Asthma

Asthma patient with inhaler in South Africa - The Union - © LHIL/Damien Schumann

Promoting standard case management with affordable medicines

With 300 million people suffering from asthma in the world, and at least 200,000 avoidable deaths occurring each year, asthma is a worldwide public health problem including in low- and middle-income countries. The prevalence and trend of asthma symptoms in children was estimated by a large epidemiological study, International Study of Asthma and Allergies in Childhood (ISAAC), conducted in 100 countries in the world. The estimated global prevalence of asthma symptoms in children aged 13-14 years was 13,6%, with wide variation among regions of the world: Oceania (26,7%), Latin America (21,5%), Eastern Mediterranean (18,8%), Anglophone Africa (15,4%), Western Europe (15,2%), North Europe and Asia (11,6%), and Francophone Africa (10,2%) (1,2). In recent years the prevalence of asthma has stabilised or decreased in industrialised and is constantly increasing in large cities of low and middle income countries (3). Currently the largest number of asthma patients live in India, Latin America and Africa. There are approximately 3 million persons with asthma in Japan and in France, compared with an estimated more than 15 million in India and over 30 million in Africa. In addition, the highest proportion of severe symptoms of asthma among those who currently wheeze was observed in the regions of Africa, Indian Sub-continent, Eastern Mediterranean and Latin America. The majority of patients living in low and middle income countries have no, or very little access to adequate asthma care.

To improve asthma care for patients living in low- and middle-income countries, the Asthma Division was created in 1995 and the first Union Asthma Guide was published in 1996. Adapted from international asthma guidelines (GINA) (4), this Guide recommended a standardised management of asthma using only essential medicines. The Guide proposed a framework based on The Union’s model for tuberculosis services using simple tools for the diagnosis and classification of severity of asthma and a technical package for monitoring and evaluation of asthma care. After its publication, The Union Asthma Division developed an operational research programme to evaluate the technical measures proposed in the Guide, to identify the main challenges for their implementation at country level and to propose actions to promote the sustainable implementation of asthma management activities in low- and middle-income countries. This evaluation in several low- and middle-income countries showed that:

• the Guide’s measures are feasible, efficient and effective.(6,7) Based on the results of this research, an updated version of the Guide was published in 2005 and updated in 2008 Management of Asthma: a guide to the essentials of good clinical practice.The Union has also developed a technical package for training in standard asthma management.
• the main challenges in implementing the guides and improving asthma care in poor countries are : lack of political commitment of governments for non communicable diseases; lack of structure or organisation for follow-up of patients, no or poor affordability to equipment and essential medicines;(9) lack of trained personnel; health services oriented for acute care and not able to organise long-term management needed for asthma care. (10)

In response to the high cost of essential asthma medicines, The Union has established the Asthma Drug Facility (ADF).(11-13) ADF aims to make quality assured essential asthma medicines available and affordable in low- and middle-income countries. This will facilitate the implementation of standard case management for asthma.

To help implement the guidelines, the Asthma Division prepared a technical package for ADF clients: material for training health personnel, including slides, a manual for course participants and a manual for course instructors; and an electronic asthma information system using EpiData Entry for monitoring and evaluation of persistent asthma.

The Union supports international advocacy efforts to improve lung health. It celebrates World Asthma Day, which is held every year on the first Tuesday in May. For more information on World Asthma Day, please visit the website of the Global Initiative for Asthma (GINA).