Poor adherence contributes to many asthma deaths
Poor adherence to medication is one of the key factors contributing to asthma deaths, according to a new report published this week.
The Global Burden
of Asthma Report looks at the prevalence, morbidity
and mortality of asthma around the world and reveals that a global increase
in asthma has occurred in both children and adults in recent decades.
The report says that, in the UK, about 20,000 new episodes of asthma
are dealt with by GPs each week. An average primary care organisation
can expect to treat 25,000 people with asthma, with over 400 people admitted
to hospital and eight asthma deaths each year.
Respiratory pharmacist Anna Murphy, Glenfield Hospital, Leicester, agrees
with the report’s findings that poor adherence, suboptimal routine
care and delay in obtaining help during the final attack contributes
to many of the deaths.
“Non-compliance rates with inhaled steroids in asthma are around
50 per cent, with studies estimating rates from 10 to 80 per cent,” she
told The Journal. “Many patients do not start to inhale their steroids
until they feel ill,” she added.
Ms Murphy said that all pharmacists, whether working in the community
or in hospital, should explain to asthma patients at every opportunity
the rationale of using regular preventive therapy with inhaled steroids.
They should also try to reduce the fears about these drugs that many
patients have.
The report says that there has been a global increase in asthma in both
children and adults, and that this increase is likely to continue over
the next 20 years. The report estimates that there will be an additional
100 million sufferers by 2005.
The UK now has one of the highest prevalence rates of asthma in the world,
with a mean prevalence of 16.1 per cent. This compares with 4.5 per cent
in Italy, 6.8 per cent in France, 6.9 per cent in Germany and 10.9 per
cent in the US.
Case fatality rates per 100,000 asthma
patients are 3.2 in England, compared with 3.6 per cent in Italy, 6.5
in France, 5.1 in Germany and 5.2 per cent in the US.
One of the report’s lead authors, Richard Beasley, of the Medical
Research Institute in New Zealand, says that in many areas of the world,
people do not have access to basic asthma medicines or medical care. “Even
where medicines are available and affordable, asthma management often
does not meet international guidelines,” he added.
The report was commissioned by the Global Initiative for Asthma, an industry
sponsored group, set up in 1993.
Allergic disease declining British
adolescents aged 12–14 years are reporting less allergic
disease, such as asthma, hay fever and eczema, according to a survey
of around 15,000 children
in 1995 and 2002. Self-reported trends of wheeze have dropped from 34 per cent
in 1995 to 28 per cent in 2002. Rates of frequent asthma attacks are also declining
(9.7 per cent in 1995 to 6.3 per cent in 2002). A paradoxical increase in the
prevalence of asthma is thought to be due to increasingly milder disease being
diagnosed (BMJ 2004;328:1052).
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