The Status of Asthma in Latin America: AIM Study

Transcription

1 The Status of Asthma in Latin America: AIM Study Montevideo, 5 de julio de 2012

2 Provincia de Santa Fe Ministerio de Salud y Medio Ambiente Hospital de Niños Dr. Orlando Alassia Dr. Hugo E. Neffen Head of the Respiratory Medicine Unit Santa Fe - Argentina

3 Dr. Hugo E. Neffen AIRLA : 2003 AIM : 2011 Impacto economico del asma no controlado

4 SÓLO 2.4 %

5 Objective Severity of Asthma Symptoms by Subjective Perception of Control 100% 13% 7% 7% 80% 41% 39% 30% 47% 0% 33% 54% 44% 46% 22% 4% 5% 9% Severe Moderate Mild Intermittent Completely controlled Somewhat controlled Well controlled Poorly/Not at all Neffen H, et al. PAHO 2005.

6 100% Estamos alcanzando las metas del GINA en América Latina? 80% Adultos Niños 69% 56% 57% 54% 47% 52% 39% 34% 2.3% 2.6% 0% Síntomas Diurnos Síntomas Nocturnos Interrupción del Sueño Despertares Exacerbaciones Metas del GINA Neffen H, et al. Rev Panam Salud Pública 2005; 17 (3):

7 Visita al Hospital o a emergencia debido al asma en LA en el ultimo año en adultos y en niños( A.I.R.L.A) Hospitalización 23% Visitas a urgencia 37% 53% Visitas no programadas 44% 0% 10% 30% 50% 59% Adultos Niños

8 Work or school absence in the past year due to asthma 70% 50% 30% 10% 0% 65% 66% 64% 64% 62% 58% 56% 55% 49% 47% 43% 37% 36% 31% 30% 31% 29% 31% 26% 25% AIRLA Total Argentina Brazil Chile Colombia Costa Rica Ecuador Mexico Paraguay Peru Uruguay Venezuela Adults Children

9 Dr. Hugo E. Neffen Lung function test in last year 100% 80% 1% 7% 6% 9% 6% 4% 5% 9% 8% 10% 5% 2% 17% 32% 33% 6% 30% 42% 33% 28% 26% 26% 29% 43% 50% 4% 4% 7% 1% 8% 9% 9% 9% 18% 13% 1% 76% 53% 59% 61% 62% 67% 49% 54% 54% 34% 38% 41% 0% AIRLA Total Argentina Brazil Chile Colombia Costa Rica Ecuador Mexico Paraguay Peru Uruguay Venezuela Never Not in past year In past year Every visit

10 Controllers vs. Rescue medication 80% 70% 64% 54% 54% 11% 6% 7% 4% 5% 4% 5% 5% 5% 4% 0% AIRLA AIRLA Total Total Persistente Severe Persistent Severa Persistente Moderate Persistent Moderado Persistente Mild Persistent Leve Intermitente Leve Dr. Hugo E. Neffen ICS Rescue Rescatadores Combination Combinación

11 Latin America does not meet GINA asthma goals GINA Treatment Guidelines Minimum (ideally no) chronic symptoms, including nocturnal symptoms AIRLA Findings 63% reported severe chronic symptoms 54% reported persistent symptoms Minimal (infrequent) episodes 56% reported daytime symptoms, 52% experienced sleep disturbances had symptoms during exercise No emergency visits 58% of patients had emergency visits Minimal need for prn beta 2 -agonist 70% used quick-relief medication No limitations on activities including exercise 75% of patients reported limitation in activities including exercise 31% of adults missed work 58% of children missed school Have normal or near-normal lung function (PEF variability <) 53% of patient never received a test 3% have peak flow meter

12 Dr. Hugo E. Neffen AIRLA : 2003 AIM : 2011 Impacto economico del asma no controlado

13 Study Design LA AIM: 2011 Population Sampling Frame Interview Length Adults and parents of adolescents (age years) with asthma (physician diagnosed and past-year medication or asthma attacks) Country Argentina Brazil Mexico Puerto Rico Venezuela Face-to-face interview screening of national sample of households Number of Households Screened 16,321 4,545 24,495 2,193 3,654 Mean: 35 minutes Completed Sample LA AIM TOTAL 51,208 2,169 13

14 Symptoms in Past 4 Weeks 100% Latin Amer. (N=2,169) Argentina (N=436) Brazil (N=400) Mexico (N=532) Puerto Rico (N=401) Venezuela (N=400) 80% 68% 56% 56% 57% 58% 50% 55% 50% 47% 47% 42% 38% 41% 34% 35% 37% 37% 34% 34% 36% 36% 35% 26% 0% Symptoms during day Symptoms at night Symptoms during exercise No Symptoms in Past 4 Weeks Q27a. In the past four weeks, (have you/has your child) had a cough, or wheezing, or shortness of breath, or chest tightness during the day? Q28a. In the past four weeks, (have you/has your child) been awakened by a cough, or wheezing, or shortness of breath, or chest tightness during the night? Q29a. In the past four weeks, (have you/has your child) had a cough, or wheezing, or shortness of breath, or chest tightness during exercise, play or physical exertion? Base: All respondents 14

15 Had an Asthma Episode in Past Year When Latin Amer. (N=2,169) Argentina (N=436) Brazil (N=400) Mexico (N=532) Puerto Rico (N=401) Venezuela (N=400) 100% 80% 37% 46% 36% 47% 44% 29% 21% 17% 35% 25% 19% 39% 38% 41% 49% 45% 23% 0% Even when you are sitting still, you felt short of breath You could only say a few words at a time because you were so short of breath You were awakened at night by your asthma symptoms frequently Q17a. During the past 12 months (have you/has your child) had an asthma episode when MULTIPLE RECORD Base: All respondents 15

16 Acute Treatment for Asthma in the Past Year Latin Amer. (N=2,169) Argentina (N=436) Brazil (N=400) Mexico (N=532) Puerto Rico (N=401) Venezuela (N=400) 100% 80% 23% 17% 27% 17% 14% 44% 43% 47% 37% 57% 37% 0% Hospitalized for asthma Unscheduled urgent or emergency visit to doctor's office, hospital, clinic, etc Q21a. (Have you/has your child) been hospitalized for asthma in the past 12 months? Q22a. Has (your/your child s) asthma caused any unscheduled urgent or emergency visits to a doctor s office, hospital, clinic or somewhere else in the past 12 months? 16

17 Symptom Control Classification of Asthma Patients (GINA 2009) 92 17

18 Perceived Asthma Control in the Past 4 Weeks: Completely or Well Controlled 100% 80% 78% 54% 55% 63% 0% Latin Amer. Argentina Brazil (N=400) Mexico (N=532) Puerto Rico (N=2,169) (N=436) (N=401) Q30. Overall, how well would you say that (your/your child s) asthma has been controlled in the past four weeks? Would you say it was completely controlled, well controlled, somewhat controlled, poorly controlled, or not controlled at all? Base: All respondents Venezuela (N=400) 18

19 Doctor Ever Give a Lung Function Test 100% 80% 70% 70% 50% 49% 50% 0% Argentina (N=436) Brazil (N=400) Mexico (N=532) Puerto Rico (N=401) Venezuela (N=400) Q42a. A pulmonary function test measures how much and how quickly you can move air out of your lungs. For this test, you breathe into a mouthpiece attached to a recording device. Has (your/your child s) doctor ever given (you/your child) a pulmonary function test? Base: All respondents Latin Amer. (N=2,169) 19

20 Medication Use in the Past 4 Weeks Latin Amer. (N=2,169) Argentina (N=436) Brazil (N=400) Mexico (N=532) Puerto Rico (N=401) Venezuela (N=400) 100% 80% 82% 63% 63% 62% 57% 61% 59% 52% 52% 45% 24% 0% Quick Relief Controller 20 Q48a. In the past 4 weeks, (have you/has your child) used any medicine to give (you/your child) quick relief or rescue from asthma symptoms? Q49a. In the past four weeks, (have you/has your child) used any medicine for long term control or prevention of (your/his/her) asthma? Base: All respondents

21 Missed Work or School in Past Year Due to Asthma 100% 80% Median Number of Days Lost Due to Asthma in Past Year % 38% 44% 47% 41% 21 0% Latin Amer. (N=2,169) Q33a. Has (your/your child s) asthma caused (you/your child) to miss work or school in the past year? Q33b. How many work or school days (have you/has you child) lost in the past year as a result of asthma? Base: All respondents Argentina (N=436) Brazil (N=400) Mexico (N=532) Puerto Rico (N=401) Venezuela (N=400)

22 Impact of Asthma on Productivity (Mean) Typical day 83 Worst day Latin Amer. (N=2,169) Argentina (N=436) Brazil (N=400) Mexico (N=532) Puerto Rico (N=401) Venezuela (N=400) Q34. Thinking about productivity on a scale of 0 to 100, where 100 means 100% productivity, where would you rank (your/your child s) productivity on a typical day? Q35. Where would you rank (your/your child s) productivity on the same scale of 0 to 100, at times of the year when (your/your child s) asthma was at its worst? Base: All respondents 22

23 Dr. Hugo E. Neffen AIRLA : 2003 AIM : 2011 Impacto economico del asma no controlado

24 Hugo Neffen 1, Sandra N Gonzalez 2, Carlos C Fritscher 3, Claudia Dovali 4, Angela E Williams 5 Journal of Investigational Allergology and Clinical Immunology, 2010; Vol. 20(7):

25 Not well controlled asthma observed in half of patients Well-Controlled Not Well-Controlled % % 31% 7% JIACI, 2010; Vol. 20(7):

26 % Patients Not well controlled patients twice as likely to require healthcare resource vs controlled patients Any unscheduled use ER / hospitalisation to to to 25 Not Well Controlled Controlled JIACI, 2010; Vol. 20(7):

27 Puntaje alto de ACT asociado con bajo costo en los Cuidados Programados / No Programados Costo (USD) 600 No programado Programado Puntaje ACT Derivado N= P<0.01 para atención programada JIACI, 2010; Vol. 20(7):

28 In Latin America. Asthma control falls short of international goals of treatment in a considerable proportion of patients The use of unscheduled resource is highest in patients with severe persistent asthma symptoms. However, even patients with mild asthma symptoms incur considerable healthcare costs Poorly controlled asthma is associated with more than twice the need for unscheduled healthcare resource than well-controlled asthma Assessing patients by their level of control, using the ACT, offers a simple approach that can lead to reduced healthcare resource use Management regimens that aim for and result in well-controlled asthma may reduce the need for unscheduled healthcare and direct cost of the disease

29 MUCHAS GRACIAS 14/06/10 Santa Fe,Argentina.