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PROBLEMS OF ASTHMA

MANAGEMENT IN PAKISTAN

BURDEN OF ASTHMA
ASTHMA IS ONE OF THE MOST
COMMON CHRONIC DISEASE
WORLDWIDE
PREVALENCE INCREASING IN MANY
COUNTRIES ESPECIALLY IN CHILDREN
OVER 300 MILLION ASTHMATIC
WORLDWIDE
GLOBAL ECONOMIC COST EXCEED
THAT OF TB HIV COMBINED
SOURCE :CHEST JULY 2006

HOW COMMON IS ASTHMA IN


PAKISTAN
THE MAGNITUDE OF THE PROBLEM IS
NOT CLEARLY KNOWN
APPROXIMATELY 10% OF ADULTS AND
20% OF CHILDREN IN PAKISTAN
ALONE ARE SUFFERING FROM THIS
DISEASE
THIS DISEASE IN OUR COUNTRY IS
STILL UNDER DIAGNOSED AND
POORLY TREATED

HOW GOOD ARE WE MANAGING


ASTHMA
POOR COMPLIANCE IS ONE OF THE
MAJOR PROBLEMS IN MANAGEMENT
OF ASTHMA AND LACK OF
KNOWLEDGE AND UNDERSTANDING
ABOUT THE DISEASE IS THE REASON
FOR POOR COMPLIANCE

SOCIAL STIGMA
IT IS NOT A CONTAGIOUS DISORDER
PATIENTS DO NOT ACCEPT
DIAGNOSIS DUE TO DISCRIMINATION
IN SOCIETY

DIAGNOSIS OF ASTHMA
PATIENTS ARE OFTEN MISDIAGNOSED
AS HAVING CHEST INFECTIONS OR
BRONCHITIS
IGNORANCE ABOUT THE DISEASE IS
COMMON AMONGST ASTHMA
PATIENTS AS WELL AS DOCTORS

FALSE HOPES AND DOCTORS


SHUFFLING
ASTHMA CAN NOT BE CURED BUT CAN BE
VERY WELL CONTROLLED
THERE ARE FALSE CLAIMS MADE BY
QUACKS AND UNPROFESSIONAL DOCTORS
CLAIMING TO CURE ASTHMA
IT IS USUALLY A LONG TERM VARIABLE
LIFETIME DISORDER PRESENT EVEN WHEN
THERE ARE NO SYMPTOMS

MISUSE OF STEROIDS
CORTICOSTEROIDS ARE THE MOST
COMMON MEDICATIONS FOR ASTHMA
MANAGEMENT WHICH IS BEING USED
THROUGHOUT THE WORLD.IT
SHOULD BE GIVEN IN INHALER FORM
EIGHTY SEVEN PERCENT (87%)
ASTHMA PATIENTS HAVE NEVER
TAKEN OR HEARD ABOUT INHALED
CORTICOSTEROIDS

MISCONCEPTIONS ABOUT
INHALERS
INHALER DEVICES ARE THE BEST
METHOD OF DELIVERING ASTHMA
MEDICATIONS
THERE ARE MANY MISCONCEPTIONS
ABOUT INHALERS AMONGST ASTHMA
PATIENTS AND DOCTORS

POOR TECHNIQUE OF
INHALERS
EIGHTY PERCENT(80%) OF
ASTHMATICS IN PAKISTAN STILL USE
SYSTEMIC THERAPY i.e. ORAL AND
PARENTAL
EVEN THOSE ON INHALED
MEDICATIONS OVER 90% ARE ON
INHALED BRONCHODILATORS AND
ONLY 10% ARE ON INHALED
CORTICOSTEROID THERAPY

EXCESSIVE USE OF
NEBULIZERS
PATIENTS MAY USE THEIR NEBULIZER
REPEATEDLY AND DELAY SEEKING
MEDICAL HELP IN SEVERE ASTHMA. IT
IS SAID THAT
IF YOU NEED A NEBULIZER , THEN
YOU NEED TO SEE A DOCTOR

DESENSITIZATION VACCINES
AND ASTHMA
IMMUNOTHERAPY HAS PROVEN NOT
TO BE OF MAJOR BENEFIT IN ASTHMA
AND THERE IS ALSO A RISK OF
DEVELOPING SERIOUS ALLERGIC
REACTIONS TO THE INJECTIONS

OVER USE OF AMINOPHYLLINE


IN ACUTE ATTACKS
AMINOPHYLLINE SHOULD NOT BE THE
FIRST DRUG TO BE GIVEN IN ACUTE
ATTACKS OF BRONCHIAL ASTHMA
SIDE EFFECTS ARE COMMON

DIET AND ASTHMA


ASTHMA CAN ALSO BE PROVOKED BY
A WIDE RANGE OF FOODS , ADDITIVES
AND PRESERVATIVES
FOODS: EGGS , PEANUTS AND
SHELFISH
PRESERVATIVES: TARTRAZINE
(ORANGE COLOURING) AND
SULPHITES (ALCOHOLIC DRINKS
SUCH AS WINE)

DISSEMINATION OF
GUIDELINES AND
ADHERENCE TO GUIDELINES
THE DEVELOPMENT OF GUIDELINES
IS A LABOURIOUS PROCESS AND ITS
DISSEMINATION AMONGST
RESEARCHERS, DOCTORS AND
PATIENTS IS A DIFFICULT TASK

COST OF TREATMENT
COST OF TREATMENT OF INHALED
CORTICOSTEROIDS IS A BIG
CHALLENGE AND NEED TO BE
TACKELED
DOCTORS HAVE A RESPONSIBILITY TO
USE MEDICATIONS APPROPRIATELY
BECAUSE OF THE HIGH COST
INVOLVED

WHAT CAN WE LEARN FROM


RECENT RESEARCH ON
ASTHMA?
LONG ACTING BETA AGONISTS
SHOULD NOT BE USED AS
MONOTHERAPY IN ASTHMA AND MUST
ONLY BE USED IN COMBINATION WITH
AN APPROPRIATE DOSE OF INHALED
GLUCOCORTICOSTEROIDS

WHAT CAN WE LEARN FROM


RECENT RESEARCH ON
ASTHMA? (CONT)
LEUKOTRIENE MODIFIERS NOW HAVE
A MORE PROMINENT ROLE AS
CONTROLLER TREATMENT IN ASTHMA
PARTICULARLY IN ADULTS

WHAT CAN WE LEARN FROM


RECENT RESEARCH ON
ASTHMA? (CONT)
MONOTHERAPY WITH CROMONES IS
NO LONGER GIVEN AS AN
ALTERNATIVE TO MONOTHERAPY
WITH A LOW DOSE OF INHALED
GLUCOCORTICOIDS IN ADULTS

KEY NOTE MESSAGE


IN ORDER TO CONTROL ASTHMA
PHYSICIAN MUST BE A GOOD
LISTENER AND EDUCATOR
WITH PROPER MANAGEMENT ALMOST
ALL PATIENTS WITH ASTHMA CAN
LEAD A NORMAL LIFE