Asthma management to be addressed with new vigour
By A Correspondent - Mumbai

While the world focussed on killer diseases like cardiovascular ailments and cancer in the last few decades, an epidemic was emerging in the form of chest related diseases, mainly COPD and thus people who were hooked on to risk factors like smoking 30 years ago, have now developed these diseases

Asthma management is all set to receive a fresh thrust in the country. As the first step in this direction, a comprehensive survey focusing on a wide range of aspects related to asthma management was launched by Glaxo Smithkline Beecham Pharmaceuticals Ltd, the global leader in respiratory medicine. This important survey christened, Asthma Insights and Realities in South Asia (AIRSA) was launched at the recently held 16th Asia Pacific Congress on Diseases of the Chest (APCDC) in the city during Nov 29 - Dec 3. The conference was significant as it was being held in the country after a gap of nearly two decades.

The conference addressed five chest related specialities cardiology, cardiac surgery, pulmonology and, critical care adult and critical care paediatrics. According to experts, chest related and pulmonary diseases are accounting for increasing morbidity and mortality and hence bringing them to the greater attention of the medical community, government as well as general public.

AIRSA, the first of its kind study in India and South Asia will survey patient knowledge and attitudes and behaviour related to asthma in South Asia. Besides India, it would cover Bangladesh, Sri Lanka and Pakistan.

While the world focussed on killer diseases like cardiovascular ailments and cancer in the last few decades, an epidemic was emerging in the form of chest related diseases, mainly COPD, says Dr Sidney S Braman, president, American College of Chest Physicians (ACCP). ‘‘These diseases develop over a period of time. And thus people who were hooked on to risk factors like smoking 30 years ago, have now developed these diseases,’’ he noted.

According to Dr Braman, a huge gap has been observed between the desired golden standard for asthma management and actual results after the prognosis. This conclusion was arrived at based on the results obtained with the studies, AIA (Asthma in America), AIRE (Asthma Insights and Realities in Europe) and AIRIAP (Asthma Insights and Realities in Asia Pacific) conducted over the last five years. Explaining this aspect further, he said, ‘‘With AIA, we found that in US, over a 12 months period, one in every 10 asthma patients was hospitalised and one in every five was treated for emergency. Moreover nearly 47 per cent of asthmatics had major limitations in their day-to-day activities including educational and recreational activities. Therefore though asthma management guidelines looked wonderful on the paper, they failed to provide the desired practical results.’’

Dr Braman opined that India with its increasing number of smokers needed to take up active measures against COPD and asthma. ‘‘Also increasing levels of pollution and usage of biomass fuel for cooking, etc. make it very important to focus on environment control in India,’’ he noted.

According to Dr S M Chandrashekhar, medical advisor, GSK, AIRSA would focus on various factors like, whether the accepted norms of asthma management are being followed in India, whether the asthmatics are explained properly by their physicians regarding their disease management plan, how many received the same in a written format, how many are currently on asthma medications, whether the patients are monitoring their condition, etc. ‘‘The study will bridge the gap between gold standards of asthma management and the reality,’’ Dr Chandrashekhar says. He further explained that factors like social stigma attached to asthma, poor management of the condition and poor awareness levels have resulted in lack of comprehensive data thus leading to underdiagnosis and undertreatment of asthma.

The methodology for the study will be ready by early January 2002 and the actual study would begin by March and the study is expected to be completed in next nine months, Dr Chandrashekar informed. Around 3000 patients representing all cross sections of the population will be screened and they would be picked up essentially from OPDs of the hospitals and clinics, he added. ‘‘We will also be networking with around 300 clinicians from all over the country to assist in our endeavour,’’ he informed.

Being the global leader in respiratory medicine, the project is a part of GSK’s corporate responsibility, said Dr Shailesh Ayyangar, vice-president, sales & marketing. ‘‘We are totally committed about AIRSA and we would provide unlimited grant to such efforts and asthma awareness programmes in future,’’ he added.

Critical care was another main topic highlighted at APCDC. Dr Braman said that in US the critical care speciality had evolved over the last two decades. ‘‘In India it is still in its nascent stage. A slight delay in keeping pace with the latest developments in this field is understandable as India has to address the healthcare needs of a huge population. But it’s certainly the way in the future,’’ he noted. According Dr Sanjeev Mehta, consultant chest specialist, Lilavati Hospital, who is also associated with ACCP India (Western region), at present there isn’t any specific pattern for critical care in India. ‘‘We haven’t even initiated a discussion on this aspect. There should be a better understanding of this speciality. It is not just restricted to ICU and ICCU as perceived by many,’’ he says.

Dr Braman pointed out a very important lesson that the physicians have to learn today need to explain what are their limitations in critical care. Said he, ‘‘Patients and their relatives have very high expectations which may not be fulfilled always. Therefore we should clearly state, ‘what we can not do’ and develop a holistic approach towards patient care.’’