There are two key messages for this year's South African World Asthma Day. The first is that asthma is a severe disease that is very common, and has marked effects on the sufferers and their families. The second is that it is preventable and treatable, with the correct use of "preventer" and "reliever" medication, and the avoidance of triggers such as smoking.
The 2003 WHO Burden of Asthma Report estimated that asthma affects as many as 300 million people worldwide, resulting in approximately 180 000 deaths per annum from the condition. Asthma is one of the most prevalent long-term illnesses in the world, with trends being particularly marked in children.
Asthma is a highly prevalent disease in South Africa. Using self-reported symptoms of asthma, the ISAAC-1 study reported 13% prevalence in South African children aged 13 to 14 years, compared to a global average of 11% or an African average of 9%.
These figures estimate that it may be the most common long-term condition in children in South Africa! A Study by Neil White & Rodney Ehrlich looking specifically in North West Cape Town (Table View area related to the oil refinery) found an incidence of 23.7% of reported asthma in children 11-14 years. This is higher than the prevalence of 11-13% in the previous ISAAC survey done in Cape Town in the mid-90s, and 10.8% in a study by Ehrlich in Mitchell's Plain in 1995.
Reports from South and Southern Africa have suggested a substantial and rising asthma prevalence. The prevalence of exercise-induced asthma in urban and rural school children is rising and the gap between the high prevalence in urban areas and lower prevalence in rural areas is diminishing. Moreover, while low socio-economic status may be associated with a lower prevalence of asthma, poverty is associated with more severe asthma and higher morbidity.
Although causes for this remain unknown, current theories implicate increasing urbanisation, reduction in the prevalence of childhood infections, change in diet and lifestyle and increased exposure to allergens or pollutants.
The most cost- effective treatment is inhaled corticosteroids (preventer pumps) and inhaled B2 agonists (reliever pumps). By using these pumps appropriately and avoiding triggers of asthma such as smoking, asthmatic people can lead completely normal lives, free from any limitation caused by their asthma.
Appropriate asthma therapy should be accessible and affordable for all those who need it. Our patients and their families should be aware of what their medications are, and how to use them, so that they can not only be healthy, but also healthy advocates for effective asthma care.
Tobacco smoke and indoor pollution (open fires) are harmful to asthmatic patients. Smoking should not be allowed in a room or vehicle in the presence of an asthmatic patient. Encourage and support smokers to quit.
In individual cases where house dust mites have been identified as a problem, appropriate control measures should be considered. (These include the use of plastic mattress covers, and pillows and duvets filled with synthetic materials, the removal of bedroom carpets and avoidance of fabric-covered furniture Regularly air all bedding sunshine, damp dust and possible, vacuum). Keep pets outside the house. Certain preservatives (e.g. benzoate and sulphites), allergens and other factors are potentially potent triggers and should be avoided.
Exercises-induced asthma should be controlled by the prophylactic use of two (2) puffs of an inhaled B2-agonist five (5) minutes before the exercise.
Prepared by Gemma Franks
Ms EC Kennel
DD: Sub Directorate Chronic Care, Rehabilitation, HBC and Geriatric Care.