Asthma is a chronic, non-communicable lung condition affecting 300 million people worldwide. Asthma was once found predominantly in industrialised countries, and now, over the past 20 years, has become an increasingly widespread problem in low- and middle-income countries, particularly in urban areas. While asthma is not curable, it can be managed, and most of the 200,000 deaths that occur each year can be attributed to poorly managed care.

 

Over the past 15 years, helping low- and middle-income countries manage asthma has been one of The Union's priorities. The Asthma Division has developed an approach to asthma management that is based on The Union's successful approach to tuberculosis and produced a guide outlining its recommendations. In 2004, the Asthma Drug Facility was established to address a major challenge for limited-resource settings – providing quality essential asthma medicines at an affordable cost.

 

The Union approach to asthma management

The Union's approach to asthma management is adapted from international asthma guidelines and uses a framework based on The Union's model for tuberculosis services. This framework advocates for standard case management, use of simple tools for the diagnosis and classification of the severity of asthma, provision of essential medicines and careful monitoring and evaluation of asthma care.

 

The Management of Asthma: a guide to the essentials of good clinical practice (3rd edition, 2008) provides a detailed description of this approach. It is based on 12 years of experience and field-testing to ensure that the recommendations are feasible and sustainable in low- and middle-income countries. In conjunction with the guide, The Union offers a technical package for training in standard asthma management.

 

The Union's evaluation has shown that the main challenges to improving asthma care are:

• lack of political commitment to fund non-communicable diseases
• lack of structure or organisation for following up patients with chronic disease
• high cost of equipment and essential medicines
• lack of personnel trained to manage asthma
• health services oriented for acute care are unable to organise the long-term management needed for asthma care.

 

In working with countries that request technical assistance, The Union seeks to help them address these challenges.

Since the high cost of essential asthma medicines is one of the most frequently cited barriers, The Union established the Asthma Drug Facility (ADF) 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.

[Management of Asthma Guide]