INT J TUBERC LUNG DIS 18(3):254 © 2014 The Union http://dx.doi.org/10.5588/ijtld.14.0096
EDITORIAL
The importance of measuring asthma control in emerging economies ALTHOUGH in recent years it has been somewhat overshadowed in terms of its impact by concern about chronic obstructive lung disease, asthma is a major global burden. Asthma has major public health implications in that in many countries it remains the most common cause of hospitalization among children. Furthermore, because as a disease it predominantly occurs in younger persons, it has a major economic impact. This impact has been underestimated in the past, especially in terms of its effect on productivity.1 Despite effective therapies, in many cases asthma control is suboptimal. However, public health campaigns based on this recognition have been shown to be effective at national level.2 In recent years there has been added recognition that although infectious diseases have a significant impact in emerging economies, chronic diseases are and will increasingly be a challenge in these countries also. With the recognition of the importance of asthma and of achieving asthma control, a number of asthmaspecific measurement tools have been used to document asthma control. They have been useful in defining asthma control and the risks associated with poorly controlled asthma, not only in terms of an individual’s increased risk of experiencing an exacerbation, but also in terms of their economic impact. In this context, the study by Serugendo et al. published in this issue is a useful contribution to the literature.3 In some respects the results are not surprising, in that the study population represents a sample of patients recruited in a hospital setting. The authors are to be congratulated, however, as they have taken a validated instrument and compared it to a pragmatic, consensus-based descriptor of the level of asthma control from the Global Initiative in Asthma (GINA). An added feature of this report that deserves comment is the apparent low level of controller therapy being used in this population. The foundation therapy for asthma remains inhaled corticosteroids (ICS), and although subpopulations of patients with neutrophilic asthma and those who are current smokers are less likely to respond to ICS, at the population level the availability and correct use of ICS has been associated with improved levels of asthma control.
The current report therefore deserves emphasis from a number of perspectives. First, the authors and others are to be encouraged to complete more largescale population-based studies documenting the degree of asthma control in emerging economies. In addition, such studies should carefully document the availability of and access to preventer asthma therapies, most notably ICS. Correlating the degree of asthma control and availability of ICS will be a powerful method of leveraging support from national governments, non-governmental organizations and industry to provide cheap, widespread access to ICS. In this regard the current study also highlights the need for The Union to continue to develop its Asthma Dug Facility as a means to improve access to asthma therapy.4 Finally, it highlights the need for asthma guidelines to continue to emphasize the pivotal role of ICS in asthma care and to bring an awareness to the challenges of managing asthma in emerging economies, as does the forthcoming revised GINA management strategy (http://ginasthma.org/). J. Mark FitzGerald, MB, MD, FRCPC, FACCP, FACP Mohsen Sadatsafavi, MD, PhD The Lung Centre Institute for Heart and Lung Health University of British Columbia Vancouver, BC V5Z 1M9, Canada e-mail: [email protected] References 1 Sadatsafavi M, Rousseau R, Chen W, Zhang W, Lynd L, FitzGerald J M, on behalf of the Economic Burden of Asthma (EBA) Study Team. The preventable burden of productivity loss due to suboptimal asthma control: a population-based study. Chest 2014 (in press). 2 Haahtela T, Tuomisto L E, Pietinalho A, et al. A 10 year asthma programme in Finland: major change for the better. Thorax 2006; 61: 663–670. 3 Serugendo A N, Kirenga B J, Hawkes M, Nakiyingi L, Worodria W, Okot-Nwang M. Evaluation of asthma control using Global Initiative for Asthma criteria and the Asthma Control Test in Uganda. Int J Tuberc Lung Dis 2014; 18: 370–375. 4 Billo N E. Do we need an Asthma Drug Facility? [Editorial] Int J Tuberc Lung Dis 2008: 12: 391.
EDITORIAL
The importance of measuring asthma control in emerging economies ALTHOUGH in recent years it has been somewhat overshadowed in terms of its impact by concern about chronic obstructive lung disease, asthma is a major global burden. Asthma has major public health implications in that in many countries it remains the most common cause of hospitalization among children. Furthermore, because as a disease it predominantly occurs in younger persons, it has a major economic impact. This impact has been underestimated in the past, especially in terms of its effect on productivity.1 Despite effective therapies, in many cases asthma control is suboptimal. However, public health campaigns based on this recognition have been shown to be effective at national level.2 In recent years there has been added recognition that although infectious diseases have a significant impact in emerging economies, chronic diseases are and will increasingly be a challenge in these countries also. With the recognition of the importance of asthma and of achieving asthma control, a number of asthmaspecific measurement tools have been used to document asthma control. They have been useful in defining asthma control and the risks associated with poorly controlled asthma, not only in terms of an individual’s increased risk of experiencing an exacerbation, but also in terms of their economic impact. In this context, the study by Serugendo et al. published in this issue is a useful contribution to the literature.3 In some respects the results are not surprising, in that the study population represents a sample of patients recruited in a hospital setting. The authors are to be congratulated, however, as they have taken a validated instrument and compared it to a pragmatic, consensus-based descriptor of the level of asthma control from the Global Initiative in Asthma (GINA). An added feature of this report that deserves comment is the apparent low level of controller therapy being used in this population. The foundation therapy for asthma remains inhaled corticosteroids (ICS), and although subpopulations of patients with neutrophilic asthma and those who are current smokers are less likely to respond to ICS, at the population level the availability and correct use of ICS has been associated with improved levels of asthma control.
The current report therefore deserves emphasis from a number of perspectives. First, the authors and others are to be encouraged to complete more largescale population-based studies documenting the degree of asthma control in emerging economies. In addition, such studies should carefully document the availability of and access to preventer asthma therapies, most notably ICS. Correlating the degree of asthma control and availability of ICS will be a powerful method of leveraging support from national governments, non-governmental organizations and industry to provide cheap, widespread access to ICS. In this regard the current study also highlights the need for The Union to continue to develop its Asthma Dug Facility as a means to improve access to asthma therapy.4 Finally, it highlights the need for asthma guidelines to continue to emphasize the pivotal role of ICS in asthma care and to bring an awareness to the challenges of managing asthma in emerging economies, as does the forthcoming revised GINA management strategy (http://ginasthma.org/). J. Mark FitzGerald, MB, MD, FRCPC, FACCP, FACP Mohsen Sadatsafavi, MD, PhD The Lung Centre Institute for Heart and Lung Health University of British Columbia Vancouver, BC V5Z 1M9, Canada e-mail: [email protected] References 1 Sadatsafavi M, Rousseau R, Chen W, Zhang W, Lynd L, FitzGerald J M, on behalf of the Economic Burden of Asthma (EBA) Study Team. The preventable burden of productivity loss due to suboptimal asthma control: a population-based study. Chest 2014 (in press). 2 Haahtela T, Tuomisto L E, Pietinalho A, et al. A 10 year asthma programme in Finland: major change for the better. Thorax 2006; 61: 663–670. 3 Serugendo A N, Kirenga B J, Hawkes M, Nakiyingi L, Worodria W, Okot-Nwang M. Evaluation of asthma control using Global Initiative for Asthma criteria and the Asthma Control Test in Uganda. Int J Tuberc Lung Dis 2014; 18: 370–375. 4 Billo N E. Do we need an Asthma Drug Facility? [Editorial] Int J Tuberc Lung Dis 2008: 12: 391.
