Global Asthma Report 2011

Worldwide, 235 million people have asthma. Although effective treatment is available, many people with asthma, especially in low- and middle-income countries, are unable to access or afford it.

A new report, and accompanying website, released today by the International Union Against Tuberculosis and Lung Disease (The Union) and the International Study of Asthma and Allergies in Childhood (ISAAC) highlights the issues surrounding asthma in the global context.

The report, authored by some of the leading asthma experts around the world, is described as an atlas of known “causes and triggers of the disease, the global prevalence, the progress being made and the significant challenges today and for the future.”

I expect to be posting more as I read through the report, but the key findings highlighted by the press release are the following:

  • ISAAC data show that asthma in children is increasing in low- and middle-income countries, where it is more severe than in high-income countries.
  • The World Health Survey found an 8.2% prevalence of diagnosed asthma among adults in low-income countries and 9.4% in the richest countries. Middle-income countries had the lowest prevalence at 5.2%.
  • Smoking and secondhand smoke are two of the strongest risk factors — and triggers — for asthma.
  • Although asthma is frequently thought of as an allergic disease, this does not apply to all cases, and the non-allergic mechanisms need to be the focus of more research.
  • Surveys around the world found asthma treatment falling short, with few patients consistently using the inhaled corticosteroids that effectively manage the disease.  For example, the Asthma in America survey found only 26.2% of patients with persistent asthma used these medicines.
  • While many countries now have asthma management guidelines, many health workers do not know how to diagnose or treat asthma and health systems are not organised to handle this type of long-term, chronic disease.
  • A 2011 Union survey of the pricing, affordability and availability of essential asthma medicines in 50 countries found dramatic variations. For example, one generic Beclometasone 100µg inhaler in a private pharmacy cost the equivalent of nearly 14 days’ wages — and a patient with severe asthma requires about 16 of these inhalers per year.
  • The Asthma Drug Facility established by The Union has been able to bring down the cost of treating a patient with severe asthma to approximately US$ 40 per year.
  • When people do not have access to ongoing care, they often end up in emergency rooms and hospitals — a costly and unnecessarily disruptive process for all involved.
  • Although economic data are unavailable for almost all low-income countries, a 2009 systematic review found annual national costs (in 2008 US dollars) ranging from $8,256 million in the United States to $4,430 million in Germany.
  • Success stories from five high- and low-income countries that have implemented asthma management activities show that well-managed asthma saves money – and enables people to get on with their active lives. For example, in Finland, the mortality, number of hospital days and disability due to asthma fell 70–90% between 1994 and 2010 and a conservative estimate of the savings was $300 million in 2007 alone.

Obviously the economic data on costs in the US needs to be updated. A recent CDC report calculated direct economic costs nearly six times higher. Nevertheless the main message remains valid. There is an urgent need to overcome the frustrating gap between what we should be able to do, and what we’ve so far been able to accomplish. As articulated by Nils Billo, Executive Director of The Union:

The tools to treat asthma are already available – there is no reason to delay. Moreover, when asthma is not diagnosed, not treated or poorly managed, and when people can not access or afford treatment, they regularly end up having to miss school or work, they are unable to contribute fully to their families, communities and societies, they may require expensive emergency care, and everyone loses.  The obstacles to well-managed asthma can be overcome.  Asthma is a public health problem that can – and should be addressed now.