Dr Jayakumar Gurunathan, AstraZeneca Pharma India highlights that asthma is a leading cause of morbidity and mortality in rural India and recommends measures to manage the disease effectively
Asthma is a heterogeneous group of disorders characterised by airway inflammation and variable bronchial hyper-reactivity to a variety of physiological, immunological, noxious and pharmacological stimuli. It occurs at all ages and is responsible for a high burden of disease all over the world. According to World Health Organisation (WHO) estimates 300 million people suffer from asthma, 255,000 people died of asthma in 2005 (WHO 2004) and over 80 per cent of asthma deaths are reported from low and lower-middle income countries (Braman 2006). Asthma more often than not remains under-diagnosed or under-treated, and as a result creates a substantial burden on individuals and families.
Asthma was one of the leading causes of morbidity and mortality in rural India (Smith 2000) and according to WHO report of 2004 caused about 57,000 deaths. High-income countries have well-established screening, evaluation and management strategies. However, the scenario is quite different in India. In our country, these strategies have not been fully implemented and Asthma continues to be slotted into the general spectrum of respiratory diseases instead of being treated independently (Sutapa Agrawal, http://www.sancd.org/FactSheets-55.html). To add to this, even though medicines for the treatment of asthma is available at affordable costs, they rarely reach more than one per cent of those who would benefit from it (Krishnakumar 2003).
According to the cross-sectional, nationally representative National Family Health Survey (NFHS)-3, the overall prevalence of asthma among adult men and women in India is similar with 1,696 and 1,627 per 100,000 respectively (IIPS and Macro International 2007). It has been observed that with age, asthmatic conditions increase in both men and women. Interestingly, the prevalence of asthma is higher in rural areas than in urban areas and it is more common among women than men.
Air pollution and asthma
Air pollution is physical or chemical changes brought about by natural processes or human activities that result in air quality degradation (Cunningham et al, 2005). The release of large amounts of smoke and other forms of waste into the air cause an unhealthy condition because the pollutants are released faster than they could be absorbed and dispersed by the atmosphere (Enger & Smith, 2000).
The role of outdoor air pollution caused by vehicular emissions in heavily polluted cities in exacerbating asthma attacks is well established, and it may also be risk factor for development of asthma. In recent years, scientists have shown that air pollution from factories and power plants is a major cause of asthma attacks. An understanding of the triggers for asthma attack can help asthma sufferers keep the disease in check. It can be as simple as avoiding dust, tobacco smoke or cockroach droppings. However, the problem arises because of the air outside our homes, which is filled with asthma triggers.
Management of asthma
Management of asthma is possible only through the prevention of the onset of disease among individuals who are susceptible to it – a common precursor to the development of asthma is allergic sensitisation. (Jones et al. 2000; Bousquet et al. 2000).
Along with environmental control and medications, the international community now considers patient education programmes an integral component of asthma management (National Asthma education programmer expert panel report 1991). Indian medical staff has called for private practitioners as well as hospital doctors to be included in continuing medical education programmes on asthma management. Additionally, provision of separate clinics for asthma at an institute level has been directed to improve patient awareness and quality of asthma care delivery. (Bedi and Singh 1994; Gupta and Gupta 2001; Hegde et al. 2002). Individual studies done in India show that efficacy of patient education and parental awareness is an effective way in managing asthma. (Singh et al. 2002; Gupta et al. 1998; Ghosh et al. 1998; Lal et al. 1995).
It is recommended that people with asthma take adequate guidance from their physician, and adopt a healthy lifestyle through a balanced diet and avoid obesity at all costs (Mishra 2004). Short acting beta-2 agonists should be used prior to anticipated exercise, in a patient with exercise-induced asthma, to alleviate symptoms.
Case of asthma can go down considerably, if diagnosed and managed at a primary care level. Absence of symptoms does not mean absence of disease, early commencement and maintenance of anti-inflammatory therapy, such as inhaled corticosteroids may prevent the progression of the disease. Most patients with mild asthma have good functional outcome and low healthcare utilisation (Koh and Irving 2007). Device plays an important role in asthma management because the appropriate dose and ease of use will determine the patient response and appropriate asthma control.
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