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PROBLEMS OF ASTHMA MANAGEMENT IN PAKISTAN

PROBLEMS OF ASTHMA MANAGEMENT IN PAKISTAN. BURDEN OF ASTHMA. ASTHMA IS ONE OF THE MOST COMMON CHRONIC DISEASE WORLDWIDE PREVALENCE INCREASING IN MANY COUNTRIES ESPECIALLY IN CHILDREN OVER 300 MILLION ASTHMATIC WORLDWIDE GLOBAL ECONOMIC COST EXCEED THAT OF TB HIV COMBINED.

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PROBLEMS OF ASTHMA MANAGEMENT IN PAKISTAN

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  1. PROBLEMS OF ASTHMAMANAGEMENT IN PAKISTAN

  2. BURDEN OF ASTHMA • ASTHMA IS ONE OF THE MOST COMMON CHRONIC DISEASE WORLDWIDE • PREVALENCE INCREASING IN MANY COUNTRIES ESPECIALLY IN CHILDREN • OVER 300 MILLION ASTHMATIC WORLDWIDE • GLOBAL ECONOMIC COST EXCEED THAT OF TB HIV COMBINED SOURCE :CHEST JULY 2006

  3. HOW COMMON IS ASTHMA IN PAKISTAN • THE MAGNITUDE OF THE PROBLEM IS NOT CLEARLY KNOWN • APPROXIMATELY 10% OF ADULTS AND 20% OF CHILDREN IN PAKISTAN ALONE ARE SUFFERING FROM THIS DISEASE • THIS DISEASE IN OUR COUNTRY IS STILL UNDER DIAGNOSED AND POORLY TREATED

  4. HOW GOOD ARE WE MANAGING ASTHMA POOR COMPLIANCE IS ONE OF THE MAJOR PROBLEMS IN MANAGEMENT OF ASTHMA AND LACK OF KNOWLEDGE AND UNDERSTANDING ABOUT THE DISEASE IS THE REASON FOR POOR COMPLIANCE

  5. SOCIAL STIGMA • IT IS NOT A CONTAGIOUS DISORDER • PATIENTS DO NOT ACCEPT DIAGNOSIS DUE TO DISCRIMINATION IN SOCIETY

  6. DIAGNOSIS OF ASTHMA • PATIENTS ARE OFTEN MISDIAGNOSED AS HAVING CHEST INFECTIONS OR BRONCHITIS • IGNORANCE ABOUT THE DISEASE IS COMMON AMONGST ASTHMA PATIENTS AS WELL AS DOCTORS

  7. FALSE HOPES AND DOCTORS SHUFFLING • ASTHMA CAN NOT BE CURED BUT CAN BE VERY WELL CONTROLLED • THERE ARE FALSE CLAIMS MADE BY QUACKS AND UNPROFESSIONAL DOCTORS CLAIMING TO CURE ASTHMA • IT IS USUALLY A LONG TERM VARIABLE LIFETIME DISORDER PRESENT EVEN WHEN THERE ARE NO SYMPTOMS

  8. MISUSE OF STEROIDS • CORTICOSTEROIDS ARE THE MOST COMMON MEDICATIONS FOR ASTHMA MANAGEMENT WHICH IS BEING USED THROUGHOUT THE WORLD.IT SHOULD BE GIVEN IN INHALER FORM • EIGHTY SEVEN PERCENT (87%) ASTHMA PATIENTS HAVE NEVER TAKEN OR HEARD ABOUT INHALED CORTICOSTEROIDS

  9. MISCONCEPTIONS ABOUT INHALERS • INHALER DEVICES ARE THE BEST METHOD OF DELIVERING ASTHMA MEDICATIONS • THERE ARE MANY MISCONCEPTIONS ABOUT INHALERS AMONGST ASTHMA PATIENTS AND DOCTORS

  10. POOR TECHNIQUE OF INHALERS • EIGHTY PERCENT(80%) OF ASTHMATICS IN PAKISTAN STILL USE SYSTEMIC THERAPY i.e. ORAL AND PARENTAL • EVEN THOSE ON INHALED MEDICATIONS OVER 90% ARE ON INHALED BRONCHODILATORS AND ONLY 10% ARE ON INHALED CORTICOSTEROID THERAPY

  11. EXCESSIVE USE OF NEBULIZERS • PATIENTS MAY USE THEIR NEBULIZER REPEATEDLY AND DELAY SEEKING MEDICAL HELP IN SEVERE ASTHMA. IT IS SAID THAT “IF YOU NEED A NEBULIZER , THEN YOU NEED TO SEE A DOCTOR”

  12. DESENSITIZATION VACCINES AND ASTHMA • IMMUNOTHERAPY HAS PROVEN NOT TO BE OF MAJOR BENEFIT IN ASTHMA AND THERE IS ALSO A RISK OF DEVELOPING SERIOUS ALLERGIC REACTIONS TO THE INJECTIONS

  13. OVER USE OF AMINOPHYLLINE IN ACUTE ATTACKS • AMINOPHYLLINE SHOULD NOT BE THE FIRST DRUG TO BE GIVEN IN ACUTE ATTACKS OF BRONCHIAL ASTHMA • SIDE EFFECTS ARE COMMON

  14. DIET AND ASTHMA • ASTHMA CAN ALSO BE PROVOKED BY A WIDE RANGE OF FOODS , ADDITIVES AND PRESERVATIVES • FOODS: EGGS , PEANUTS AND SHELFISH • PRESERVATIVES: TARTRAZINE (ORANGE COLOURING) AND SULPHITES (ALCOHOLIC DRINKS SUCH AS WINE)

  15. DISSEMINATION OF GUIDELINES AND ADHERENCE TO GUIDELINES • THE DEVELOPMENT OF GUIDELINES IS A LABOURIOUS PROCESS AND ITS DISSEMINATION AMONGST RESEARCHERS, DOCTORS AND PATIENTS IS A DIFFICULT TASK

  16. COST OF TREATMENT • COST OF TREATMENT OF INHALED CORTICOSTEROIDS IS A BIG CHALLENGE AND NEED TO BE TACKELED • DOCTORS HAVE A RESPONSIBILITY TO USE MEDICATIONS APPROPRIATELY BECAUSE OF THE HIGH COST INVOLVED

  17. WHAT CAN WE LEARN FROM RECENT RESEARCH ON ASTHMA? • LONG ACTING BETA AGONISTS SHOULD NOT BE USED AS MONOTHERAPY IN ASTHMA AND MUST ONLY BE USED IN COMBINATION WITH AN APPROPRIATE DOSE OF INHALED GLUCOCORTICOSTEROIDS

  18. WHAT CAN WE LEARN FROM RECENT RESEARCH ON ASTHMA? (CONT’) • LEUKOTRIENE MODIFIERS NOW HAVE A MORE PROMINENT ROLE AS CONTROLLER TREATMENT IN ASTHMA PARTICULARLY IN ADULTS

  19. WHAT CAN WE LEARN FROM RECENT RESEARCH ON ASTHMA? (CONT’) • MONOTHERAPY WITH CROMONES IS NO LONGER GIVEN AS AN ALTERNATIVE TO MONOTHERAPY WITH A LOW DOSE OF INHALED GLUCOCORTICOIDS IN ADULTS

  20. KEY NOTE MESSAGE • IN ORDER TO CONTROL ASTHMA PHYSICIAN MUST BE A GOOD LISTENER AND EDUCATOR • WITH PROPER MANAGEMENT ALMOST ALL PATIENTS WITH ASTHMA CAN LEAD A NORMAL LIFE

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