Asthma management in low and middle income countries: case for change

Abstract

Asthma is the most common non-communicable disease in children, and among the most common in adults. The great majority of people with asthma live in low- and middle-income countries (LMICs), where they suffer disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality.Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1–3 times/week do not need (or benefit from) ICS. Even when ICS is prescribed, many patients manage their asthma with oral or inhaled short-acting beta2 agonist (SABA) alone, due to issues of availability and affordability. A single ICS-formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS-formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries.The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death – despite the availability of highly effective therapeutic approaches – is unacceptable. A World Health Assembly Resolution on universal access to affordable effective asthma care is needed to focus attention and investment on addressing this need.

The reality of managing asthma in sub-Saharan Africa – Priorities and strategies for improving care

“…[23] Sections of the strategy have been expanded to address the needs of patients living in these resourceconstrained settings. GINA activities include publishing articles on the implementation of the GINA strategy in the context of LMICs, [7,[64][65][66] World Asthma Day advocacy efforts to shine a spotlight on the needs of patients with asthma around the world, including in LMICs, [67] and promoting management of asthma in LMICs as a key topic for research. [68] An important aspect of all these efforts is to ensure patients with asthma, wherever they may be and are provided with care that meets a basic quality standard as outlined in the GINA strategy.…”

Asma e seus aspectos fisiopatológicos: revisão integrativa da literatura

“…Este estudo contribui de forma direta para a comunidade científica, ao passo em que realiza uma revisão integrativa dos dados bibliográficos presentes nas literaturas mais atualizadas acerca da temática da asma, dando destaque aos seus aspectos fisiopatológicos. Faz-se necessário que as informações aqui apresentadas sirvam de base para o estabelecimento de medidas públicas efetivas por parte dos órgãos governamentais a níveis federal, estadual e municipal, com o intuito de se oferecer melhorias à cobertura terapêutica exercida sobre tal patologia, que como citado anteriormente, foi a responsável por gerar cerca de 250.000 óbitos no ano de 2021 no mundo (Mortimer et al, 2022).…”

“…Na segunda metade do século XX, no ocidente, a asma foi a única doença crônica tratável que aumentou em prevalência e em número de internações (Serebrisky, & Wiznia, 2019). Em 2021, foram relatadas cerca de 250.000 mortes decorrentes de tal patologia (Mortimer et al, 2022).…”

“This guideline is not practical; it might be practical to specialists like you”: Doctors’ experiences of the Global Initiative for Asthma (GINA) guideline in Nigeria; A qualitative study

“…LMICs for example through recommendations in the report that address resource-limited settings and publications that put the GINA report in the context of the reality of asthma management in LMICs [9,17]. However, little is known about how effective these efforts have been or how the GINA report is perceived and implemented in LMICs like Nigeria.…”

“…The GINA strategy can be adapted for use in individual countries in consideration of national health systems and availability and affordability of asthma diagnostic and treatment services [14]. Over recent years, GINA has been working to maximize the relevance of the GINA report to LMICs for example through recommendations in the report that address resource-limited settings and publications that put the GINA report in the context of the reality of asthma management in LMICs [9,17]. However, little is known about how effective these efforts have been or how the GINA report is perceived and implemented in LMICs like Nigeria.…”