Asthma is an anti-inflammatory chronic disease which affects the lungs. It mainly affects the airway linings which swells and the muscles encircling the airway tightening causes the airway narrow. This makes it difficult to get airway in and out of the lungs which causes the bronchial hyper responsiveness. The symptoms of the disease include:
- abdominal pain,
- increase in respiratory pulse rates (Corn 2013).
Common environmental allergens that are responsible for an asthma attack are:
- dust or mites,
- irritants such as smoke,
- air pollution,
- paints and cleaning agents
- respiratory illnesses like colds,
- sore throats
Even exercises, feeling and expression of strong emotions like anger, crying, yelling and excitement have been known to trigger an asthmatic attack (Asthma and Allergy Foundation of America 2015).
Prevalence of Asthma across our case countries
The percentage prevalence of the disease is different in all countries depending upon the geographical location, environmental behavior and life-styles. According to a recent global statistics by the Global Asthma Network, approximately 334 million people around the world are affected by it. Among them 14% of children and around 8.6% of young adults (aged 18-45 years) suffer from this condition (Global Asthma Network 2014). The prevalence is more in developed countries than the developing countries.
In India, 3-38% of children and around 2-12% of adult population are affected by it, with a national burden of this disease estimated to be at 18 million (Cavkaytar & Sekerel 2014; Jindal et al. 2012). In India, it is found more prevalent in females as compared to the male population. The condition is known to increase with age in rural areas because of the use of wood and coal as a fuel for cooking (Salvi et al. 2014). Another reason attributed to asthma is the family history of smoking habits.
With respect to Australia, one child in six under the age of 16 are affected by it and about 17-30% of adults are affected (WHO 2016). Further, with respect to the whole population, the prevalence was in 10.8% of the total population. It is found more common in people living in regions with high altitudes (Australian Bureau of Statistics 2015).
However, in case of USA, as per the 2014 survey, the prevalence was found to be 7.7% overall. However in case of children it was higher at 8.6% as compared to 7.4% prevalence among adult population (Centres for Disease Control and Prevention 2016).
In UK, compilation of patient and clinician reported data showed that 15.6% population (9.8 million) have been diagnosed with the disease. Similarly 29.5% (18.5 million) population showed signs suggestive of the disease (Mallol et al. 2013).
In Japan, although data does not exist on the prevalence of the disease among adults, it has been found prevalent among 17.9% of children in the 6-7 years of age group. On the other hand for teenagers (13-14 years) there is a lower prevalence of 13%. However, over the decades the number of patients of asthma has increased but the mortality rate has decreased in the country (Nishima 2009).
With respect to Africa, asystematic review of past statistical surveys was conducted in 2013. The survey revealed that the prevalence of 12.8% for the total population of the continent (Adeloye et al. 2013).
Common symptoms and diagnostic procedures
The common symptoms are:
- wheezing sound during normal breathing,
- increased nasal secretions,
- hyper expansion of thorax,
- difficulty in breathing,
- atopic dermatitis,
- shortness of breath and
In case of such symptoms, a pulmonary test or spirometry test is undertaken for confirmation. Whereas, in some cases blood test is also used to diagnose the allergens or to detect a problem with the immune system (Corn 2013).
In cases of acute asthma, the most common method for testing is pulse octimetry method . This is because it rapidly detects the changes in oxygen saturation and provides an early warning of dangerous hypoxemia (Service 2010). Methacholine Challenge tests are also conducted for the diagnosis of the asthma, since lungs of an asthmatic patient is sensitive to methacholine. One can detect this as a drop in lung function during a Spirometry test. Other tests that are conducted are electrocardiogram, chest X-Ray, Brochoprovocation Test, Peak flow test, air responsiveness, and allergy tests (Dykewicz et al. 1998).
Thus among all the case countries, the Spirometry test was found to be most commonly used for the detection of this disease.
There are mainly two group of medicines for asthma, corticosteroids and bronchodilators. Corticosteroids work as preventers and bronchodilators help in immediate relief of symptoms. These medicines are also required to be given either for long or short term to the patients, depending upon their mode of action. Table 1 shows a list of such long and short term drugs for asthma. Drugs like bronchodilators and inhaled steroids are expensive. Due to which use of these medicines are less in low income countries such as India and Africa. This negatively affects the uptake of therapy among the population. The high cost of the drugs and increasing prevalence causes a great impact on economical growth of the country. This is through direct cost (medicines and hospital stay cost) and indirect costs (missed work and loss of productivity) (Barnett & Nurmagambetov 2011).
Long term and short term medications:
|Long term medication||Quick term relief medication|
|Long Acting Beta agonists||Anticholinergics|
|Combination Inhaled Corticosteroids||Beta agonists combination Anticholinergics|
|Mast cell stabilizers|
With respect to the overall economic burden of asthma, in 2007 alone, USA spent $56 billion on treatments. While in Europe, the economic cost of asthma was $14.5 billion in 2010 (Accordini et al. 2012; Global Asthma Network 2014).
Immunotherapy can be another treatment option. This method is useful when specific allergens leading to asthmatic attack are known. In this type of therapy long term exposure to small quantities of the allergen results in lesser reaction and hence less-frequent asthma attacks (Warrington 2010). In India, corticosteroids and bronchodilators by inhalation routes are the most common drugs because they provide targeted drug delivery, act faster. Also a small dose is efficient and it easy to take (Dolovich et al. 2005).
Need of higher spending towards public health
From the study, one can conclude that the prevalence of the disease has been increasing that has subsequently led to a significant increase of the economic cost for countries. Developing countries are suffering more than developed countries. This is due to poor diagnostic measures and less access to treatment and affordable therapeutic agents. There should be major shift in public health perspectives globally, with respect to spreading awareness as well as providing access to affordable long term care for their population. Furthermore, the ever increasing presence of pollutants in the air is worsening the situation, thus creating a pressure bubble on the health regulators.
- Accordini, S. et al., 2012. The cost of persistent asthma in Europe: an international population-based study in adults. International Archives of Allergy and Immunology, 160(1), pp.93–101. Available at: http://www.karger.com/Article/Abstract/338998 [Accessed January 3, 2017].
- Adeloye, D. et al., 2013. An estimate of asthma prevalence in Africa: a systematic analysis. Croatian Medical Journal, 54(6), pp.519–531.
- Asthma and Allergy Foundation of America, 2015. What Triggers or Causes Asthma? Asthma and Allergy Foundation of America.
- Australian Bureau of Statistics, 2015. National Health Survey: First Results (2014-15), Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001.
- Barnett, S.B.L. & Nurmagambetov, T.A., 2011. Costs of asthma in the United States: 2002-2007. Journal of Allergy and Clinical Immunology, 127(1), pp.145–152.
- Cavkaytar, O. & Sekerel, B.E., 2014. Baseline management of asthma control. Allergologia et Immunopathologia, 42(2), pp.162–168.
- Centres for Disease Control and Prevention, 2016. Most Recent Asthma Data. Centres for Disease Control and Prevention .
- Corn, J., 2013. What is Asthma?, Available at: https://www.thoracic.org/patients/patient-resources/resources/asthama.pdf.
- Dolovich, M.B. et al., 2005. Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines. Chest, 127(1), pp.335–371.
- Dykewicz, M.S. et al., 1998. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 81(5 Pt 2), pp.478–518.
- Global Asthma Network, 2014. The Global Asthma Report 2014, Auckland, New Zealand. Available at: http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf.
- Jindal, S., Aggarwal, A. & Gupta, D., 2012. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). The International Journal of Tuberculosis and Lung Disease, 16(9), pp.1270–1277. Available at: http://www.ingentaconnect.com/content/iuatld/ijtld/2012/00000016/00000009/art00025 [Accessed January 3, 2017].
- Mallol, J. et al., 2013. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: A global synthesis. Allergologia et Immunopathologia, 41(2), pp.73–85. Available at: http://linkinghub.elsevier.com/retrieve/pii/S0301054612001097 [Accessed January 3, 2017].
- Nishima, S., 2009. Present State and Problems of Asthma Treatment in Japan. Japanese Society of Allergology, 52(1), pp.50–53.
- Salvi, S.S. et al., 2014. Asthma Insights and Management in India: Lessons Learnt from the Asia Pacific -Asthma Insights and Management (AP-AIM) Study. Journal of The Association of Physicians of India, 63(9), pp.36–43. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27608865.
- Service, N.H., 2010. Dyna Vision Mobile Real Time Remote Patient Monitor, America.
- Warrington, R., 2010. Immunotherapy in asthma. Immunotherapy, 2(5), pp.711–725. Available at: http://www.futuremedicine.com/doi/10.2217/imt.10.47 [Accessed January 3, 2017].
- WHO, 2016. Bronchial Asthma- Fact Sheet. WHO. Available at: http://www.who.int/mediacentre/factsheets/fs206/en/.