Asthma remains a public health problem
Mexico is a middle-income country, with 127.8 million inhabitants, a third of which live in urban areas. Asthma in Mexican school children has been surveyed twice: the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III in 2001-2003; and Global Asthma Network (GAN) Phase I in 2016-2019. ISAAC Phase III was carried out in 10 centres in Mexico. The prevalence of “wheezing in the past 12 months” varied between 3.6-12.7% in 6-7 year olds (children) and 3.9-14.4% in 13-14 year olds (adolescents). GAN included 15 centres in Mexico with 35,780 children and 41,399 adolescents participating. The prevalence of “wheezing in the past 12 months” was 10.2% in children and 11.6% in adolescents. The prevalence of “asthma diagnosed by a doctor” was much lower, 5.4% and 6.6% in children and adolescents, respectively. Less than 5% of the participants in both age groups had a written asthma treatment plan. According to these results, the prevalence of asthma symptoms has increased in the past 15 years. However, the prevalence of diagnosis and treatment was less than 10% in both groups. Also, a negative association was observed between asthma symptoms and altitude >1500 meters above sea level.
Access to medicines
Mexico has national asthma management guidelines for paediatric patients such as the clinical practice guidelines-CENETEC and the asthma management guide (Manejo Integral del Asma, MIA). Both of these documents mention important medicines for asthma rescue and control, such as: salbutamol, budesonide, montelukast, beclomethasone, tiotropium; drugs for combination therapy such as salmeterol-fluticasone, budesonide-formoterol; and biological therapy such as omalizumab, accessible at public and private levels.
The Instituto Nacional para la Salud y el Bienestar (INSABI) was founded in 2020 to provide and guarantee the free provision of health services, medicines, and other associated supplies to people without social security. However, until this is fully implemented, free medicines are available only to those patients belonging to the Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), the Secretaría de la Defensa Nacional, and the Secretaría de la Marina. This represents a challenge for the management of asthmatic patients without insurance since these medicines will most of the time represent a significant expense for parents, limiting access to treatment and, therefore, symptom control. It is expected that in the course of 2022, all patients with asthma will have free access to medicines regardless of their insurance or the medicines they require.
National Challenges for Asthma Management
Asthma is a public health problem in our country, so continuous training of first contact for physicians and paediatricians is required for the proper diagnosis and management of patients with asthma. In January 2021 an expert session was held with the Senate of the Mexican Republic to publicise the increase in asthma in the paediatric population, the need to increase the number of asthma medicines available and stimulate the training of medical personnel.