With good long-term management, the burden of asthma can be reduced.
In the Global Asthma Report 2014, the Global Asthma Network (GAN) has brought together an up-to-date overview of the key issues regarding asthma globally.
When examining the burden of asthma today, there is much to be concerned about.
Asthma is a common chronic non-communicable disease that affects as many as 334 million people of all ages in all parts of the world. It is a cause of substantial burden to people, often causing a reduced quality of life, not only due to its physical effects, but also its psychological and social effects. The various estimates of its economic burden, mostly due to productivity loss, are all significant. Further, avoidable asthma deaths are still occurring due to inappropriate management of asthma, including over-reliance on reliever medication rather than preventer medication. Asthma is a particularly serious burden in low- and middle-income countries least able to afford the costs.
While our knowledge has increased, the remaining gaps in the data are significant.
While hospital admissions save lives during acute asthma attacks, there are many places where the number of hospital admissions is too high, and the reasons for this need more research. The factors affecting asthma also require further research. New surveys are needed to update asthma trends, assess the burden of asthma and access to effective management. Meanwhile, GAN is working towards closing the data gaps.
But much of this burden of disease and lack of information is avoidable.
Asthma which is well controlled imposes far less of an economic and personal burden than non-controlled asthma. Strategies towards improving access and adherence to evidence-based therapies can therefore be effective in reducing the personal and economic burden of asthma in all countries. Implementation of relatively simple measures within a systematic national or local strategy can improve early detection of asthma and provide effective preventive treatment. Asthma management guidelines are an essential part of successfully managing asthma and promoting the delivery of quality asthma care; these are widely available.
Political commitment and action are required to make the burden of asthma a thing of the past.
The Global Asthma Report 2014 makes many recommendations to the World Health Organization (WHO), governments, health authorities and health professionals, which, if followed, will transform asthma globally from a burden to an inconvenience.
As part of their asthma strategy, every country needs:
- An up-to-date approach to the diagnosis and management of wheezing in young children. This is an evolving field. This report includes a review of recurrent wheezing in infants including information from a recent international study. If an infant presents with frequent and/or severe episodes of recurrent wheezing they should be diagnosed and managed as asthma, unless there is evidence to the contrary.
- Guaranteed access to quality-assured essential asthma medicines. This is vital to improving asthma outcomes. Essential asthma medicines need to be on all national lists of essential medicines and reimbursed medicines; this is not yet the case. Essential asthma medicines are inhalers which are complex devices, requiring accurate manufacturing to produce a reliable dose with particles of an inhalable size. Many devices on the market are substandard or unaffordable. WHO has a key role in setting standards for these medicines, and all parties must working to make them affordable.
- Effective policy action on known, remediable causes of asthma such as parental smoking (for children) and occupational exposures (for adults).
- Capacity building of trained health professionals. This is vital and can be enabled by participation in research. Short courses in research generally, or asthma research in particular, provide opportunities for ‘upskilling’ in research for those with limited time and resources.
In low- and middle-income countries, efforts should be accelerated to make asthma a lung health priority. Asthma management and control is feasible even in low-income countries, and it should be on everyone’s agenda. In 2012 WHO published guidelines for asthma management in low-income settings.
GAN will work with others to achieve better asthma outcomes 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 advocacy activities.
Together, we can ensure that asthma is managed so that its associated disability, death, and economic drain is massively reduced – even if prevalence rises.