Global Study Finds Asthma Management Inadequate

Luis García-Marcos, PhD

An international investigation on asthma assessed medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood.¹ Based on the findings that suggested inadequate management and disease control, investigators urged for the implementation of improvement strategies targeting treatment adherence worldwide, specifically related to those affected in low and middle-income countries.

World Health Organization (WHO) estimates reported that in 2019, 262 million people were affected by asthma and the non-communicable disease was the cause of death for 455,000 people. The chronic respiratory condition is the most common non-communical disease disease among children, and has one of the highest prevalence rates worldwide.

The Global Asthma Network Data

The team of investigators led by Luis García-Marcos, Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children‘s Hospital, University of Murcia and IMIB Bio-medical Research Institute, used data from the Glocal Asthma Network phase 1 cross-sectional epidemiological study (2015-2020).

Children (6-7 years), adolescents (13-14 years), and adults (19 years or older), were given a validated, written questionnaire to complete distributed through their schools. Parents or guardians completed the survey for children and adolescents.

Investigators collated responses for those with a diagnosis of asthma based on their medicine regimen over the past year, identifying the type of inhaled or oral medicine and frequency of use. The questions also assessed asthma symptoms and health visits to determine the severity of symptoms and extent of asthma control within the same time period.

Additionally, the investigation categorized countries by income level based on gross national income per capita according to the 2020 World Bank classification.

Results were demonstrated by proportions and 95% confidence interval (CI), and generalized structural equation multilevel models were utilized to examine factors involved with receiving medicines and having poorly controlled asthma across each age group.

Asthma Severity, Medicine Use, and Country Income

The study included 453,473 individuals from 63 centers in 25 countries. The population of children consisted of 101,777 and of that, 6445 (6.3%) had an asthma diagnosis from a doctor. The adolescent group of 157,784 included 12,532 (7.9%) who had a diagnosis, and in the group of 193,912 adults, 6677 (3.4%) had received a diagnosis.

Investigators found that symptom severity and country income category were factors in the use of asthma treatment. Inhaled short-acting β2 agonists (SABA) were used the most, spanning from 29.3%-85.3% acrossi age groups, followed by inhaled corticosteroids (12·6–51·9%).

Individuals residing in middle-to-low-income countries represented a significantly higher proportion of individuals not taking inhaled corticosteroids alone or with long-acting β2 agonists despite reporting severe asthma symptoms.

Without factoring in country income, this proportion remained high across all age groups. In children, 934 (44.8%) of the 2085 with severe symtoms were not participating in treatment. This rate was higher among the group of 3345 adolescents (2011 [60.1%]), and the group of 2058 adults (1142 [55.5%]).

"Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines," investigators wrote.

Compared with high-income countries, countries with low income were associated with overall poor asthma control. Findings demonstrated a significant association between having an asthma management plan and use of inhaled or oral medicine, independent of country income and asthma severity.

"Asthma management and control is frequently inadequate, particularly in low-resource settings," the team concluded. "Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries."

References:

1. García-Marcos L, Chiang C, et al. Asthma Management and Control in Children, Adolescents, and Adults in 25 countries: a Global Asthma Network Phase I Cross-Sectional Study. The Lancet Global Health. Published February 2023. https://doi.org/10.1016/S2214-109X(22)00506-X
2. World Health Organization. Fact Sheets: Asthma. Published May 11, 2022. https://www.who.int/news-room/fact-sheets/detail/asthma