Managing asthma well is key to living life normally

Shobha Shukla *

If essential and lifesaving medicines and proper care are available, accessible and affordable for all people with asthma, they can manage their asthma properly and lead a normal life. On this year’s World Asthma Day, Dr Guy Marks, Professor of Respiratory Medicine, University of New South Wales (UNSW) Australia and President of the International Union Against Tuberculosis and Lung Disease (The Union) reminded us that even as asthma continues to be the most common chronic illness in children globally, it affects adults as well.

“Four million people have asthma globally - this global burden is only slightly decreasing with time. The international study on asthma and allergies in adolescent children (13-14 years old) shows a high prevalence of asthma in many parts of the Asia Pacific region where more than 1 in 5 children have symptoms of asthma. Asthma affects people of all ages and in all parts of the world - in high as well as in low- and middle-income countries. But while the risk of dying from asthma is extremely low in high income countries, the risk is remarkably high in low- and middle-income countries. In fact, 50% of all deaths due to asthma occur in India (5 lakh deaths every year in India)”, said Dr Marks.

Dr Guy Marks alerted that “access to affordable and quality-assured medicines for asthma, access to acute care and the high risk posed by air pollution remain a challenge in low- and middle-income countries. Lack of access to inhaled steroids is an especially important factor for high morbidity and mortality and high number of asthma attacks in these nations. Affordability is a major barrier to access to right asthma medication.”

“An important part of managing asthma and stopping deaths from it is getting access to effective treatment. The right quality assured medicine should be prescribed by the treating doctor, should be available at the right time and should be affordable to the patient. Many poor-quality medicines are also available which should not be used. More importantly, because a lot of asthma medicines are taken by inhalation, children and adults with asthma need to know how to use these devices”, he said.

Dr Surya Kant, Past President of Indian College of Allergy, Asthma and Immunology; and Professor and Head of Respiratory Medicine, King George’s Medical University (KGMU) said: “People who have uncontrolled asthma have higher risk of developing Covid-19 infection with increased severity of the disease, hospitalisation and premature mortality. That is why I appeal to all those who have asthma to strictly follow their asthma management and treatment and adhere to Covid-appropriate behaviour. Regular inhalation therapy, proper use of mask and Covid vaccination are important means to prevent asthma exacerbations and Covid-19.”

Dr Surya Kant, who is also the nodal officer of KGMU Covid-19 response, and among the brand ambassadors for National Health Mission Covid vaccination rollout added: “Tobacco smoking can increase the risk of SARS-CoV-2 infection up to 2.5 times. Those TB patients who have patches in lungs also have higher risk of getting infected. People with uncontrolled asthma, TB (current patients or those who had TB earlier, but chest X-Ray shows lung patches) and those who use tobacco have higher risk of Covid-19 and serious outcomes.”

Why are asthma related deaths high in low- and middle-income countries?

Dr Guy Marks and Dr Surya Kant both highlight the avoidable reasons for alarmingly high deaths in low- and middle-income countries, including India:

- Lack of access to effective treatment. The most effective treatment is inhaled corticosteroids, which has been in use since the last 50 years, but it is still not readily available in many countries.

- Lack of access to acute care during severe attacks of asthma, which could be fatal if acute hospital care for managing them is not available.

- Increased exposure to some exacerbating factors that trigger or worsen asthma, like air pollution. So, in countries with high levels of outdoor air pollution - smoke, traffic related pollution, industrial air pollution - it is likely that people with asthma will have more severe attacks and be at greater risk of dying.

What triggers asthma?

“There are some identified airborne triggers/ hazards, not just for asthma but for other respiratory diseases as well. These are tobacco smoke- either by smoking directly or exposure to secondhand smoke, household indoor ambient air pollution largely due to solid fuel combustion from cookstoves, and outdoor ambient air pollution- like particulate air pollution from burning of agricultural waste, from traffic and from industry.

These airborne threats to health are very important risk factors for many diseases- not only respiratory but also for cancers and heart diseases. Other conditions such as tobacco use related lung disease, obesity, underweight or exposure to other triggers or risk factors also complicate asthma”, explained Dr Marks.

Progress on asthma is not enough

Dr Marks remarked that asthma remains a major problem globally. There is substantial avoidable suffering and death due to asthma which we need to address. Most of the progress that has been made (particularly for people with mild or moderate asthma) is NOT new drugs or new tests but new ways of using the drugs and tests that are available.

There is much to be done by way of improving access to medicines, particularly their distribution, reducing the cost, and getting them delivered to patients in feasible ways so that they can use them most easily.

The key message for people living with asthma is about asthma treatment- inhaled steroids that are sometimes called controller or preventer medicines- control as well as prevent symptoms and prevent the risk of dying from asthma. People also need to know that asthma could be fatal if they do not take regular steroid treatment.

Dr Marks made an important point on equity: “Those countries have done better where people recognised that we are all in this (pandemic crisis) together. As a global community what we do affects other people and what other people do affects us. And this should not just be in our local community but globally. The current outbreak in India now is having ripple effects throughout the world. So, you cannot control Covid-19 in just one country- it has to be controlled in the whole world.”