Despite the increased focus on the health and development burden of non-communicable diseases (NCDs), the priority interventions will do little to ameliorate the enormous and growing impact of asthma, according to an article by the Steering Group of the Global Asthma Network published this week in The Lancet Respiratory Medicine.
Asthma affects 235 million people worldwide, causing them to lose time at school or work and thus exacting both direct and indirect costs for themselves, their families and society. Among children, it is the most common chronic disease, with 15% of all children having suffered from asthma symptoms in the past 12 months.
Chronic respiratory diseases are among the five priority NCDs that are the principal concern, but the interventions proposed – tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies – are more relevant to the other four: heart disease, stroke, cancer and diabetes, the article says.
"The focus of the discussion about NCDs has been on adult mortality", says co-author Dr Nils E Billo, Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union). "Asthma rarely causes death, although its impact is enormous, with the Global Burden of Disease report ranking it 14th in terms of global years lived with disability".
One of the NCD priority interventions – access to essential medicines and technologies – is a critical issue for asthma. According to research conducted by The Union, the high cost of quality-assured essential asthma medicines is a major obstacle to effective care, especially in low- and middle-income countries.
"But access to medicines alone is not enough", says Billo. "They have to be linked to programmatic disease management to have a significant effect". The other interventions, specifically tobacco control and improved diet, could be expected to have some positive impact, but they are not at the heart of what is needed for improved global asthma control.
With the global burden of asthma increasing rapidly over the past two decades, what is urgently needed is a balanced approach that combines research and policy issues focused on the following:
• Research to discover the causes of the disease and the reasons for its increasing prevalence, as well as to study other issues, such as ways to optimise the cost-effective use of efficacious asthma medicines.
• Prevention of asthma attacks and control of symptoms through improved access to quality-assured essential asthma medicines
• Improved training in self-management for patients and extensive training for clinicians, nurses and health care workers who diagnose and manage asthma
• Strengthening of health systems to improve long-term management and regular follow-up of patients with asthma
• Investment in asthma surveillance to monitor and evaluate progress.
Addressing the specific needs of asthma is particularly important given the global increases in asthma prevalence that are likely to occur in the next two decades if nothing is done. It would be ironic and counter-productive, the article concludes, if progress were achieved in the prevention and control of the "old" major NCDs, such as cardiovascular disease, cancer and diabetes, while the looming global epidemic of asthma was ignored.
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Read the article:
Pearce N, Asher A, Billo N, Bissell K, Ellwood P, El Sony A, García-Marcos L, Chiang C-Y, Mallol J, Marks G, Strachan D. Asthma in the global NCD agenda: a neglected epidemic. The Lancet Respiratory Medicine, Early Online Publication, 18 February 2013.
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2813%2970023-7/fulltext
For more information:
• The Global Asthma Network: www.globalasthmanetwork.org
• The Asthma Drug Facility: www.globaladf.org
• Global Asthma Report 2011: www.globalasthmareport.org
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