Academic journal article Bulletin of the World Health Organization

The Public Health Implications of Asthma

Academic journal article Bulletin of the World Health Organization

The Public Health Implications of Asthma

Article excerpt


Health economics is receiving more attention as decision-makers--including purchasers, physicians and patients--seek a more comprehensive understanding of the impact of adopting new health care strategies in developed and developing countries. Formal economic evaluation is playing an increasingly important role in health care decision-making, including that related to asthma (1).

Asthma, a chronic disease that affects both children and adults, has been the focus of clinical and public health interventions during recent years. In the present paper we discuss firstly the burden of asthma including the trends in prevalence, severity, mortality and disability-adjusted life years (DALYs) as well as the barriers to its optimal management. Secondly, the role of the workplace environment as a contributor to the general burden of asthma will be examined. Thirdly, surveillance of asthma as part of the WHO noncommunicable disease (NCD) surveillance programme for disease management will be examined. Finally, we review the direct and indirect costs of asthma and how they can be optimized and predicted.

Burden of asthma

Importance of noncommunicable diseases in developed and developing countries

There is no doubt that, for the next 10-20 years, communicable diseases will remain the predominant health problem for the populations of many developing countries. Worldwide, NCDs represent 43% of the burden of disease and this is expected to increase in the future, particularly in developing countries (2). There is already evidence that the prevalence of certain NCDs, such as diabetes, asthma, chronic obstructive pulmonary disease (COPD), epilepsy and hypertension, is increasing rapidly in some low-income countries (3).

In developing countries, chronic respiratory diseases (CRDs) represent a challenge to public health because of their increasing frequency and severity, and the projected trends and economic impact (4, 5). Health care planners are also faced with the consequence of a dramatic increase in tobacco use and must establish priorities for the allocation of limited resources.

Trends in prevalence

Asthma is one of the most common chronic diseases in the world. It is estimated that around 300 million people in the world currently have asthma (6). In the global burden of asthma report of the Global Initiative for Asthma, the prevalence of asthma in different countries has been considered to range from 1% to 18% of the population (see Fig. 1; web version only, available: (6).


The prevalence of asthma increases as communities adopt modern lifestyles and become urbanized (5). With the proportion of the world's population living in urban areas projected to increase from 45% to 59% in 2025, there is likely to be a marked increase in the number of people with asthma worldwide over the next two decades. It is estimated that there may be an additional 100 million people with asthma by 2025 (6).

However, the prevalence of asthma and allergy may decrease in children in some countries with a high prevalence of the disease (7). In some countries, an increasing prevalence of allergic rhinitis, but not asthma has been observed (8). It is therefore possible that the increase in the asthma epidemic is coming to an end in some countries (Fig. 2).


Trends in severity and mortality

Although the information on asthma mortality is unreliable in many countries, it is estimated that asthma accounts for about 250 000 deaths per year worldwide (6). There are large differences between countries, and, unexpectedly, the rate of asthma deaths does not parallel prevalence (Fig. 1). Many of the deaths are preventable, being due to suboptimal long-term medical care and delay in obtaining help during the final attack. The countries with the highest death rates are those in which controller therapy is not available (6). …

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