Worldwide Study Finds Asthma Control, Management Inadequate in Lower-Income Countries

Asthma management and control is often inadequate, especially among children living in low-income countries, according to findings of a recent study. Asthma management strategies should focus on improving adherence to treatment guidelines worldwide, the authors wrote, with an emphasis on these areas with disproportionately worse asthma management.

“Improved asthma control is an urgent need worldwide, particularly in children and in less affluent countries,” the authors noted. “Improving the availability and affordability of inhaled medicines in less affluent countries should be a priority.”

This cross-sectional study is the first to collect individual-level data on asthma treatment on a global scale, while including economic data. The results were published in The Lancet Global Health.

Data came from the Global Asthma Network Phase I cross-sectional epidemiology study between 2015 and 2020, in which a questionnaire was distributed by schools to children (ages 6-7 years), adolescents (ages 13-14 years), and adults (19 years or older). Eligible adults were the parents or guardians of children and adolescents included in the survey.

A total of 453,473 individuals from 63 centers in 25 countries were included in the study. Of the total, there were 101,777 children, 157,784 adolescents, and 193,192 adults.

Of the individuals who were diagnosed with asthma by a doctor, 6445 (6.3%) were children, 12,532 (7.9%) were adolescents, and 6677 (3.4%) were adults.

Additionally, the researchers looked at data on the use of inhaled medicines. The most used medicines for asthma in the previous year were inhaled short-acting b2 agonists (range across groups, 29.3%-85.3%) and inhaled corticosteroids (12.6%-51.9%).

The proportion of individuals with severe asthma who did not take inhaled corticosteroids was high among all age groups, and significantly higher in middle-to-low-income countries:

• 934 (44.8%) of 2085 children
• 2011 (60.1%) of 3345 adolescents
• 1142 (55.5%) of 2058 adults

The study also looked at how many people used asthma management plans. The proportion of individuals who used an asthma management plan are lower than ideal according to guidelines:

1. 4049 (62.8%) children
2. 6694 (53.4%) adolescents
3. 3168 (47.4%) adults

The proportions of individuals with well-controlled asthma were as follows:

1. 2840 (44.1%) children
2. 6942 (55.4%) adolescents
3. 4081 (61.1%) adults

Additionally, independent from asthma severity or country income, using a management plan was associated with the use of an inhaled medicine:

1. Children: adjusted odds ratio (AOR), 2.75; 95% CI, 2.40-3.15
2. Adolescents: AOR, 2.45; 95% CI, 2.25-2.67
3. Adults: AOR, 1.78; 95% CI, 1.55-2.04

Lastly, poor asthma control was associated with low country income:

1. Children: OR, 2.33; 95% CI, 1.32-4.14
2. Adolescents: OR, 3.46; 95% CI, 1.83-6.54
3. Adults: OR, 4.86; 95% CI, 2.55-9.26

Overall, the results of this study revealed a need for better asthma management and control strategies in order to lessen the global burden of asthma.

“In conclusion, improved asthma control is an urgent need worldwide, particularly in children and in less affluent countries,” the researchers wrote. “Improving the availability and affordability of inhaled medicines in less affluent countries should be a priority.”

Reference

García-Marcos L, Chiang CY, Asher MI, et al; Global Asthma Network Phase I Study Group. Asthma management and control in children, adolescents, and adults in 25 countries: a global asthma network phase I cross-sectional study. Lancet Glob Health. 2023;11(2):e218-e228. doi:10.1016/s2214-109x(22)00506-x