Asthma: Rising Prevalence And The Key Challenges In The Management

Over the past three-four decades, there has been a significant increase in the number of morbidity and mortality due to asthma. As per the WHO’s 2019 data, an estimated 262 million people worldwide were affected by asthma and caused nearly 4,61,000 deaths. The low- and lower-middle-income countries registered the most asthma-related deaths, and still, many of the cases remain under-diagnosed and under-treated. 

The limited access to quality care and medication is a major reason for the increasing burden of asthma in the developing world. Apart from the economic front, it also causes a significant physical burden on the patient. The affected person has to avoid physical activity and exercise and often require to abstain from coming in close contact with certain environmental triggers. Overall, it has a direct negative impact on the social and mental well-being of the person. 

Asthma is a non-communicable disease (NCD) that affects the lungs’ airways. It is a chronic condition that results in inflammation and narrowing of the bronchial tubes and limits the airflow. Increasing environmental smoke due to industrialization, urbanization, and air pollution has contributed significantly to the increasing prevalence of asthma. The lifestyle changes related to diet and physical activity, and obesity are also expected to closely associate with the increase in asthma prevalence.

What are the most common types of asthma?

Asthma is categorized on the basis of severity, symptoms, and triggers. Sometimes, the symptoms of different types of asthma often overlap with each other. The identification of the type of asthma plays a key role in the treatment. Some of the common types of asthma include:

• Childhood asthma – Childhood asthma is a chronic condition in which the airways are narrowed. The symptoms are generally difficult to diagnose. 
• Adult-Onset asthma – It is mostly developed in adulthood, i.e., beyond the age of 20. The symptoms are more persistent, and the chance for death is also higher as compared to childhood asthma.
• Allergic asthma – It is the most common type of asthma, often triggered when the person comes in contact with dust, mold, pollen, or similar particles.
• Exercise-induced asthma  – A person experiences exercise-induced asthma while doing physical activity or exercise. It results in extreme shortness of breath, wheezing, and a tight chest. 

Apart from these, cough-variant asthma, occupational asthma, non-allergic asthma are some common types of asthma. 

What are the risk factors for asthma?

Certain genetic and environmental factors can influence the risk of asthma. If either of the parents has asthma, it increases the risk of developing asthma in children about three to six times. Similarly, the allergic condition (such as atopic dermatitis), smoking (or exposure to secondhand smoke), stress, exposure to certain chemicals, air pollution, viral respiratory illness during childhood, and obesity increases the risk. 

What are the most common symptoms and signs associated with asthma?

The symptoms develop when the person encounters an asthma trigger such as dust, cold air, cigarette smoke, pollen, or similar particles. The symptoms of asthma vary from person to person and also according to the severity. In the case of severe symptoms, the person might require emergency health care, and in some cases, it can also lead to death.  The most common asthma symptoms include persistent or frequent coughing, wheeze, shortness of breath, and chest tightness. Similarly, increased mucus production, trouble during exercise and sleep due to breathing problems, poor concentration, and tiredness during the day are other symptoms. It is observed that the early recognition of the signs and symptoms can play a vital role in managing asthma. 

How is asthma diagnosed?

The asthma is diagnosed based on the medical history of the patient and a physical examination. Personal history considers the previous medication intake, family history of asthma or related disease, existing medical conditions, lifestyle, exposure to particular harmful environmental exposure, and others. In the physical examination, the doctor examines the nose, throat, and upper airways. A lung function test is carried out to detect how well the person exhales air. Lung function test includes Spirometry, FeNO Test, and Peak Airflow. Similarly, the X-ray of lungs or sinuses is also performed. 

What are asthma treatment options available in the market?

As of now, there is no cure for asthma; however, with the support of medications, its symptoms can be minimized to the level that the affected person can live a healthy and active life. As per the Asthma UK and British Lung Foundation Partnership, In UK, “around 5.4 million people are currently receiving treatment for asthma which accounts for nearly one in every 12 adults and one in every 11 children”. 

The type of medication that a person requires depends upon age, symptoms, and severity. The two types of medicines available in the market include long-term controllers and quick-relievers. The controller medications for asthma aims to prevent or improve the chronic symptoms in patients who experience asthma more frequently. The person needs to take medicine regularly. Some of the most common long-term control medicines include inhaled corticosteroids, leukotriene modifiers, cromolyn sodium, theophylline, inhaled long-acting beta-agonists, and others. In contrast, rescue medications or Quick-Relief Medicines work within a short period of time. They are not taken on daily biases but for rapid relief of symptoms in case of an asthma attack. short-acting beta-agonists, long-acting muscarinic antagonists (LAMA), or anticholinergics are common Quick-Relief Medicines for asthma. Similarly, today certain biologics are also available to treat asthma.

At the global level, companies such as Amgen, AstraZeneca, GlaxoSmithKline, Regeneron Pharmaceuticals and others are actively engaged in the development of new therapies for asthma. At present, many therapies are in the clinical stage of development; the launch of these in the coming year is expected to improve the treatment scenario. 

What are the key challenges in the asthma market?

Asthma today is a global health issue affecting countries worldwide and also people across different age groups. It has a direct and indirect socio-economic impact on the person and their families. Along with the rising prevalence, the cost of treatment has also increased many folds over the years. Asthma is generally considered a costly illness due to its chronic nature. The cost of treatment varies significantly from country to country. As per the Annals of the American Thoracic Society, in 2013, the economic burden of asthma on the United States, including costs incurred by absenteeism and mortality, was around $81.9 billion. 

Under-diagnosis is one of the major challenges in asthma management. Similarly, the limited access to quality healthcare is another reason for the high death rate due to asthma, particularly in developing countries. If proper treatment is provided to the patient, the asthma-related death can be avoided.  The regulatory issues, high cost of inhalers, skipping medication, poor healthcare infrastructure, and training of healthcare workers, especially in developing countries, create huge challenges. Similarly, the lack of knowledge and resources and side effects of the medications also make asthma management difficult.

What lies ahead?

Asthma causes a significant number of deaths worldwide every year. To tackle the rising prevalence, the WHO, in coordination with the local governments, is actively involved in diagnosing, treating, and monitoring asthma. 

Similarly, asthma is included in the WHO’s Global Action Plan for the Prevention and Control of NCDs and the United Nations’ 2030 Agenda for Sustainable Development. In the coming years, the research and development activities by the key pharmaceutical companies, rising awareness among people, key initiative by the health organization and the governments, the launch of emerging therapies, easier-to-use inhalers, technological advancement in diagnosis and treatment strategies will drive the market growth rate and also provide the better healthcare outcome for the people affected with asthma.