Treating Asthma

While AIDS, tuberculosis and other maladies get most of the ink, asthma is a serious and growing problem. It is estimated that 235 million people are afflicted with the condition, which accounts for one in every 250 deaths worldwide.

Asthma is growing as air pollution increases. It is the US’s fastest growing chronic disease, affecting 22 million Americans, with more than 4,000 dying every year and 1.8 million sufferers visiting emergency rooms, according to the Center for Disease Control in the US.

“The suffering and waste of resources caused by not managing asthma effectively are much greater than the cost of effective action.” Dr Nils E Billo, MD, MPH, Executive Director of International Union Against Tuberculosis and Lung Disease.

India contributes to 10 percent of the global burden of asthma, with 3-5 percent of its population being asthmatic. Childhood asthma incidence in India ranges from 2.1 percent to 11.8 percent.

The word ‘asthma’ comes from a Greek word meaning ‘panting’ or ‘breathless’. It is a disease of the bronchial tubes (called the airways) that typically presents with “wheezing”, shortness of breath and/or coughing, particularly in children, which are caused by the allergic reaction between a trigger allergen that enters the body and the antibody called the IgE (Immunoglobulin E). This leads on to inflammation and narrowing of the airways, causing spasm difficulty in breathing.

As symptoms of asthma mimic those of other lung diseases it is often difficult to distinguish it from other chronic lung diseases like TB, particularly in settings where diagnostic facilities are sub-optimal. So it often goes undiagnosed, or is misdiagnosed, especially in children. According to Dr BP Singh, a chest specialist in India, “If a child has recurrent cough and upper respiratory tract infection the doctors often misdiagnose this as primary complex and start giving anti-tuberculosis treatment. This is a serious concern—you are misdiagnosing the disease and misusing the drug.”

Surya Kant, Head of the Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University and Chairperson of the Indian Chest Society (North) says that, “Usually asthma has a clinical diagnosis. In children, nocturnal or early morning cough is an alarm for asthma, and so is breathlessness during playing. In adults it is episodic breathlessness—not continuous. But a word of caution here— all breathlessness is not asthma, just like all that glitters is not gold.”

Asthma is not curable, but it can be controlled and managed with existing medicines. Hence patient education is essential to help them lead a normal and healthy life. They need to learn how to manage their asthma: how and when to take their medicines and when to seek help from health care facilities. According to Dr BP Singh, “The problem is that most people neither have awareness about the disease nor access to healthcare facilities where they can seek proper treatment. A study conducted in Mumbai found that many clinical physicians themselves were not aware of the exact management of the patients. This is probably one of the biggest hindrances.”

The ideal treatment for controlling asthma is inhalation therapy. Inhaled corticosteroids are non- addictive and free from side effects even in the long term. Chiang Chen Yuan, director of the Department of Lung Health and NCDs at the The Union, says that, “By using inhaled corticosteroids, most asthma patients can control their asthma: they will have no symptoms (or very mild symptoms), no asthma attacks, no unplanned emergency hospital visits, no limitation of activities, no airflow limitation and minimal bronchodilator use (2 times per week).

Unfortunately, the majority of asthma patients do not use inhaled corticosteroid. The global Asthma Insights and Reality surveys reported that fewer than 20 percent of patients with moderate-severe asthma use inhaled corticosteroid. This could be related to, apart from poor affordability, clinicians’ practice and patients’ preference. However, clinicians are in a position to influence patients’ preference.”

In India also more than 70 percent of asthma patients depend on oral medication. Dr Singh feels that, “In India, people are using less of this drug due to poor prescription, poor adherence to treatment and also due to the myth or patients’ belief that if one uses them there are going to be lot of side effects.”

The truth is that properly dosed inhalers and do not cause any side effects. Inhalation therapy is a targeted delivery of the drug to the lungs and it does not go to any other body organ. In oral medication only 1 percent of the drug goes to bronchial mucosa and the rest goes to other parts of the body through blood system causing severe side effects. Secondly in inhalation therapy the dose is very small (in micrograms), whereas in oral medication it is of the order of milligrams.

According to Dr Surya Kant, “Inhalation therapy costs around Rs4-5 (US$0.1) per day, making asthma treatment one of the cheapest treatments available in India. Inhalers are just like spectacles. If your bronchial tubes are weak, use an inhaler in the same way as you would use specs if your eyes are weak. As one brushes the teeth daily, so also an asthma patient needs to take the inhaler daily in the morning and evening. This will help control asthma very effectively.”

The Union has worked with the International Study of Asthma and Allergies in Childhood, a research network established more than 20 years ago. It has also established the Asthma Drug Facility as a procurement mechanism to provide quality-assured essential aerosol medicines, used routinely in the treatment of asthma, at reduced costs. Since 2010, the ADF has successfully delivered inhaled corticosteroids at low prices to countries in Latin America, the Middle East, South-East Asia and Africa.

Professor Nadia Ait Khaled, The Union's Advisor on Asthma, says that, “Asthma is under- diagnosed and under-treated in the world, particularly in resource limited settings. With adequate diagnosis and long term management of asthma, patients could have a normal social and professional life. The number of emergency room visits and hospitalizations will decrease dramatically and consequently decrease the economic and disability burden of patients, families and governments.”

(Shobha Shukla is managing editor of Citizen News Service. She writes frequently on medical issues. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)