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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Severe childhood asthma in low and middle-income countries
Jose A Castro-Rodriguez1, Manuel E Soto-Martínez2, Carlos E Rodriguez-Martinez3
1Department of Pediatric Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
Severe asthma in low- and middle-income countries presents significant challenges despite lower prevalence. Improving access to affordable treatments and addressing environmental factors are crucial for better child asthma management.
Area of Science:
- Public Health
- Pediatric Respiratory Medicine
- Global Health Equity
Background:
- Severe asthma affects children and adolescents in low- and middle-income countries (LMICs), causing significant morbidity and management challenges.
- Prevalence is influenced by socioeconomic inequities and environmental risk factors like pollution and allergens, with disadvantaged children at higher risk.
- Inadequate treatment is common, with low use of inhaled corticosteroids and spacers, and outdated medication choices in some regions.
Purpose of the Study:
- To analyze the challenges and cost-effective management strategies for severe asthma in LMICs.
- To identify key barriers to adequate asthma care and follow-up in these settings.
- To propose public health priorities for improving asthma outcomes in LMICs.
Main Methods:
- Review of current asthma prevalence, risk factors, and treatment patterns in LMICs.
- Analysis of the cost-effectiveness of various asthma management therapies, including biologics.
- Identification of barriers to healthcare access and patient compliance.
Main Results:
- Despite lower prevalence, severe asthma poses significant morbidity and management issues in LMICs.
- Many patients receive suboptimal treatment, with low adherence to recommended therapies like inhaled corticosteroids and spacers.
- Cost-effective treatments include maintenance and reliever therapy (MART) and triple therapy; biologics are not cost-effective in LMICs.
- Poorly organized health services, limited diagnostics, and patient non-compliance are major barriers to adequate follow-up.
Conclusions:
- Urgent public health interventions are needed to improve severe asthma care in LMICs.
- Priorities include enhancing access to affordable medications, improving diagnostic capabilities, and mitigating environmental risk factors.
- Addressing socioeconomic disparities and healthcare system weaknesses is essential for reducing asthma burden in vulnerable populations.
Abstract:
Although severe asthma in low- and middle-income countries (LMICs) is relatively uncommon in children and adolescents (2.1 % and 4.3 %, respectively), it results in significant morbidity, occasional fatality, and great challenges of management, compared to high-income countries. Additionally, nearly 6 % of infants in LMICs experience nighttime symptoms on a weekly basis. Socioeconomic inequities and exposure to environmental risk factors contributed to variability in prevalence, with children from disadvantaged backgrounds being at a higher risk of developing the condition. Numerous preventable risk factors have been identified in these regions, including tobacco smoke, indoor and outdoor pollution (e.g., the use of biomass fuels), allergens, diet, and urbanization, among other lifestyle factors. Almost half of the patients with severe asthma received inadequate treatment. For example, only 55 % use inhaled corticosteroids (ICS), and while most physicians prefer pressurized metered-dose inhalers, only a third recommend using spacers. In some countries, oral short-acting beta agonists and theophylline are still used as treatment options. Compared to fixed-dose ICS/long-acting beta-agonists (LABA), maintenance and reliever therapy (MART), adding tiotropium, and triple therapy (ICS + LABA + LAMA) are cost-effective options in LMICs. Biologic drugs are expensive and have limited access, and studies have shown that omalizumab and dupilumab are not cost-effective treatments in LMICs. Barriers to adequate follow-up include poorly organized health services, limited spirometry, and patients' non-compliance. Public health efforts should prioritize improving access to affordable asthma medications, enhancing diagnostic capacity in underserved areas, and addressing environmental risk factors that contribute to asthma.
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