The Global Burden of Disease study 2019 estimated that India accounts for 13 per cent of the global asthma burden with 34.3 million cases of asthma. Furthermore, India also accounts for over 42 per cent of all global asthma-related deaths and ranks number one in the world for disability-adjusted life years (DALYs) due to asthma. According to the Global Asthma Network (GAN) study, nearly 70 per cent of individuals with severe asthma symptoms aren’t clinically diagnosed as having asthma, with less than 9 per cent of those diagnosed receiving ICS (inhaled corticosteroids) treatment, which is the foundation of asthma management.
Keeping all these statistics in mind, the startling disproportion between the prevalence of the disease and the level of morbidity due to the disease in India can be attributed to two key factors – underdiagnosis and unwillingness to accept the right treatment owing to associated myths. Therefore, in my opinion, to combat these two factors, there is an inherent need to create heightened awareness about the disease as well as a better understanding of inhalation therapy, which is vital in the effective management of the disease.
What do you think is the reason behind the increasing burden of asthma in India?
Fueled by lack of awareness about the disease and the associated notions about its recommended treatment i.e., inhalers, asthma as a disease category is plagued by myths, stigma, and lack of information leading to the improper management of the disease.
In fact, the taboo associated with asthma has led to patients not wanting to be termed as asthmatics with only about 23 per cent of asthmatics calling their condition by its actual name. Patients often overlook early symptoms, putting off early medical intervention which is critical to the effective management of any chronic respiratory disease. Additionally, misconceptions about inhalers being harmful or addictive leads to conditions either being left untreated, or patients just abruptly discontinuing doctor-prescribed treatment once symptoms are manageable. In fact, it could be said that the burden of social stigma associated with asthma in India is comparable to the disease burden itself.
All these factors paired with the increased prevalence of risk factors on a socio-cultural and lifestyle level, further adds to the increased burden of asthma in the country.
What is the solution that can help combat the current scenario?
Lack of patient education, stigmas associated with inhalers, and concerns about medication side-effects needs to be combated with a considerable shift in perception in the way India views asthma and inhalers. And to achieve this change, a threefold approach of – Awareness about the disease, Acceptance, and Adherence of its recommended treatment needs to be championed across the country and the sector.
Awareness around asthma and its management is a preliminary step that lays the foundation for a better, more well-informed conversation around the disease and treatment efficacy. Serving as a gateway to the next crucial phase which is acceptance of the condition itself as well as its treatment-tackling the social stigma around asthma, educating patients about inhalers, their benefits in asthma management, inhaler usage as well as correct device technique.
These two phases ultimately aid in the final stage of treatment adherence. While inhalation therapy is the cornerstone in asthma management, more than 40 per cent of asthmatics do not adhere to treatment and stop the use of inhalers once they feel better. Therefore, it’s the hope that with better awareness, comes heightened acceptance and increased adherence, thereby improving the patient’s quality of life.
What are some challenges around asthma management in India?
The key barriers to asthma management in India are – the social stigma associated with the diagnosis of the disease, as well as acceptance of the recommended route of drug delivery i.e. inhalation and for those on inhalation therapy, adherence to the prescribed treatment. Furthermore, according to an article published on challenges faced in managing adult asthma in Asian countries– poor awareness of the disease and its management, access to healthcare and cost of medication, poor inhaler technique and inability to recognize the warning signs, further adds to the challenge.
These factors not only contribute to inadequate treatment and management of the disease but also fundamentally hinder patients from getting diagnosed accurately.
There are a lot of social stigmas attached to inhalers, what are the steps that need to be taken to address the challenge?
Even though Inhalation therapy is the recommended drug delivery method for managing asthma – the perception that inhalers can cause side effects, the aversion to inhalers is rampant amongst both asthmatics as well as caregivers. In fact, parental concerns about the use of inhalers range from growth suppression to addiction. Additionally, with most asthmatics viewing the use of inhalers or even carrying an inhaler as an embarrassment and an impediment to their social life, the social stigma associated with the therapy is yet another barrier to overcome.
These widespread misconceptions can be attributed to multiple factors like lack of guidelines or guidance regarding device selection, poor inhaler technique, and limited information to help patients better understand the importance of inhalation therapy. With the latter posing a more profound effect on the diagnosis and management of the disease. Here patient education through dedicated patient educators can help address these challenges.
Spending time with patients to educate them about their condition and help them understand the benefits of inhalation therapy as the right way to manage asthma is important. Additionally, it helps address the barriers as well as social stigmas associated with inhalers. We’ve seen the effectiveness of this strategy play out whenever a Breathefree educator, whether digitally or in-person, has engaged with patients. This in turn has helped us solve some of the unmet needs seen in the management of asthma.
How is Cipla working towards awareness and management of asthma?
At Cipla, we are guided by our purpose of ‘Caring for Life’, keeping patients at the core of everything we do. Our endeavor is to go beyond the pill and help patients lead healthier lives. We believe that an attitudinal and behavioral shift towards a disease can be driven through adequate empowerment and consistent support given to both patients as well as the healthcare network. We’ve been driving this ambition through a multidimensional approach championed by mass awareness campaigns like #BerokZindagi as well as a lot of patient-centric initiatives like Breathefree, which is a comprehensive patient support program.
With #BerokZindagi we have been running one of the largest patient awareness campaigns for asthma. Through this campaign we have, so far, worked on – creating awareness by engaging the masses through social conversations, driving acceptance of inhalers by addressing myths and stigma and combating a lack of information with knowledge enablers to educate patients on the benefits of inhalation therapy and how to use inhalers correctly.