Chest
Decreasing the Global Burden of AsthmaThe Global Burden of Asthma
Section snippets
Asthma Prevalence Initiatives
Since 1989, GINA has collected asthma prevalence data from various surveys throughout 20 geographic regions, and compiled them to produce the Global Burden of Asthma report4 that was released in February 2004. Survey questionnaires were based on the symptom of “wheeze,” which is a key symptom for identification of individuals with asthma. Wheezing occurring at any time over a 12-month period has good specificity and sensitivity for bronchial hyperresponsiveness and a diagnosis of asthma in
Global Asthma Prevalence
Approximately 300 million people worldwide currently have asthma, with estimates suggesting that asthma prevalence increases globally by 50% every decade.4 Prevalences are high (> 10%) in developed countries and, although data are still missing (including data for much of Africa), rates are increasing in developing regions as they become more westernized (Fig 3).4 There have also been sharp increases in South Africa and the countries of the former Eastern Europe, including the Baltic States.
Why Is Asthma Prevalence Increasing?
Although understanding of many aspects of asthma has improved over the past decades, the fundamental causes of the disorder and the reasons for its increased prevalence remain largely unknown. Interestingly, the increase in asthma prevalence has been associated with a rise in atopic sensitization and a parallel increase in other allergic conditions (eg, eczema and rhinitis). Allergic sensitization appears to begin in utero. There is, undoubtedly, a genetic component to asthma, and it seems
Morbidity and Mortality
Most cases of asthma are diagnosed and managed at a primary care level. Current statistics show that there is significant morbidity and mortality among asthma sufferers, as illustrated in Figure 5 with data compiled by the National Asthma Campaign, a patient-support organization in the United Kingdom.14
Internationally, trends indicate an increasing number of hospital admissions for asthma, which is most pronounced in young children, and which reflects an increase in severe asthma, poor disease
Economic Burden
Globally, the economic costs associated with asthma exceed those of tuberculosis and HIV/AIDS combined.20 Developed economies can expect to spend 1 to 2% of their health-care budget on asthma.4 Investigations have shown22 that the financial burden on patients with asthma in different Western countries ranges from $300 to $1,300 per patient per year. In the United States, the total direct medical and indirect economic costs (ie, loss of school or work days, lost productivity, premature
Reducing the Global Burden of Asthma
Unfortunately, there are a number of significant barriers to reducing the burden of asthma (Table 3).4 For the governments of much of the population of the world, asthma is not a health-care priority. In developing countries, many patients have very limited access to care and essential medications. In addition, asthma management must compete for access to this limited medical care and funding with other illnesses. For example, in Africa the most urgent health-care priorities are poor nutrition,
GINA: Six-Point Asthma Management Program
As part of its commitment to reducing the global burden of asthma, GINA has outlined a six-point patient management plan to address one of the greatest challenges: the effective handling of the increased numbers of asthma patients in primary care (Table 4).4 The plan focuses on patient education, written medication plans, and ongoing communication and review with patients and their providers. The introduction of specialist asthma nurses in some European countries (eg, the United Kingdom,
Participant Feedback and Discussion
Various aspects of Dr. Braman's presentation were put to the participants of the American College of Chest Physicians symposium, with a specific focus on experiences in their own clinical practices. Questions addressed to the participants included the following:
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What percentage of your clinical practice is dedicated to treating asthma?
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What percentage of your patients have asthma that is intermittent, mild persistent, moderate persistent, or severe persistent?
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Is there a consistent referral
Conclusions
Despite considerable knowledge with regard to the pathologic basis of asthma, the ongoing increases in asthma prevalence—and subsequent increases in morbidity and mortality—cannot yet be explained. In addition, the GINA goals of asthma management are not being achieved, with considerable underdiagnosis and underappropriate or inappropriate treatment. A significant proportion of patients are receiving only basic care and are not able to benefit from therapeutic advances. For the majority of the
Acknowledgment
The author thanks Carole Manners, PhD, for writing and editorial support in the development of this article.
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Dr. Braman has no conflict of interest or financial investment that would pertain to the substance of this article. However, he has been a consultant and has been on the speakers bureau of GlaxoSmithKline, Altana Pharma, BI, and Schering Plough Inc.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).