Public health policy and guidelines for management of Asthma
Currently, 300 million people suffer from asthma globally, of that one-tenth reside in India. Nearly 4,89,000 people die annually due to asthma. Majority of fatalities occur in low- and middle-income countries, such as the Middle East and Africa (Masoli et al., 2004). Also, people with asthma in low- and middle-income countries suffer more severe symptoms in comparison to those in high-income countries. This is because of inaccurate diagnoses, no or less availability of health care, and financial incompetence for treatment (Kant, 2013). Furthermore, the concern increases as the complexity and severity of allergic diseases continue to increase especially in children and young adults (WAO, 2011). This sudden upsurge of allergic diseases calls for an inspection of existing health policy measures to counter the issue.
Global policy scenario
Asthma has been regarded as an incurable disease, demanding appropriate management. To ensure a good quality of life, it is imperative for sufficient policy structures to be in place. This necessitates the execution of relevant measures for prevention and control of the disease.
International Collaboration in Asthma, Allergy, and Immunology (iCAALL), is a joint effort by the American Academy of Allergy Asthma and Immunology (AAAAI), the European Academy of Allergy and Clinical Immunology (EAACI), the American College of Allergy Asthma and Immunology (ACAAI) and the World Allergy Organization (WAO). The consortium promotes knowledge and raises awareness at different levels.
Global Initiative on Asthma (GINA), Launched in 1995 as a collaborative effort between the National Heart, Lung and Blood Institute (NHLBI) and the World Health Organization (WHO). A new update of the GINA guidelines emphasizes on disease control. Besides enlightenment upon therapeutic options, it also spreads awareness about Asthma-COPD overlap. In order to reduce the global burden of asthma, the guidelines design stimulates the implementation of practical guidelines (Bousquet et al., 2007).
White Book on Allergy (WAO) reports statistics on the growing epidemic of allergy worldwide. It also offers a set of recommendations the “Declaration of Recommendations” for governments and health care policy makers (Pawankar, 2014).
Policy scenario in India
Indian guidelines for asthma, a collaborative initiative by the Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP); offers an evidence-based outline for general and pulmonary physicians for the diagnosis and management of asthma in general (Koul & Patel, 2015). The recommendations follow grade classification system, which forms the basis for the recommendation. The power of the guidelines lies in the evidence-based approach. RCTs and meta-analysis form the basis of approach for management, diagnosis, and treatment guidelines. However, certain shortcomings of the guidelines involve lack of consideration of practice settings. Furthermore, the local differences in availability and cost of therapies are also not taken into account. This document is the sole guideline governing asthma management in a large country with world’s second highest population.
Policy scenario in the USA
The USA leads India in policy formulation for asthma management, with a number of non-profitable organizations. The various federal and state government agencies along with these organization undertake the issues of policy legislation.
|Asthma and Allergy Foundation of America||Supporting policies aimed towards improved access to healthcare, promoting medical research, and high quality of life for people suffering from Asthma|
|Allergy and Asthma Network, Mothers of Asthmatics||Network of families dedicated to offering information about living with asthma, and the relevant policy issues|
|American Lung Association||Working with the mission to prevent lung diseases and promoting lung health. The organizational programs aim to influence the development and enforcement of laws and regulations at national, state, and local level. Thereby helping policymakers with authoritative information.|
|CDC’s Public Health Law Program||Working with the mission to improve public health through law. It also offers resources dedicated to public health issues, especially focused on asthma.|
|Department of Health and Human Services||Healthy People 2020 national health objectives for asthma dedicated to the promotion of respiratory health facilitated through prevention, detection, treatment, and educational efforts.|
Table 1: Initiatives for prevention, management, and treatment of Asthma in the USA
Other relevant policy measures include Global Allergic Rhinitis and its Impact on Asthma guideline (ARIA). provides an evidence-based practice for management of AR. It has recently been updated using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology (Brożek et al., 2017). National Asthma Policy Agenda works towards the development of public policy agenda to reduce morbidity and mortality due to asthma.
The policy management of non-communicable diseases, such as Asthma, needs to be addressed in a similar fashion as the communicable diseases. These are communicated by global promotion of products and lifestyles, lest they insidiously undermine the health and wealth of nations. The high, middle and low income countries need to collaborate to counter the increasing mortality rates and economic burdens. Additionally, worldwide solutions need to focus on generalizable preventive and curative solutions. With respect to India, to accomplish this shared purpose it is important to recognize the need to decrease the allergy burden. The large population demands development of cost-effective innovative preventive strategies. Hence, a highly integrated, holistic approach, such as shown by the USA can help lower mortality rates simultaneously enhancing the quality of life.
- Bousquet, J., Clark, T.J.H., Hurd, S. & Khaltaev, N., 2007. GINA guidelines on asthma and beyond. allergy, 62, pp.102-12.
- Brożek, J.L. et al., 2017. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines—2016 revision.
- Kant, S., 2013. Socio-economic dynamics of asthma. Indian Journal of Medical Research, 138(4), pp.446–48.
- Koul, P.A. & Patel, D., 2015. Indian guidelines for asthma: Adherence is the key. Lung India, 32(1), pp.S1–S2.
- Masoli, Fabian, Holt & Beasley, 2004. The global burden of asthma: executive summary of the GINA Dissemination Committee report. allergy, 59(5), pp.469-78.
- Pawankar, R., 2014. Allergic diseases and asthma: a global public health concern and a call to action. WAO Journal, 7(1), p.12.
- WAO, 2011. Allergic Diseases: A Global Public Health Concern.