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Asthma: How to treat and prevent the high impact disease

August 16, 2017

Sereina de Zordo from the aha! Swiss Allergy Centre outlines the global burden of asthma and how through various methods and programmes it can be managed

Wheezing, chest tightness, shortness of breath and cough – these are typical symptoms of allergic asthma. It is characterised by a chronic airway inflammation and spasmodic narrowing of the airways. Symptom frequency, intensity and their impact on quality of life vary individually. Asthma is a potentially serious and sometimes fatal chronic disease¹.

A global burden

Furthermore, asthma is a major health problem, affecting around 300 million people worldwide and causing annual costs of €17.7 billion in Europe. In Switzerland, around 12% of children and 6% of the adult population are suffering from the disease. Allergies mainly against indoor and outdoor allergens originating from pollens, house dust mites, domestic animals or moulds, as well as occupational allergens are the most common causes of allergic asthma. Viral infections, dust, odours, smoke, pollutants or exercise are factors which enhance or trigger the asthma symptoms.

Untreated or poorly treated allergic rhinitis (e.g. caused by pollen allergy) leads to asthma in around 30% of the allergic patients. Consequently, with proper diagnosis² and treatment of allergies and asthma, €142 billion could be saved per year in Europe. An appropriate diagnosis by specialists apparently is of fundamental importance^{2, 3}.

Asthma-management

The ultimate goal of an adequate asthma therapy are no exacerbations, no restrictions in everyday life, no nocturnal awakenings, optimum lung function and any necessary emergency treatments.

First and foremost, contact with the allergen has to be avoided or reduced as much as possible. Therefore the first imperative is to identify the allergens and triggers and, if possible, to eliminate them in order to prevent asthma attacks.

Medical treatment to reduce symptoms may include individually tailored medicines, which dilate the airways and e.g. steroids for a long-term treatment to ease swelling and inflammation.

After a thorough investigation, specific immunotherapy is often recommended for allergic asthma. This is a causal treatment by increasing the tolerance to a specific allergen and no longer triggering an allergic reaction. For this subcutaneous or sublingual treatment, a well-controlled or rather intermittent or mildly persistent asthma is required, dependent on the eliciting allergen. On an economic level, the cost-effectiveness of immunotherapies in allergic asthma patients overweighs the pharmacotherapies on a long-term basis⁴.

The need for educational programmes and prevention

Effective asthma-management has to be completed by additional education on a patient’s level. Structured patient’s education programmes lead to improved clinically relevant conditions, better self-management and symptom control, as well as higher life quality. Combined with exercises for symptom recognition, adaptations in therapy and emergency treatments as well as in the inhalation techniques are essential⁵. Recent Swiss studies show that 6 out of 10 asthma patients do not use their inhalation devices correctly and that there is a need for educational programmes⁶.

In Switzerland, aha! Swiss Allergy Centre together with the Lung Association is leading project partners by offering such patient’s asthma courses.

There is a worrying increase in asthma and allergy prevalence almost worldwide. To take into account not only the economic costs but also, in particular, the burden of the disease in all affected people, the consideration of prevention factors related to atopic diseases is crucial. Based on the German guidelines on allergy prevention, there is data for different preventive factors against the development of asthma. Regarding allergy prevention, the following exposures should be avoided: active and passive tobacco smoke exposure, obesity, indoor air pollution and outdoor air pollution like nitrogen oxides or particulate matter (e.g. PM2.5 or PM10)7. There is further need for information in the population regarding allergy and asthma prevention. An appropriate diagnosis, as well as an effective short and long-term treatment, is also a crucial factor. This is where patients, doctors, as well as health organisations should closely work together – to treat and prevent the high impact disease.