Improving management and asthma education programs in Iran
Public Health Plan
Like many other countries in the world, Iran is facing an increasingly growing number of asthmatic patients. The prevalence of asthma in Iran, using core questions from ISAAC, between November 2015 and February 2016 was estimated to be 12.4% in 13-14 year old adolescents (N= 16,850). However, some are still underdiagnosed or undertreated since there is a social stigma attached to asthma in Iran. Not only do many patients deny that they suffer from asthma, but also some physicians dissuade them from using their inhalers. This problem finds its roots in the people's steroid phobia as well as being worried about cardiac side effects of bronchodilators and addiction to inhaled steroids.
In regard to asthma triggers, Iranian people, particularly in large cities face air pollution as a serious challenge. Smoking is also a problem, particularly for asthmatic children and women as passive smokers. The health care system in the MOH gathers data every two years about tobacco and there are some clinics throughout the country which offer services for tobacco cessation to smokers; however, it does not seem to be effective enough. Although not affordable for many, almost all essential asthma medicines and leukotriene receptor antagonists are available, either produced in or imported to Iran.
The educational curriculum is based on the most updated GINA and expert panel reports. Iranian Society of Asthma and Allergy (ISAA) follows regular educational programmes not only for physicians but also for asthmatic patients and their family members too, which is held at least annually under the pretext of celebrating world asthma day. Continuous educational programmes are held by ISAA and more than 130 allergists are now working in the medical universities throughout the country. The focus of these meetings is on asthma diagnosis and management to keep physicians updated. Although mobile-based education is not widespread, patients and caregivers, in the context of educational programmes, are instructed on self-management and the right technique of how to use inhalers and spacers. This instruction can also be undertaken at the physicians’ offices. Thanks to having close cooperation with the MOH and the National Asthma Council, ISAA has the privilege of using the facilities of these organisations to increase people's knowledge and improve their attitude and performance in controlling the burden of asthma.
The Persian version of GINA strategy and a regularly updated national guideline of asthma are available on http://ginasthma.ir. There is a national asthma committee, whose members are some officials. These include the manager of non-communicable diseases centre in the MOH; some allergists and pulmonologists as the representative of Iranian society of asthma and allergy; Iranian society of pulmonology or medical universities; and some invited partners. These organisations, none of which are international, are working under the supervision of the MOH and supervise any measures which have been taken concerning asthma throughout the country.
In summary, asthma is a growing issue in Iran. However, thanks to the availability of relatively affordable medicines and regular educational programs, it is reasonably under control.