools to enable centres to follow and use the methodology will be available on the GAN website.

Impact

GAN is currently the only global study of asthma in populations (following on from the ISAAC programme) and will contribute new information on adult as well as childhood asthma. GAN connects with others who strive for a world where no-one suffers from asthma and has established communication with worldwide organisations concerned with respiratory health and non-communicable diseases (NCDs), especially in low-and middle-income countries.

ISAAC demonstrated that asthma and allergies are global health problems and that environmental factors are key. GAN is continuing this work. The value of GAN is attested to by the large number of centres that have expressed an interest in participating, and the fact that major international respiratory and NCD advocacy organisations involved in monitoring and preventing chronic respiratory disease have expressed their support for GAN.

GAN has set ambitious targets to decrease severe asthma by 50% by 2025 and to increase the access to quality-assured essential asthma medicines (Figure 1). If these targets are achieved, then the burden of, and suffering from, asthma in the world will be markedly reduced.

Conclusion

GAN seeks to build on the work of ISAAC and The Union to lessen the suffering from asthma in the world through surveillance of asthma, research, capacity building, improving access to effective asthma management and care, including quality-assured essential medicines, and to advocate for asthma to be high on the public health agenda.

Recommendation

Health professionals in all countries should ensure that their country is represented in the Global Asthma Network.

Innes Asher, Nils Billo, Karen Bissell, Chiang Chen-Yuan, Philippa Ellwood, Asma El Sony, Luis García-Marcos, Javier Mallol, Guy Marks, Neil Pearce, David Strachan

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