The purpose of this report
The Global Asthma Report (GAR) 2022, prepared by the Global Asthma Network (GAN), is the fourth such report (others 2011, 2014, 2018). 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 2022 report brings together in one document an up to date account on what is known and 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.
At the time of our last report in 2018, the most recent information on asthma prevalence and severity from international surveys was about 15 years old. This gap has now been remedied by the completion of GAN Phase I surveys of over 450,000 children (aged 6-7) or adolescents (aged 13-14), and in addition their parents or guardians in 63 centres from 25 countries during the period 2015-2020.
Although the prevalence of asthma symptoms in each age group was greater in high- and upper-middle-income countries than in low- and lower-middle-income countries, the proportion of affected individuals with more severe symptoms was similar (between one-third and one-half) in each income category and age group.
Comparisons with previous ISAAC surveys using the same methods in the same centres from 14 countries show that the prevalence and severity of asthma symptoms among children and adolescents has changed little, on average, since the early 2000s.
The recent GAN surveys provide new evidence concerning the clinical management of asthma in both higher- and lower-income settings. About one-half of affected children and adolescents and about one-third of affected adults had asthma symptoms that were inadequately controlled by treatment. One in five affected children and adolescents had received no effective medicine for their asthma.
Since the last GAR in 2018, international guidance on asthma management has changed. In 2019, the Global Initiative for Asthma (GINA) recommended that short-acting β2-agonists should not be used alone and that all adults and adolescents with asthma should receive inhaled corticosteroid (ICS)-containing therapy, either daily or, in mild asthma, as-needed. Based on evidence, the reliever preferred by GINA across all treatment steps is a combination of ICS and formoterol, a rapid-onset long-acting β2-agonist.
Systematic review of the evidence by the Cochrane Collaboration supports the use of these combined inhalers on an as-needed (“reliever”) basis in mild asthma, reducing the need for daily ICS as “preventer” medication. However, these combined inhalers are currently much more expensive than the short-acting β2-agonist alone; this cost barrier needs to be addressed. GAR 2018 included national perspectives on the burden and management of asthma from several countries. In this report we have included profiles from 23 places in six World Health Organization (WHO) Regions – Africa: Cameroon, Nigeria, South Africa; Americas: Argentina, Brazil, Costa Rica, Mexico; Eastern Mediterranean: Iran, Pakistan, Saudi Arabia, Sudan, Syria; Europe: Greece, Kosovo, Russia, Spain; South-East Asia: India, Sri Lanka, Thailand; Western Pacific: China, New Zealand, Pacific Islands, Taiwan.
Two of the major global challenges of this decade – COVID and climate change – are addressed in the context of asthma in this report.
Asthma remains a worldwide health problem
Asthma is a common chronic disease that is estimated by the Global Burden of Disease collaboration in 2019 to affect as many as 262 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 24th among the leading causes of years lived with disability and 34th 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.
About 1000 people per day die from asthma. These fatalities are of serious concern because many of them are preventable. Although age-specific asthma mortality rates have fallen in many countries over the last decade, the number of deaths certified as asthma has changed little, due to ageing of the population. 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 ICS crucial for the long-term control of asthma.
Evidence from the ongoing COVID-19 pandemic suggests that ICS are unlikely to have adverse effects on the outcome of SARS-CoV2 infection among asthmatics, so their use should continue to be promoted, either alone or in combination with a long-acting β2-agonist inhaler.
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 (including WHO, governments, health authorities) to address this and achieve more success stories.
Asthma is a global priority requiring global action
Asthma is one of the most significant NCDs. Two of the five interventions adopted by 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 2030 Sustainable 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. Global and national policies to control greenhouse gas emissions and mitigate the effects of climate change should consider their impact on asthma.
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. Routinely collected information on hospital admissions due to asthma is almost entirely restricted to high-income countries, limiting the value of admission rates for surveillance of the global burden of this disease.
Asthma persists as 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.