Dr.

Mohammad Hayatun Nabi

MPH(Aus), MHSM(Aus)
Dept. of Public Health

ASTHMA
Asthma

Dr.Mohammad Hayatun Nabi

is a chronic disease characterized

by recurrent attacks of breathlessness and
wheezing, which vary in severity and
frequency from person to person.

Symptoms

may occur several times in a

day or week in affected individuals, and
for some people become worse during
physical activity or at night.
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ASTHMA FACTS

Asthma is the most common chronic disease among

children.

Dr.Mohammad Hayatun Nabi

According to WHO estimates, 300 million people

suffer from asthma and 255 000 people died of asthma
in 2005.

Asthma is not just a public health problem for high

income countries: it occurs in all countries regardless
of level of development. Over 80% of asthma deaths
occurs in low and lower-middle income countries.
Asthma is under-diagnosed and under-treated,
creating a substantial burden to individuals and
families and possibly restricting individuals activities
for a lifetime.

WHAT IS AN ASTHMA ATTACK?

During

Dr.Mohammad Hayatun Nabi

an asthma attack, the lining of the

bronchial tubes swell, causing the airways to
narrow and reducing the flow of air into and
out of the lungs.

Recurrent

asthma symptoms frequently cause

sleeplessness, daytime fatigue, reduced activity
levels and school and work absenteeism.

Asthma

has a relatively low fatality rate

compared to other chronic diseases.
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WHAT TRIGGERS AN ASTHMA

ATTACK?
Some

Dr.Mohammad Hayatun Nabi

causes and triggers are common to all

people with asthma, and some are more
individual.

Although

the fundamental causes of asthma

are not completely understood, the strongest
risk factors for developing asthma are inhaled
asthma triggers.

THESE INCLUDE:
indoor

Dr.Mohammad Hayatun Nabi

allergens (for example house

dust, mites in bedding, carpets and
stuffed furniture, pollution and pet
dander);
outdoor allergens (such as pollens and
moulds);
tobacco smoke; and
chemical irritants in the workplace.

WHAT TRIGGERS AN ASTHMA

ATTACK?

Dr.Mohammad Hayatun Nabi

Other triggers can include cold air, extreme

emotional arousal such as anger or fear, and
physical exercise.
In some people, asthma can even be triggered by
certain medications, such as aspirin and other
non-steroid anti-inflammatory drugs, and betablockers (which are used to treat high blood
pressure, heart conditions and migraine).
Urbanization has also been associated with an
increase in asthma, however the exact nature of
this relationship is unclear.

GLOBAL BURDEN AND

MANAGEMENT OF
ASTHMA IN DEVELOPING
COUNTRIES

MORTALITY
to 9 /100 000 in industrialized countries
Mortality rate higher in poorest minorities
of industrialized countries
No data available in developing countries

Dr.Mohammad Hayatun Nabi

DISEASES

IN DALYS*, WORD BANK

ESTIMATION1999
Region

Tuberculosis

COPD

Asthma

Africa
Southeast Asia
Western Pacific
Eastern
Mediterranean
Europe
The Americas
World

2.3
3.4
2.2
1.8

0.5
1.5
8.5
1.3

0.6
0.8
1.3
0.9

1.4
0.9
2.3

4
1.8
2.7

1.6
1
0.9

* Disability-adjusted life years

World Health report 2000, health systems, improving performance
Dr.Mohammad Hayatun Nabi

10

ASTHMA COST
Direct: drugs, consultations, hospitalizations
Indirect: loss in productivity
Intangible: patient/ family repercussions
Direct cost/patient : 300 to 1000 $US
In US : 2 billions of US $/year, 5,5% of family
income by patient
Costs and deaths increase with inadequate care

Dr.Mohammad Hayatun Nabi

11

HOW TO REDUCE THE BURDEN OF

ASTHMA?

Short-term medications are used to relieve

symptoms.
People with persistent symptoms must take longterm medication daily to control the underlying
inflammation and prevent symptoms and
exacerbations.

Dr.Mohammad Hayatun Nabi

Although asthma cannot be cured, appropriate

management can control the disease and enable
people to enjoy good quality of life.

12

HOW TO REDUCE THE BURDEN OF

ASTHMA?

Although asthma does not kill on the scale of

chronic obstructive pulmonary disease (COPD) or
other chronic diseases, failure to use appropriate
medications or to adhere to treatment can lead to
death.

Dr.Mohammad Hayatun Nabi

Medication is not the only way to control asthma.

It is also important to avoid asthma triggers.
With medical support, each asthma patient must
learn what triggers he or she should avoid.

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Standardized care with

essential drugs
Diagnosis and asthma severity based on symptoms and PEF

No inhaled beclomethasone

Dr.Mohammad Hayatun Nabi

Inhaled beclomethasone Severe

2000g/d
persistent
Step
Prednisolone ?
down
Inhaled beclomethasone Moderate
1000g/day
persistent
Mild
Inhaled beclomethasone 500g/day
persistent

Intermittent

Inhaled salbutamol 100g on demand < 4 times/day at all severity grade

Technical package as in TB: Treatment card and register

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Dr.Mohammad Hayatun Nabi

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BARRIERS FOR
MANAGEMENT OF ASTHMA IN
POOR COUNTRIES
Low income and low health expenditure per
capita
Highest priorities: communicable diseases
Poor organization of health services
Health personnel: number and training
Low patient affordability for asthma drugs

Dr.Mohammad Hayatun Nabi

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THE WAY FORWARD AND THE

ROLE OF WHO

The Organization plays a role in coordinating

international efforts against the disease.
The aim of its strategy is to support Member States
in their efforts to reduce the disability and
premature death related to asthma.

Dr.Mohammad Hayatun Nabi

WHO recognizes that asthma is of major public

health importance.

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WHO'S PROGRAM OBJECTIVES

ARE:
Surveillance

Primary

prevention to reduce the level of exposure to

common risk factors, particularly tobacco smoke,
frequent lower respiratory infections during
childhood, and air pollution (indoor, outdoor, and
occupational exposure); and

Dr.Mohammad Hayatun Nabi

to map the magnitude of asthma,

analyze its determinants and monitor trends, with
emphasis on poor and disadvantaged populations;

Identifying

cost-effective interventions, upgrading

standards and accessibility of care at different levels
of the health care system.
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WHO ACTIVITIES

GLOBAL ALLIANCE AGAINST CHRONIC

RESPIRATORY DISEASES (GARD):

It is a voluntary alliance of national and international

organizations, institutions and agencies from a range
of countries working towards a common goal of
reducing the global burden of chronic respiratory
diseases.

Dr.Mohammad Hayatun Nabi

GARD contributes to WHOs global work to prevent

and control chronic respiratory diseases.

GARD focuses on the needs of low- and middle-income

countries and vulnerable populations, and fosters
initiatives that are tailored to local needs.
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NATIONAL ACTIONS NEEDED

Dr.Mohammad Hayatun Nabi

-Identify asthma as a public health problem

-Include inhaled beclomethasone on national
list of essential drugs
-Buy drugs at lower prices
-Establish national guidelines using essential
drugs only
-Organise training of health personnel to
avoid high cost and inefficient practices
-Provide essential drugs through insurance?

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CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)
Chronic

The

more familiar terms 'chronic bronchitis'

and 'emphysema' are no longer used, but are
now included within the COPD diagnosis.

Dr.Mohammad Hayatun Nabi

Obstructive Pulmonary Disease

(COPD) is not one single disease but an
umbrella term used to describe chronic lung
diseases that cause limitations in lung
airflow.

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THE MOST COMMON

SYMPTOMS OF COPD ARE
breathlessness,

However, COPD is not just simply a "smoker's

cough", but a under-diagnosed, life threatening
lung disease that may progressively lead to
death.

Dr.Mohammad Hayatun Nabi

or a 'need for air',

excessive sputum production,
and a chronic cough.

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QUICK COPD FACTS

According

WHO

predicts that COPD will become the

third leading cause of death worldwide by
2030.

Dr.Mohammad Hayatun Nabi

to the latest WHO estimates

(2007), currently 210 million people have
COPD and 3 million people died of COPD
in 2005.

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THE MOST IMPORTANT RISK

FACTORS FOR COPD ARE:
Tobacco

Dr.Mohammad Hayatun Nabi

smoking
Indoor air pollution (such as biomass
fuel used for cooking and heating)
Outdoor air pollution
Occupational dusts and chemicals
(vapors, irritants, and fumes)

24

DIAGNOSIS

Diagnosis of COPD should be considered in any patient

who has symptoms of a chronic cough, sputum
production, dyspnea (difficult or labored breathing) and
a history of exposure to risk factors for the disease.

Dr.Mohammad Hayatun Nabi

A chronic obstructive pulmonary disease (COPD)

diagnosis is confirmed by a simple test called
spirometry, which measures how deeply a person can
breathe and how fast air can move into and out of the
lungs.

Where spirometry is unavailable, clinical symptoms and

signs, such as abnormal shortness of breath and
increased forced expiratory time, can be used to help 25
with the diagnosis.

Dr.Mohammad Hayatun Nabi

26

DIAGNOSIS
A

Dr.Mohammad Hayatun Nabi

low peak flow is consistent with COPD, but

may not be specific to COPD because it can be
caused by other lung diseases and by poor
performance during testing.
Chronic cough and sputum production often
precede the development of airflow limitation
by many years, although not all individuals
with cough and sputum production go on to
develop COPD.
Because COPD develops slowly, it is most
frequently diagnosed in people aged 40 years
or over.

27

BURDEN
More than 3 million people died of COPD in
2005, which corresponds to 5% of all deaths
globally.
Most of the information available on COPD
prevalence, morbidity and mortality comes from
high income countries.
Even in those countries, accurate epidemiologic
data on COPD are difficult and expensive to
collect.
It is known that almost 90% of COPD deaths
occur in low- and middle-income countries.

Dr.Mohammad Hayatun Nabi

28

BURDEN
At

Dr.Mohammad Hayatun Nabi

one time, COPD was more common in men, but

because of increased tobacco use among women in
high-income countries and the higher risk of
exposure to indoor air pollution (such as biomass
fuel used for cooking and heating) in low-income
countries, the disease now affects men and women
almost equally.
In 2002 COPD was the fifth leading cause of death.
Total deaths from COPD are projected to increase
by more than 30% in the next 10 years unless
urgent action is taken to reduce the underlying risk
factors, especially tobacco use.
Estimates show that COPD becomes in 2030 the
third leading cause of death worldwide.

29

THE ROLE OF WHO

WHO

Dr.Mohammad Hayatun Nabi

recognizes that chronic obstructive

pulmonary disease (COPD) is of major public
health importance.
The Organization plays a role in coordinating
international efforts against the disease.
The aim of its strategy is to support Member
States in their efforts to reduce the toll of
disease, disability and premature death
related to COPD.

30

INTERNATIONAL ACTION IS
NEEDED TO
increase

Dr.Mohammad Hayatun Nabi

public awareness of the disease to

make sure patients and health professionals
recognize the disease and are aware of the
severity of associated problems;
organize and co-ordinate global
epidemiological surveillance to monitor
global and regional trends in COPD; and
develop and implement an optimal strategy
for its management and prevention.

31

WHO ACTIVITIES

WHO leads the Global Alliance against Chronic

Respiratory Diseases (GARD), which is a voluntary
alliance of national and international organizations,
institutions and agencies from a range of countries
working towards a common goal of improving global
lung health.

Dr.Mohammad Hayatun Nabi

Global Alliance against Chronic Respiratory

Diseases (GARD):

Its vision is a world where all people breathe freely.

32

WHO ACTIVITIES

GARD focuses specifically on the needs of low and

middle income countries and vulnerable
populations.
The Global Initiative for Chronic Obstructive
Pulmonary Disease (GOLD) is part of GARD.

Dr.Mohammad Hayatun Nabi

GARD promotes an integrated approach that

capitalizes upon synergies of chronic respiratory
diseases with other chronic diseases.

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Dr.Mohammad Hayatun Nabi

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