Asthma

Updated 12 September 2016

Asthma is under recognised in SA

Far too many South Africans are never diagnosed with the chronic respiratory disease asthma, which kills almost 300 people per million each year, according to a report.

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While experts claim that asthma, which is a life-threatening condition, may be overdiagnosed in the UK, Cape Town paediatrician Dr Shirani Naidoo tells Health24 the illness remains under recognised in South Africa.

Writing in the journal Archives of Disease in Childhood, professor Andrew Bush and Dr Louise Fleming of Imperial College and Royal Brompton Hospital in London claim that doctors are overdiagnosing asthma in children in the UK where about 1.1 million children are being treated for the condition.

Read: Children are getting asthma pumps for no good reason

Asthma can be defined as when airways become inflamed, thickened and constricted, resulting in symptoms of wheezing, chest tightness, shortness of breath and coughing.

Treatment of asthma revolves around two factors: preventative environmental control and medication to prevent or treat the condition.

Environmental control means avoiding things that will trigger an asthma attack, like cigarette smoke or dust. Medication is the mainstay of asthma treatment and the type and amount of medication prescribed to each patient will differ.

Although doctors under-diagnose the condition in the past, the authors suggest the pendulum has now swung too far in the other direction with asthma being overdiagnosed and inhalers dispensed almost as a "fashion accessory". Bush and Fleming attribute this to incorrect diagnoses and the absence of a difinitive test.

They warn that the overdiagnosis of asthma exposes patients to the potentially harmful side effects of medications they do not need, including adrenal failure and growth suppression and an increased risk of respiratory infections.

Watch: What happens during an asthma attack? (Warning, graphic)

However, in South Africa, which has one of the highest reported mortality rate for asthma in the world according to the 2014 Global Asthma Report, the killing disease remains largely under recognised.

"In South Africa we are still grappling with access to care and access to essential drugs," said Dr Naidoo, Senior Specialist at Red Cross Childrens Hospital and chairperson of the National Asthma Education Programme, a non-profit organisation that disseminates impartial information about asthma.

"Far too many people are never diagnosed with asthma or if diagnosed, struggle to access the required medication in a sustainable manner, given the frequent supply chain issues that result in medication shortages at public health facilities," she said.

"Access to preventative, non–emergency care remains uneven across SA with asthma remaining under recognised by health professionals", cautioned Dr Naidoo while adding that "there is a lack of awareness among patients themselves about asthma".

Dr Naidoo said there is a heavy burden of respiratory diseases such as TB and Chronic Obstructive Pulmonary Disease (COPD) that overlap or may co-exist with asthma adding to the difficulties with diagnosis.

"Asthma is however fully controllable and a previously ill patient can be returned to health and an active life."

She said that controller therapy is needed for most patients and not only in severe cases.

Dr Naidoo also pointed out that using asthma devices is not always easy. "Make sure that they are demonstrated to you and you demonstrate it back to your health care worker"
 
She added that control management is not the same as cure and that stopping inhaler therapy early if the child has a few good months usually leads to a relapse.

Quality of life can still be enjoyed despite children being asthmatic, noted Dr Naidoo.
 
"If parents can control asthma, their child should not have to give up any of the joy of being a child because of their asthma."

Read: South Africa has world’s fourth highest asthma death rate

According to a report by the Global Initiative for Asthma (GINA), South Africa has the world’s fourth highest asthma death rate among five to 35 year olds. Of the estimated 3.9 million South Africans with asthma, 1.5% die of this condition annually.

The high death rate of asthma sufferers in South Africa is likely to reflect the living conditions conducive to asthma aggravation, said Pulmonologist, Dr Justus Kilian in a statement distributed by Cipla Medpro.

He explained that the socio-economic disparity in access to quality healthcare may also be one of the reasons affecting asthma diagnosis and treatment.

“Asthma diagnosis and treatment is often inadequate, especially because there are many misconceptions about the disease and how it should be treated, one being that asthmatics usually outgrow the disease, however, asthmatic triggers can occur only later in life.

"Educating the public and patients will certainly encourage the adherence to action plans, which will lead to reporting of symptoms long before an emergency situation will develop,” he said.

Article resources:

Archives of Disease in Childhood: Is asthma overdiagnosed? by Professor Andrew Bush and Dr Louise Fleming; http://adc.bmj.com/content/early/2016/03/08/archdischild-2015-309053.short?g=w_adc_ahead_tab

Asthma UK: Asthma UK comment on overdiagnosis media story; https://www.asthma.org.uk/about/media/news/comment-on-article-claiming-doctors-are-overdiagnosing-asthma/

Global Asthma Report 2014: http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf

Masoli M, Fabian D, Holt S, Beasley R; Global Initiative for Asthma (GINA) Program. The global burden of asthma: Executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469-478.

Health24; South Africa has world’s fourth highest asthma death rate: http://www.health24.com/Medical/Asthma/News/South-Africa-has-worlds-fourth-highest-asthma-death-rate-20130210

Also read:

Practical advice for asthma sufferers (and their parents)

Debunking asthma myths

7 asthma triggers to watch out for

 

Ask the Expert

Asthma Expert

Professor Keertan Dheda has received of several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others.Read his full biography at the University of Cape Town Lung Institute

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