According to the 2014 Global Asthma Report by the Global Asthma Network, South Africa has the highest age adjusted asthma death rate per million of population. Of the estimated 3,9m South Africans with asthma, 1,5% die of this condition annually.
“Asthma prevalence in Southern Africa is higher than any other area on the continent, with more than 20% of school children across the region suffering from this condition. In South Africa, asthma is the third most common cause of hospital admissions of children, yet only 2% of patients with asthma receive treatment,” says Paul Miller, CEO of Cipla SA.
COPD still largely undiagnosed
Miller also points to the issue of chronic obstructive pulmonary disease (COPD) and latest data which reveals that the disease ranks within the top three causes of mortality in the world, yet it still remains largely undiagnosed.
A recent survey by The Chest Research Foundation revealed that South Africa has the highest incidence of COPD in 24 countries. In addition, of over 30,000 adults surveyed globally (aged 55 and over) on COPD prevalence, revealed that, of the adults surveyed in Cape Town alone, 19% exhibited symptoms of COPD.
“As we are all interested and invested in the advancement of respiratory care, it is vital to collaborate on the latest information on asthma, COPD and allergy,” says Miller.
Asthma control remains a problem
Professor David Price, University of Aberdeen: primary care respiratory medicine, says that despite decades of comprehensive asthma guidelines and medical recommendations, lack of asthma control remains a serious problem for patients at all treatment levels.
“Examining the reasons for sub-optimal asthma control also reveals issues with patient factors including adherence to inhaler use, inhaler technique and device satisfaction,” he explains.
RCTs are not efficient measuring tools
High quality data is needed to determine the main reasons for poor asthma control and to monitor the efficacy of newly developed asthma interventions.
“Currently, the standard practice in assessing patients is randomised clinical trials (RCTs), which also evaluates therapeutic efficiency. One of the main constraints with RCTs however, is the fact that these trials do not take into consideration real-life factors that may impact patient outcomes,” he says.
Prof. Price says it is crucial to delve deeper into discussions about the current RCTs which are an insufficient method to establish the effectiveness of treatments.
“RCTs may not show the advantages of drugs that are better tolerated, faster-acting or easier to take using simpler regimes, and may not fully represent the therapeutic effects or costs in a wider clinical population.”
Misdiagnosis and poor outcomes
“Real-life, observational studies have an advantage here, as they consider lifestyle habits and comorbidities. Essentially, this offers us the opportunity to study the use and selection of inhaler devices in routine care settings, taking into account real-life factors that are typically excluded in strictly controlled RCTs.”
The main reasons for poor asthma control among patients are: incorrect diagnosis, rhinitis, smoking, poor adherence, or poor inhaler technique, possibly leading to suboptimal health outcomes. It is important to note that the last two listed are all device-related problems and could be improved through further research and studies, says Prof. Price.
Incorrect inhaler technique
Despite significant improvements in inhaler delivery efficiencies, incorrect inhaler technique remains a key reason for poor asthma control resulting in costly hospital admissions, emergency department visits, antibiotic and corticosteroid courses.
“We need to examine the critical errors in inhaler use, as well as explore the comparative effectiveness of various inhaler devices and the value of breath actuated inhalers (BAIs) in routine care.”
“What is clear is that asthma control is poor and a major reason is inhaler technique. This needs to be addressed with real urgency and more scrutiny. Patients should at least be in a position where they have access to the most appropriate inhalers for their specific needs and be able to operate their personal devices, as this is quite an unavoidable issue,” urges Prof. Price.