06 May 2013

Time to control asthma

World Asthma Day takes place Tuesday 7 May 2013. The theme of World Asthma Day 2013, is 'You Can Control Your Asthma' with the sub-theme of 'It's Time to Control Asthma.'

This theme was chosen to emphasise that effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives and can prevent emergency visits to the hospital.

According to the National Asthma Education Programme, asthma control means that a person with asthma has:
  • No (or minimal) asthma symptoms
  • No waking at night due to asthma
  • No (or minimal) need to use “reliever” medication – if a person with asthma needs his/her reliever more than twice a week, their asthma is not controlled 
  • The ability to do normal physical activity and exercise
  • Normal (or near-normal) lung function test results (PEF and FEV1)
  • No (or very infrequent) asthma attacks
More than 300 million people around the world have asthma and the disease imposes a heavy burden on individuals, families, and societies. The Global Burden of Asthma Report, a compilation of published data on the prevalence and impact of asthma around the world that was launched on World Asthma Day 2004 remains an important reference and indicates that asthma control often falls short and there are many barriers to asthma control around the world.

Lack of asthma control

Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet the Global Burden of Asthma Report documents ample evidence that, in many regions around the world, this goal is often not met. In South Africa the situation is dire.

Hospitalisations, emergency room visits, and other urgent care occur when a person’s asthma is not under control. Although the rates of these medical visits generally increase as the prevalence of asthma rises, the very high proportions of people with asthma who require such care in South Africa is an indication that lack of control is widespread.

This indicate that there is a major opportunity to reduce hospitalisations in South Africa  by improving asthma control, and on World Asthma Day 2011 NAEP is continuing with a GINA initiative launched in 2010 which encourages governments and health departments around the world to improve asthma control and reduce asthma hospitalization 50% by 2015.

Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma. According to the Global Burden of Asthma Report, the majority of asthma deaths are preventable.

What are the barriers to asthma control?

Although the barriers to asthma control vary from country to country and from region to region around the world, the Global Burden of Asthma Report identifies several patterns:


Some people with asthma symptoms may never receive a diagnosis of asthma, and thus do not have the opportunity for good asthma treatment and control. Various factors such as poor access to medical care, under recognition by health professionals, lack of awareness among patients, and overlap of asthma symptoms with those of other diseases contribute to under diagnosis of asthma including Southern Africa.


Barriers relating to treatment are the most commonly cited in the Global Burden of Asthma Report, occurring in one form or another in almost all regions around the world:
  1. The high cost of medicines means that many people with asthma may not receive sufficient medication to control their disease.
  2. Asthma medications are not available in some areas.
  3. Treatment that is not consistent with evidence-based guidelines may hamper asthma control.  In South Africa there are wide variations in prescribing practices, and even when cost is not a barrier under treatment may still occur.
  4. The underuse of inhaled glucocorticosteroids for long-term management of asthma is a particular problem. These medications diminish chronic inflammation in the lungs of asthma patients, and are a key to controlling the disease.
  5. A general lack of access to medical care limits asthma treatment and control. This lack of access may arise from socioeconomic factors, or may be a matter of scarce infrastructure and poor transport, especially in rural areas.

People with asthma may not understand how to use their medications properly, or may not understand concepts such as asthma control and when to seek help for worsening asthma that would help them manage their disease effectively. Misconceptions about asthma and its treatment are widespread.

Environmental health

Avoiding risk factors that cause asthma symptoms is an important strategy for improving control.

However, in many areas in South Africa, people with asthma may be exposed to conditions such as outdoor or indoor air pollution, cigarette smoke, or chemicals on the job that make their asthma worse.

Improving control

The Global Burden of Asthma Report also details a number of instances where improving asthma control has reduced the burden of this disease. For example:
  1. Declining asthma mortality rates over the last 10 years have been attributed to the increased use of inhaled glucocorticosteroids therapy and increased use of inhaled glucocorticosteroids has led to a reduction in asthma severity.
  2. National asthma campaigns have reduced asthma morbidity and mortality. The National Asthma Education Programme (NAEP) includes educational components for both health professionals and the general public.
A strategy for achieving and maintaining asthma control is set out in the GINA Global Strategy for Asthma Management and Prevention and has been adopted by the NAEP. The strategy requires four interrelated components of therapy:

•    Develop patient/doctor partnership
•    Identify and reduce exposure to risk factors
•    Assess, treat, and monitor asthma
•    Manage asthma exacerbations

The National Asthma Education Programme (NAEP)

The National Asthma Education Programme (NAEP) is a non-profit organisation that aims to disseminate impartial information about asthma diagnosis and treatment to health professionals and the South African public.  It also runs courses, workshops, and meetings for the public and professionals. NAEP (The National Asthma Education Programme) was first launched in 1989 by Key Opinion Leaders in South Africa and is part of an international organisation/drive which subscribes to guidelines set out by GINA (Global Initiative for Asthma), SATS (South African Thoracic Society) and ALLSA (Allergy Society of Asthma.  

Membership to the public is free of charge and can be accessed by contacting the NAEP or registering on their website:

Tel: 0861 asthma (278462)

(Picture: woman using inhaler from Shutterstock)

Read Health24’s Comments Policy

Comment on this story
Comments have been closed for this article.

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

Still have a question?

Get free advice from our panel of experts

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

* You must accept our condition

Forum Rules