The purpose of this report
The Global Asthma Report 2018 is the third such report prepared by the Global Asthma Network (GAN). GAN builds upon the work of the International Study of Asthma and Allergies in Childhood (ISAAC) and The International Union Against Tuberculosis and Lung Disease (The Union) to monitor asthma and improve asthma care, particularly in low- and middle-income countries (LMICs).
This report brings together in one document an up to date account on where the major gaps lie in asthma information and management. It is intended to influence those in authority to act promptly and wisely to reduce the global burden of asthma.
Asthma remains a worldwide health problem
Asthma is a common chronic disease that is estimated to affect as many as 339 million people worldwide. It is a cause of substantial burden of disease, including both premature death and reduced quality of life, in people of all ages in all parts of the world. Globally, asthma is ranked 16th among the leading causes of years lived with disability and 28th among the leading causes of burden of disease, as measured by disability adjusted life years (DALYs).
Asthma continues to be a major source of global economic burden in terms of both direct and indirect costs. Strategies to improve access and adherence to evidence-based therapies can be effective in reducing the economic burden of asthma in both developed and developing countries.
Global trends in the burden of asthma are poorly documented
Establishing the proportion of the population who have asthma (that is, the prevalence of asthma), and comparing this prevalence between countries, requires the use of standardised measures implemented in large-scale, global surveys. The last such surveys were about 15 years ago. GAN is currently collecting new information on global asthma prevalence, severity, management and risk factors in children and adults.
Hospital admissions for asthma are an indirect indicator of the burden of more severe asthma, and the efficacy of care. Large reductions in asthma admission rates have occurred over the last decade in several higher income countries. Currently, routinely collected asthma admissions information is almost entirely restricted to high-income countries, limiting the value of admission rates for surveillance of the global burden of asthma.
Deaths due to asthma are of serious concern because many of them are preventable. Although asthma mortality rates have fallen in many countries over the last decade, avoidable asthma deaths are still occurring due to inappropriate management of asthma, including over-reliance on reliever medication, rather than preventer medication, and this needs to be rectified.
Effective treatments for asthma are often unavailable or unaffordable
Many governments have overlooked asthma in their plans to address non-communicable diseases (NCDs) and have made little progress in improving access to asthma management and medicines, especially the inhaled corticosteroids crucial for the long-term control of asthma.
Inhaled therapy is essential for treatment of acute and chronic asthma, and the metered dose inhaler with a spacer is the optimal delivery system in children. Proper modification of a low cost 500ml plastic bottle creates an effective spacer, with the neck of the bottle held in the mouth. For a young child a mask should be attached to the bottle neck.
In many countries, essential asthma medicines are unavailable, unaffordable, or are of unreliable quality, resulting in unnecessary burden and mortality from asthma. Patients are dying of asthma in low-income countries from lack of effective management. Prompt action is needed from leaders (governments, development partners and technical organisations) to address this and achieve more success stories.
Asthma as a national policy issue: examples from around the world
Africa: Profiles from Benin, Ghana, Kenya, Nigeria, South Africa and Sudan show that asthma is a large problem. Unmet needs should be addressed by comprehensively applying asthma Standard Case Management and improving access to affordable quality-assured essential asthma medicines.
Asia and India: Profiles from China, India, Indonesia, Malaysia and Thailand indicate that the burden of asthma is substantial, but asthma remains underdiagnosed and undertreated. Many asthma patients are not using inhaled corticosteroids, mainly because these medicines are either inaccessible or unaffordable. To improve asthma care, implementation of asthma guidelines should be strengthened.
Latin America: Profiles from Argentina, Brazil, Chile, Colombia and Mexico demonstrate important advances in asthma care, but to improve asthma care from infancy to late adulthood there are continuing needs for: implementation of national asthma programmes with up-to-date public registries, universal access to essential asthma medicines, and education on asthma for parents, patients and health personnel.
Asthma is a global priority requiring global action
Asthma is one of the most significant NCDs. Two of the five interventions adopted by the World Health Organization (WHO) to tackle NCDs – tobacco control, and essential medicines and technologies – will directly reduce the worldwide burden of asthma. A third priority aimed at reducing obesity – improved diets and physical activity – is likely to be beneficial for asthma.
The focus of the United Nations (UN) 2030 Strategic Development Goals on mortality alone does not capture morbidity and the imperative to reduce the worldwide burden of asthma. Economic prosperity will be helped by correctly treating asthma, especially in LMICs.
Policies are needed to enable access to affordable, good quality medical care and quality-assured asthma medicines for all people with asthma worldwide. Patient advocacy can ensure integration of patient viewpoints into planning and policy decisions.
Asthma monitoring needs to be ongoing and widespread. Nearly half of the world’s countries have never studied the prevalence of asthma. For many of the remainder, the latest available information on the prevalence and severity of asthma is about 15 years old.
Asthma is a major but remediable global health problem. We call upon world leaders to action the recommendations in this report, which are summarised on the following pages.