“I Can’t Breathe” became a slogan in 2020 for a different kind of civil unrest, but for 339 million people living with asthma worldwide, this is an everyday concern. While the former is a call to action to bring about racial justice and structural change, I would submit that the latter is a clarion call to end ignorance and under-diagnosis for something that can, and should be treated, on time.
Even in movies, inhalers and nebulizers have long been cast as debilitating devices showcasing vulnerability or levity. But asthma should have a place only in an asthmatic’s lungs, not in our heads.
With these stereotypes dominating public perception, it is no wonder that asthma is rife with misconceptions and the disease is under-reported, ignored, and under-diagnosed.
The first World Asthma Day was observed on May 4, 1998, by the Global Initiative for Asthma, a WHO collaborative organization, to raise awareness of the disease. This year’s theme is “Uncovering Asthma Misconceptions” and is particularly important in light of the ongoing covid-19 pandemic. To clarify, nothing so far has shown us that asthmatics are more susceptible to getting infected by covid-19, nor does wearing a mask aggravate their condition. Other misconceptions around asthma include the myth that it is contagious, that patients suffering from asthma can’t exercise, and that children can outgrow asthma. None of these are true.
The WHO reports that India harbors 15-20 million asthmatics and of these, 10-15% are children. However, no amount of triangulation of medicine use gets us to this number of people being diagnosed and treated. Asthma is consistently under-reported, many times due to the social shame attached to asthma, and constant underestimation of the signs and symptoms of the disease.
In India, factors like pollution, overcrowding, and poor housing conditions add severely to the asthma burden. When we look at rural communities, the stigma is so deep-rooted that parents often do not disclose their children’s asthma publicly, fearing negative consequences on their societal image, career or even familial prospects. This belief does not plague only the rural or the illiterate. While the disease is more prevalent in rural India, the phenomenon of ignoring the disease, and therefore under-diagnosis and under-reporting is rampant everywhere.
We have just completed the anniversary of the worst year of this century, and yet we ignore, under-report and under-diagnose a disease that can be readily treated. In fact, covid-19 has hindered the diagnosis and treatment of asthma patients due to lockdowns and fear of venturing out, even to a doctor. The respiratory segment of the Indian pharmaceutical market de-grew by 4.5% over the past year as compared to growing north of 10% each year for the past 5 years.
Asthma is treatable, not curable. But if asthma is not diagnosed and treated the right way at the right time, it can lead to severe symptoms which have a negative impact on quality of life, even leading to a financial and functional burden.
On-time detection and intervention for an asthma patient are paramount. It doesn’t take much. An in-depth talk with a doctor, and if they deem fit, a physical examination and lung function test would follow. While willingness to communicate is the first obstacle, there are other variables at play too – especially time sensitivity and chances of wrong diagnosis due to similarity in clinical features to other respiratory illnesses like Chronic Obstructive Pulmonary Disease (COPD).
While on-time detection is important, there has to be openness and adherence to treatment options, including inhalers. The availability of new medicines and devices has changed the treatment landscape and dramatically improved the lives of asthma patients.
There are two factors that inhibit disease complications – correct usage techniques of inhalers and adherence. Studies have shown that 87% of asthma patients in the U.S. have incorrectly used their metered-dose inhalers (MDI) at least once. With our considerable lack of infrastructure, India would only fare worse. A data from a study conducted in a tertiary care hospital in India showed that 27% of asthmatic patients enrolled were non-adherent to their medications.
The chosen mantra of the India pharma industry is patient-centricity. Tethering this perspective to asthma requires not just medical interventions, but also digital ones. The rise of connected devices ensuring appropriate dosing, adherence and providing significant patient-analytics in the asthma space opens up a whole world of predicting exacerbations, assistance in decreasing medication doses during stable periods, triggering treatment pathways on the basis of weather conditions, and more.
On this World Asthma Day and in the days following it, let’s together address the misconceptions around asthma, ensure that those with the disease live full uncompromised lives, and focus our healthcare efforts on more pressing needs.
Nilesh Gupta is the Managing Director of Lupin Ltd