High prevalence of infectious diseases can lead to underdiagnosis and inadequate treatment of asthma.
In Indonesia, a country of 261 million people, geographic and demographic characteristics vary among provinces. National data on emergency visits, hospital admissions, and mortality of childhood asthma are not available. However, studies using the questionnaire from the International Study of Asthma and Allergies in Childhood (ISAAC) determined the prevalence of asthma in children in some provinces (Table). The prevalence differs by province, ranging from 4-11% in 6-7 year olds and from 6-13% in 13-14 year olds.
Infectious diseases in Indonesia are still a significant problem, contributing to a lack of awareness and health worker expertise in the diagnosis and management of childhood asthma. This can lead to underdiagnosis and inadequate treatment of asthma in children. Poor access to asthma medicines worsens the problem. Inhaled bronchodilators and corticosteroids are expensive and, although national insurance covers some medicines, availability is limited in most district hospitals. Leukotriene receptor antagonists and anti-IgE are available but not covered by national insurance. Spacers are often not available, resulting in the use of nebulisers in most provinces, and oral bronchodilator use is common. Asthma education and written asthma action plans are not part of asthma management in Indonesia.
The national asthma guideline was updated by the Indonesian Pediatric Respirology Working Group of the Indonesian Pediatric Society in 2015 (adapted from international guidelines), but implementation presents challenges. Diagnosis is clinical, as spirometry is not available in most hospitals. Since 2015, the Indonesian Pediatric Society and Ministry of Health have conducted training on paediatric asthma in some provinces. Efforts are underway to improve the affordability of asthma medicines, e.g. proposing more asthma medications that are covered by the National Health Insurance.