Together we can all STOP asthma!

Today we celebrate World Asthma Day, an annual event organised to improve asthma awareness and care globally.

It is estimated that asthma affects around 235 million patients globally. Although the prevalence of the illness in developed countries has stagnated or even declined, there has been a surge in disease incidence in low- and middle-income countries which are increasingly experiencing higher asthma complication rates than developed countries.

This year’s World Asthma Day theme ‘STOP for asthma’ emphasizes on Symptom evaluation, Testing for treatment response, Observation and assessment for asthma response and finally Proceeding with treatment adjustment.

We aim to arm patients, carers and healthcare workers with relevant information about asthma and its management.

The adage “Life can only be understood backwards; but it must be lived forwards” is one that is quite relevant in the field of medicine. Documentation on asthma goes as far back as 2600 BC when ancient Chinese scribes accurately described asthma as an illness that was characterised by noisy breathing.

Historically, the treatment of asthma varied significantly from the inhalation of smoke from burning herbs to outrightly bizarre treatments such as drinking the “soup of fat hens” or smoking tobacco. As the art of medicine advanced, asthma was increasingly understood to be a direct result of an overreaction of the respiratory tract immune system due to harmless substances such as pollen, smoke or dust.

In fact, a widely appreciated theory, the hygiene theory, advances that as a society’s social-economic conditions and hygiene improves, the immune system becomes increasingly hyperresponsive to harmless environmental substances resulting in various allergic conditions such as asthma.

Over the years, scientists’ determination to better manage asthma paid off with newer asthma medicines being developed. Broadly, asthma treatments can be divided into two, relievers and controllers.

Reliever medication are used to eliminate the chest tightness and difficulty in breathing experienced during asthma attacks whereas controllers are used to reduce or even prevent asthma attacks from occurring ab-initio.

Asthma medicines have also evolved from predominantly oral and injectable forms (which ameliorate asthma symptoms albeit with many unwanted side effects) to inhalation medication which have become indispensable in asthma treatment.

Interestingly, the precursor of the modern-day inhalers was developed by a father whose daughter was experiencing challenges using her asthma medication highlighting the significant role played by carers of asthma patients.

Inhaled medicines have over time revolutionised asthma treatment resulting in much smaller drug quantities being delivered directly to the lung and adjacent airways without passing through the blood stream and causing unwanted side-effects.

Inhaled controller medication like steroids suppress the excessive immune reaction in the lungs preventing the occurrence of disruptive asthma symptoms, hospitalization and even asthma-related deaths.

All the treatment benefits associated with inhaled steroids have occurred while simultaneously reducing the debilitating side-effects of prolonged oral steroids such as obesity, hypertension, osteoporosis, facial mooning, diabetes, acne and skin thinning making inhaled steroids vital in asthma treatment.

Further advances in drug development have also led to the combination of several asthma controllers in single inhaler devices and the simplification of drug administration frequencies. Nowadays, inhaled asthma controller medications can even be used once a day in stark comparison to earlier inhaled steroids which were typically used four times a day!

Another key element of this year’s theme is asthma control, a key topic due to the rising levels of poorly controlled asthma and its association with high healthcare costs and poor disease outcomes.

In fact, numerous patient surveys show that up to half of all asthma patients are sub optimally controlled despite the better asthma knowledge and medication available.

Worse still, many asthmatics have adapted their daily activities to their illness with others outrightly downplaying their disease’s severity. In fact, to guarantee good asthma control, it would require the partnership of key stakeholders such as patients, their careers, doctors, healthcare policy developers and implementors.

The important role played by patients and their carers is increasingly being appreciated with patient-friendly asthma assessment tools such as the asthma control test being developed to allow patients to objectively evaluate their illness.

In fact, such simple paper or internet-based asthma control scoring tools take a few minutes to fill providing important information which could be used to improve asthma management and alert patients when to urgently seek medical attention thereby limiting disease complications such as repeated asthma attacks and even asthma-related deaths.

In reflecting on this year’s World Asthma Day theme, the use of appropriate asthma treatments and the pro-active assessment of asthma control can change the existing narrative of poor asthma outcomes in developing countries like Kenya. Together, let us STOP asthma!

(Dr Biko is the Respiratory and Allergy Medical Advisor at GSK. Email

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