Asthma Awareness Month: Underdiagnosis and lack of adherence to treatment increasing Asthma burden in India

The Global Burden of Disease (GBD) study has estimated that India is home to over 30
million asthmatics, accounting for 13.09% of the global burden. However, when it comes to
mortality, India accounts for over 42% of all global asthma deaths. Despite being a leading cause of morbidity and mortality, the disease continues to be undiagnosed and untreated for years.

Population-based studies done globally, have estimated that 20% to 70% of patients with asthma remain undiagnosed and hence untreated.

The various contributory factors for underdiagnosis and undertreatment of asthma include lack of disease awareness, poor adherence to inhalation therapy, illiteracy, poverty, and social stigma. The patients often overlook their early symptoms which eventually lands them in a more critical condition. According to the Global Asthma Network (GAN) study, 82% of patients with early symptoms and 70% of patients with severe asthma, remain undiagnosed in India.

The percentage of adherence to the optimal treatment is also very low among diagnosed patients, with less than 2.5% of patients using daily inhalation therapy.

Asthma often referred by lay public as ‘swas’, ‘dama’, or ‘cold and cough’, is a chronic respiratory disease that causes difficulty in breathing, chest pain, cough, and wheezing. The disease affects the airways of the lungs, causing chronic inflammation, which makes the airways more sensitive to triggers thereby increasing the chances of asthma attacks.
Citing the GAN study,Dr Rajesh Swarnakar,National Secretary; Indian Chest Society, Director &
Chief Consultant Pulmonologist–Department of Respiratory, Critical Care,Sleep Medicine and
Interventional Pulmonology,Getwell Hospital & Research Institute, Dhantoli, Nagpur stressed
on the importance of addressing the social stigma towards asthma. “When an asthmatic patient consults a doctor, only 71% of doctors give the diagnosis of “Asthma” as the name of their disease while close to a third (29%) use other terminologies. Also, at the patient level, only 23% asthmatic patients call their disease as asthma. Social stigma associated with asthma and use of inhalers is prevalent. Further, patients barely adhere to medication and mostly take symptom driven treatment.

Awareness, Acceptance and Adherence need to be aligned to win against asthma.”
Dr Rajesh Swarnakar,National Secretary;Indian Chest Society,Director & Chief Consultant
Pulmonologist–Department of Respiratory, Critical Care, Sleep Medicine and Interventional
Pulmonology, Getwell Hospital & Research Institute, Dhantoli, Nagpur highlighted, “Asthma is
considered as a stigma and many patients conceal the disease. It is only when the symptoms
aggravate or are intolerable a patient consults a physician and will take the medication that is
prescribed. We need to keep reminding patients that Symptom-free is NOT asthma-free. This
remains one of the biggest challenges in asthma management. Many patients discontinue using inhalers once they feel better. This discontinuation often leads to flare up of symptoms which can worsen disease outcomes. Further, incorrect notions such as inhalers being harmful and habit forming also play a role in treatment non-adherence. Hence this needs to be addressed aggressively”

The need of the hour for patients is to gain timely consultation with a physician, which will help him get the right information and diagnosis for his symptoms and start with the right treatment early on.

Timely diagnosis is very important to manage asthma. Understand your asthma symptoms and
consult your doctor.