Thailand
Despite progressive asthma guidelines and increased access to medicine, asthma prevalence remains high
Asthma has been a common chronic illness in Thailand. The result of GAN Phase I in Bangkok showed that the prevalence of asthma has stabilised in both age groups, 6-7 year olds and 13-14 year olds. The increase availability of asthma controllers throughout Thailand might have helped lower the national rate of people with severe asthma attacks presenting to emergency rooms as well as the number of asthma hospital admissions. ICS are very popular choices. Lower cost generic versions of ICS are included in the Essential Medicines List subsidised by the Government for those eligible for medical support (governmental employees, those under the social security program and universal health coverage).
Global Asthma Network survey
The GAN Phase I study in Thailand found that the asthma prevalence was 14.6% and 12.5% in 6-7 and 13-14 years old, respectively. The prevalence of severe wheeze was 6.8% and 5.8% respectively. There is an urgent need for an in-depth study to define epidemiological factors responsible for this increase.
Air pollution measures
Thailand has enforced stricter regulation to reduce outdoor air pollution, namely cleaner air emissions and vehicle fuels. Despite this, air quality in Bangkok and Chiang Mai continues to be at a critical level, especially in cooler months. Effective advocacy by non-governmental organisations are quite successful. Smoking at homes and in public places are now rare events.
Guidelines
The Chest and Allergy Society in Thailand regularly update asthma guidelines for adults and children. Social media has made it easier for parents and patients to find appropriate professional care.
Allergy
Thailand has been noted to have increased numbers of patients with food allergy and atopic dermatitis. The reason for this worrisome, unusual increase is uncertain at this point. Similarly, GAN Phase I substantiated the increasing prevalence of asthma in children and adolescents. If a phenomenon of allergic march operates in this country, one might expect an increase in the number of asthmatic patients rather than a decrease in the next decade.
COVID-19
There is no doubt that paediatric asthma clinics are among health care services significantly affected by the COVID-19 pandemic. The number of new patients evaluated is restricted, and the frequency and/or the total number of patients monitored has reduced. In addition, diagnostic modalities, including lung function testing, fractional exhaled nitric oxide, or methacholine tests, are limited as are nebulised treatments. However, many asthma services have actively responded to these challenges, especially using tele-health, which have flourished in all medical specialties during the COVID-19 epidemic. Clinicians considered such clinics suboptimal, but adequate for the short period under the lockdown. Standardised tools, such as the Asthma Control Test or the Asthma Control Questionnaire were also used.
