Asthma Disparities: A Global Perspective

Transcription

1 Asthma Disparities: A Global Perspective Innes Asher Department of Paediatrics: Child and Youth Health The University of Auckland, New Zealand Chair of the International Study of Asthma and Allergies in Childhood (ISAAC) and the Global Asthma Network 19 May

2 85% of the world s 7.2 billion people live in low and middle income countries (LMICs) GNI per capita

3 Asthma is one of the commonest global respiratory diseases 500,000, ,000, ,000, ,000, million Prevalence 300,000, ,000, ,000, ,000, ,000,000 50,000,000 - Tuberculosis Asthma Pneumonia COPD WHO. Global tuberculosis report 2012; Ruuskanen O et al. Lancet 2011; 377: ; Vos T et al. Lancet 2012; 380:

4 Asthma is the 14th most important disorder in terms of global years lived with a disability (YLD) Vos T et al. Lancet 2012; 380:

5 Are there global disparities? Asthma burden Environmental factors Asthma management

6 Prevalence of asthma symptoms in children - until 1991 there were few studies

7 ISAAC*: 306 research centres in 105 countries *The International Study of Asthma and Allergies in Childhood

8 Prevalence ISAAC found that: o asthma occurs everywhere in the world o is more common than was thought o there are large variations

9 Lai CKW et al. Thorax 2009; 64:

10 Lai CKW et al. Thorax 2009; 64:

11 Lai CKW et al. Thorax 2009; 64:

12 Prevalence changes over time ISAAC found that o asthma overall is increasing o increases are more common in LMICs

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14 Severity Wheezing in the past 12 months and at least one of : >4 attacks of wheeze >1 night per week sleep disturbance from wheeze wheeze limiting speech Lai CKW et al. Thorax 2009; 64:

15 ISAAC found that asthma is more commonly severe in LMICs

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18 WHO: Asthma Mortality Data Poorer quality data in LMICs WHO Detailed Mortality Database, February 2014 update

19 WHO: Asthma Mortality Data Poorer quality data in LMICs Higher mortality in LMICs WHO Detailed Mortality Database, February 2014 update

20 The economic costs of asthma are very large o Health care costs and productivity losses increase with poor asthma control o Productivity losses are at least as large as health care costs o Little known from LMICs

21 Environmental factors suggested by ISAAC Inverse associations of asthma symptoms with: o breast feeding in non-affluent countries o fresh fruit and vegetable intake

22 Environmental factors suggested by ISAAC Positive associations of asthma symptoms with: o open fire cooking o farm animals o high intensity truck traffic exposure o tobacco smoke exposure o dampness in homes o burger/fast food intake o obesity o paracetamol/antibiotic use

23 Cooking with open fire only and current wheeze Age of children 6-7 yrs yrs Fully adjusted OR (95%CI) 2.17 ( ) 1.35 ( ) Wong GWK, et al. Lancet Resp 2013; 1(5):

24 Farm animals and current wheeze L Smit. IJE 2012:41:761 Fully adjusted OR (95%CI) Countries In pregnancy In 1 st year of life Non-affluent 1.38 ( ) 1.27 ( ) Affluent 0.95 ( ) 0.96 ( ) Brunekreef B, et al. Int J Epidemiol 2012; 41: ISAAC 2012

25 Launched at the UN Summit on NCDs Sept 2011

26 o Established 2012 o Builds on the work of ISAAC and the International Union of Tuberculosis and Lung Disease (The Union) o Current funding - The Union

27 Global Asthma Network 248 centres in 113 countries All countries invited

28 Global Asthma Network Targets Decrease severe asthma by 50% by 2025 proportion of symptomatic people with asthma not on ICS* time off work/school because of asthma unplanned visits for asthma hospital admissions for asthma severity of asthma mortality from asthma * Inhaled Corticosteroids

29 Asthma Management Guidelines available in 89% of 103 countries Ellwood P et al. ATS Conference abstract and poster: San Diego May 2014.

30 Asthma Management Guidelines available in 89% of 103 countries Ellwood P et al. ATS Conference abstract and poster: San Diego May 2014.

31 National Asthma Strategies for adults in 23% of 103 countries Ellwood P et al. ATS Conference abstract and poster; San Diego May 2014.

32 Global Asthma Network Targets Increase access to quality-assured essential asthma medicines by 2018: On the WHO prequalification list On National Essential Medicines Lists Available in all countries Affordable in all countries

33 Why are these targets important?

34 Essential asthma medicines survey 2011 in 50 LMICs 90% 80% 70% 60% 50% 40% Salbutamol ICS(Beclometasone or Budesonide) Both Salbutamol and ICS 30% 20% 10% 0% Salbutamol ICS(Beclometasone or Budesonide) Both Salbutamol and ICS Babar Z et al. PharmacoEconomics 2013

35 72% LMICs did not have both Salbutamol and ICS on Essential Medicines Lists 90% 80% 70% 60% Salbutamol 50% 40% 30% 28% ICS(Beclometasone or Budesonide) Both Salbutamol and ICS 20% 10% 0% Salbutamol ICS(Beclometasone or Budesonide) Both Salbutamol and ICS Babar Z et al. PharmacoEconomics 2013

36 LMICs: Poor availability of salbutamol and ICS 100% 90% 80% 70% 60% 50% 40% 30% Salbutamol 100µg ICS (Beclometasone or Budesonide) 20% 10% 0% Private Pharmacy National Procurement Centre Public Hospital Pharmacy Babar Z et al. PharmacoEconomics 2013

37 If drugs are available, are they affordable?

38 Salbutamol 100 µg inhaler No. days minimum wage to buy one 120% 100% 80% 60% Salbutamol 100µg 40% ICS (Beclometasone or Budesonide) 20% 0% Private Pharmacy National Procurement Centre Public Hospital Pharmacy Babar Z et al. PharmacoEconomics 2013

39 Beclomethasone 100µg inhaler No. days minimum wage to buy one 120% 100% 80% 60% Salbutamol 100µg 40% ICS (Beclometasone or Budesonide) 20% 0% Private Pharmacy National Procurement Centre Public Hospital Pharmacy Babar Z et al. PharmacoEconomics 2013

40 Budesonide 100µg inhaler No. days minimum wage to buy one 120% 100% 80% 60% Salbutamol 100µg 40% ICS (Beclometasone or Budesonide) 20% 0% Private Pharmacy National Procurement Centre Public Hospital Pharmacy Babar Z et al. PharmacoEconomics 2013

41 Unaffordable asthma medicines not just a problem in LMICs.the cost of a steroid inhaler without insurance in the USA varies from $139 to over $300, depending on the brand and the dose required. Editorial. Affordable Care Act. Lancet Respiratory Medicine 2014;2:339

42 Poor quality of manufacture of the intricate components of MDIs more likely in LMICs

43 To reduce disparities in asthma we must increase access to affordable quality - assured essential asthma medicines

44 A model - the Asthma Drug Facility (ADF) A project of The Union The ADF has been making it possible to obtain qualityassured essential medicines at affordable prices in LMICs including: o Benin o Burundi o El Salvador o Honduras o Kenya o Sudan o Vanuatu o Vietnam

45 In summary global asthma disparities which particularly affect LMICs include Changes over time in prevalence Severity Mortality Knowledge of economic costs Environmental factors National asthma strategies Essential medicines (availability, affordability, quality)

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