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Improving Asthma Management and Control in India with Breathefree

Gogtay JA.

RDD Asia 2016. Volume , 2016: 33-36.

Abstract:

Asthma and chronic obstructive pulmonary disease (COPD) have become significant social, medical, and financial burdens in India, affecting nearly 50 million individuals. Most asthma begins in childhood and continues into adulthood, so patients are impacted throughout their lifetime and societal costs accumulate. Treatment mainstays are inhaled corticosteroids (ICS) with or without long acting beta agonists (LABAs), but many patients also need the addition of oral montelukast or inhaled tiotropium if they continue to have low lung function and exacerbations. As our understanding of the pathophysiology of the disease and the pathways involved in the inflammatory process has improved, biologics are becoming an important part of treatment, especially in those with severe asthma. 

In spite of the treatment options now available, and the possibility of good control in the majority of patients as shown in the Gaining Optimal Asthma Control (GOAL) study, asthma control in the real world continues to be poor. The Asia-Pacific Asthma Insight and Management (AP-AIM) study surveyed 3,630 patients in eight countries. Using the Global Initiative for Asthma (GINA) definition of asthma control, only 7.6% had well controlled asthma with the highest percentage reported from Singapore (14%) and the lowest from India (0%) and China (2%). The AP-AIM India study was conducted in eight urban cities in India: Ajmer, Delhi, Kolkata, Rourkela, Chennai, Mangalore, Mumbai and Rajkot. Face-to-face interviews were conducted in adult asthmatics and parents of asthmatic children. This study clearly highlighted the fact that asthma management in India remains very poor, with a significant proportion of patients experiencing bothersome symptoms and worsened quality of life. A similar study conducted in the US had already shown that failing to achieve the GINA defined level of asthma control was associated with higher health care resource utilization and lower productivity. The Indian part of the study showed 93% more work/school absenteeism related to asthma (compared to healthy patients) and that a majority of patients were taking oral medication. Nathan et al. recently published results of the global Asthma Insights and Management (AIM) study conducted in over 10,000 patients from across the world. This study showed that while only 9% of patients had well controlled asthma as defined by guidelines, a median of 67% perceived their asthma to be well or completely controlled. Importantly, this study revealed an ongoing need for improving asthma care and education.