Asthma can be deadly, especially for children. Cipla South Africa is at the forefront of a collective effort to ensure those in need receive the most effective treatment.

Asthma is a respiratory condition that affects millions of people in South Africa and can even lead to death. Sadly, South Africa has one of the highest rates of childhood asthma in Africa, and teenagers are experiencing more severe asthma symptoms than ever before. The risk factors for severe asthma are linked to various sociodemographic factors.1.

Available research shows that we have not been treating the condition properly for a long time, only focusing on symptoms. As such, an estimated 1 000 people die from asthma every day, according to the Global Asthma Report.

"In South Africa, mortality due to asthma is still one of the highest in the world, and a leading cause of absenteeism from work,” says allergy specialist and founder of the Allergy and Asthma Clinic in the Western Cape, Dr Corli Lodder. “We grapple with a general misunderstanding of the condition, including the fact that while the condition may be the same, the triggers may be different and need to be thoroughly assessed and understood.”

According to the 2022 Global Asthma Report, South Africa has one of the highest rates of childhood asthma. For instance, over 20% of the population of all children in South Africa, well beyond the global rate of 1 in 10, show symptoms. This cross-sectional study was conducted by the Global Asthma Network between 2015 and 2020.

Consistently around the world, asthma management has been found to be inadequate, especially amongst children.

The Global Asthma Initiative (GINA) has established a thorough collection of recommendations, known as the Global Strategy for Asthma Management and Prevention, updated in 2023. This guide serves to aid healthcare providers and the wider public in identifying the most effective treatment for their respective asthma condition.

In the first step, a doctor must be able to confirm a diagnosis, pin-pointing what type of asthma the patient suffers from, and the possible contributing factors. 

Increasing evidence shows that once co-morbidities, environmental factors and behaviour (like exercise and quitting smoking) are managed as best as possible, a combination drug treatment is the most effective, as is indicated in the latest GINA Guidelines.

Using a reliever, which muscle-relaxant pump (short-acting Beta-2 adrenergic receptor agonists/ SABA), as well as a controller, which are inhaled corticosteroids taken daily, patients learn to treat the symptoms. In fact, treating only the acute symptom with the muscle relaxant may lead to complications, as the inflammation of the airway will persist, even when the muscle is relaxed. 5

Reliever treatment can also contain inhaled corticosteroids.

Reliever medication is used for quick relief of acute symptoms by reducing the inflammation and opening up the airway, such as during asthma exacerbations.

Controller medication contains steroids and are taken daily to control symptoms, reduce inflammation, and prevent asthma attacks. Controller medications should be taken daily even when one does not have symptoms.

The Global Asthma Report also reported that from a sample of over 450 000 people, from 63 centres in 25 countries around the world, the most used medicine was the SABA inhaler, ranging from 29.3% to 85.3%, and inhaled corticosteroids, from 12,6% to 51.9%.

The proportion of people with severe asthma symptoms not taking the corticosteroid was high in all ages. An average of around 45% of children, 60% of adolescents and 55.5% of adults were doing so, and this was significantly higher in middle-to-low-income countries, like South Africa. 6

Asthma management plans developed from the GINA Guidelines were used by about 63% of children, 53% of adolescents, and 47·4% of all adults. This was reflected in the fact that 44·1% children, 55·4% of adolescents, and 4081 (61·1%) adults had well controlled asthma.

Poor asthma management is especially prevalent in low-income countries, where healthcare providers often don’t offer patients sound treatment, for a variety of reasons. Chief among these the widespread poor training of doctors on asthma, even in higher income countries. 7

Other factors working against low-income countries is the lack of reliable access to essential asthma medicines. When they do receive the medication, they are often not allocated properly and patients may not be able to use them effectively, often due to language barriers.7

"Asthma is a chronic condition that needs to be treated just as seriously as other conditions,” Dr Lodder says. “For instance, people with heart conditions will regularly have electrocardiogram (ECG) scans and diabetics will test for blood sugar levels, but very few people with asthma or those treating the condition make use of peak flow meters, that measure how much air is moving in and out of the lungs. These are the educational gaps we need to close amongst population, as well as the medical community.”

In the field, we work directly with new medical graduates who enter the Cipla network each year to complete their entire two-year internship at Cipla offices around the world.

In our endeavour to provide education about asthma, we cover a vast array of topics, including detailed theoretical concepts, assessments, and treatment strategies. In an effort to make asthma education both engaging and enjoyable, Cipla launched the Bronki Boosters campaign in 2021. This campaign, highlighted by an animated comic series, aimed to dispel misconceptions about inhaler use among children and simultaneously ensure their correct usage.

With 6.34 million inhalers dispensed in South Africa alone, the packaging made of plastic needs to be collected and recycled properly to ensure limited impact on the environment. Cipla’s campaign, partnering with pharmacies around the country, ensures that empty inhalers are repurposed into items that make a difference in communities while helping reduce the collective carbon footprint.

With correct inhaler usage, it is possible to treat than asthma effectively, using a fast-acting reliever for acute symptoms and a slow-acting controller, taken regularly to prevent asthma attacks.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881662/ 

http://globalasthmareport.org/burden/deaths.php 

http://globalasthmareport.org/regions/southafrica.php 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881662/ 

https://ginasthma.org/wp-content/uploads/2023/05/GINA-2023-Full-Report-2023-WMS.pdf 

http://globalasthmareport.org/foreword/summaries.php 

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00506-X/fulltext