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As we approach World Asthma Day on the May 2, 2023, we reflect on the theme “ Asthma Care for All”. Prevalence of Asthma is increasing amongst ...children, adolescents and adults. Under-diagnosis, underutilization of inhaled corticosteroids, inaccessibility of treatment, and unaffordability of medicines are amongst the challenges that low-middle income countries are faced with. This commentary seeks to highlight the challenges, the resources available and to suggest recommendations that can be implemented to improve asthma care for all and reduce burden of asthma in Africa.
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Asthma is the most common chronic respiratory disease (CRD) worldwide and is estimated to affect 262 million causing significant mortality and morbidity, and has emerged as an important public health problem in many Latin American (LA) countries ove...r the last 30 or so years. LA is a highly diverse region in terms of geography, climate, wealth, and ethnicity including 20 different countries with 639 million inhabitants, where 40 million are estimated to have asthma. A common feature of LA countries is the high level of social inequalities3 (Figure 1). In LA, asthma prevalence in both children and adults is highly variable and, where high, is among the highest worldwide, particularly in coastal tropical cities.
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Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased ast...hma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (GINA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines.
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Asthma is the most common non-communicable disease in children and remains one of the most common throughout the life course. The great majority of the burden of this disease is seen in low-income and middle-income countries (LMICs), which have disp...roportionately high asthma-related mortality relative to asthma prevalence. This is particularly true for many countries in sub-Saharan Africa. Although inhaled asthma treatments (particularly those containing inhaled corticosteroids) markedly reduce asthma morbidity and mortality, a substantial proportion of the children, adolescents, and adults with asthma in LMICs do not get to benefit from these, due to poor availability and affordability. In this review, we consider the reality faced by clinicians managing asthma in the primary and secondary care in sub-Saharan Africa and suggest how we might go about making diagnosis and treatment decisions in a range of resource-constrained scenarios. We also provide recommendations for research and policy, to help bridge the gap between current practice in sub-Saharan Africa and Global Initiative for Asthma (GINA) recommended diagnostic processes and treatment for children, adolescents, and adults with asthma.
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Asthma is the most common noncommunicable disease in children, and among the most common in adults. According to the most recent estimates from the Global Asthma Network Phase I study, around one in... 10 children and adults have symptoms of asthma and one in 20 school-aged children have severe asthma symptoms, with marked variations in prevalence and in prevalence trends between countries and regions of the world. The Global Burden of Disease Study estimated that asthma caused the loss of 21.6 million healthy years of life (disability-adjusted life years) and 461 069 deaths in 2019. Approximately 90% of the asthma burden of disease is borne by people living low and middle income countries (LMICs). Some countries report very high (up to 90%) rates of uncontrolled asthma. While the prevalence of asthma is highest in countries with a high Socio-Demographic Index (SDI), death rates from asthma are highest in countries with low and lower middle incomes.
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The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of ...ttribute-to-highlight medbox">asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
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Asthma is the commonest chronic childhood disease and encompasses a spectrum of airway diseases with similar symptoms. Inaccurate diagnosis remains common, especially in younger children, with failure to characterize the different “...tribute-to-highlight medbox">asthmas.” Children worldwide repeatedly suffer symptoms which severely affect their everyday lives. Children die from asthma, especially in low and middle-income countries (LMICs). In many countries, asthma prevalence is rising. Access to effective care and changing environments are hugely variable and may explain the higher morbidity in inner-city children, in LMICs, and in deprived populations in high-income countries. Despite the disease being eminently controllable, morbidity and mortality persist.
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You can’t cure asthma. However, you can take steps to control the disease and prevent its symptoms. For example:
-Learn about your asthma and ways to control it
-Follow your written ...s="attribute-to-highlight medbox">asthma action plan
-Use medicines as your doctor prescribes (Here’s how to use your inhaler device)
-Identify and try to avoid things that make your asthma worse
-Keep track of your asthma symptoms and level of control
-Get regular checkups for your asthma
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Asthma:
• is one of the most common respiratory complaints in the world today.
• affects one in ten children (10%) and one in twenty adults (5%)
• can occur for the first time at any age, even in adulthood.
•usually begins before th...e age of five years. A few children affected will ‘outgrow” it during their teenage years but it usually persists if contracted in adulthood.
• tends to run in families as do related allergic conditions like hay fever and eczema.
• cannot as yet be cured but if kept under control, those affected will be able to live normal lives enjoying full involvement in sport and all other activities.
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Asthma is a common breathing condition that affects 20% of all children Asthma tends to run in families, although this is not always the case. You may have seen someone at school who uses an inhale...r to help them breathe better and control asthma symptoms.
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Asthma is a chronic lung disease affecting people of all ages. It is caused by inflammation and muscle tightening around the airways, which makes it harder to breathe.
Symptoms can include coughing, wheezing, shortness of breath and chest tightne...ss. These symptoms can be mild or severe and can come and go over time.
Although asthma can be a serious condition, it can be managed with the right treatment. People with symptoms of asthma should speak to a health professional.
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Asthma is a chronic lung disease affecting people of all ages. It is caused by inflammation and muscle tightening around the airways, which makes it harder to breathe.
Symptoms can include coughing, wheezing, shortness of breath and chest tightne...ss. These symptoms can be mild or severe and can come and go over time.
Although asthma can be a serious condition, it can be managed with the right treatment. People with symptoms of asthma should speak to a health professional.
more
Asthma is a chronic lung disease affecting people of all ages. It is caused by inflammation and muscle tightening around the airways, which makes it harder to breathe.
Symptoms can include coughing, wheezing, shortness of breath and chest tightne...ss. These symptoms can be mild or severe and can come and go over time.
Although asthma can be a serious condition, it can be managed with the right treatment. People with symptoms of asthma should speak to a health professional.
more
This guide provides a systematic, practical approach to support primary care and other healthcare professionals to improve the care of peopel over the age of 18 years with difficult to manage asthma.
Asthma can be a serious disease, but if you understand
the disease and take the right medication to control it, you
should have no problems or symptoms due to your asthma,
even when you are pregn...ant. To be free from asthma
attacks, you should also check your lung function and use
an action plan if any symptoms occur.
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Asthma Action Plan
Doctor’s Name:
Doctor’s Phone Number:
Main Emergency Contact:
Backup Emergency Contact:
Green Zone: No coughing, wheezing, chest tightness, or shortness of breath.
Can do usual activities:
Every day: Take these medic...ines, even if you’re not having any symptoms.
Avoid triggers that you know make your asthma worse.
Medicine: / How much to take: / When to take:
Before you exercise: Take 2 or 4 Puffs of_____ 5 minutes before you start, as needed.
...
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Asthma is a chronic lung disease, which means it cannot be cured. But with the right treatment asthma can be kept under control so that those affected area be to live completely normal lives enjoyin...gfull involvement in sport and all other activities.
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Asthma usually causes symptoms over a long period and cannot be cured. But asthma can be kept under control so that those affected are able to live enjoying full involvement in sport and all other a...vtivies. New guidelines for the treatment of asthma put effective control of asthma as the most important goal.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma m...edication improves asthma control and quality of life. The aim of this journal is to provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequen...t in children. A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
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