INDIA CONTRIBUTES to 42 percent of global asthma deaths, according to a report published online in Lung India journal related to respiratory medicines on Tuesday. While inhaled corticosteroids (ICS) is a standard treatment, authors of the study have said that the main reason for the rise in deaths is that 90 percent of asthmatics do not get the right medication.
The country has an estimated 34.3 million asthmatics, that is 12.9% of the global 262 million cases. Every year, 4.61 lakh people die due to asthma in the world, and India contributes to 1.98 lakh deaths. This is indeed very worrying, and it was important to identify the cause for this, Dr Sundeep Salvi, Director of Pulmocare Research and Education (PURE) Foundation and the lead author of the study, told The Indian Express.
“We conducted an in-depth analysis earlier this year after obtaining the sales of inhaled corticosteroids (ICS) in India from the IQVIA (Intercontinental Marketing Services and Quintiles), an authentic source of drug sales in the country. This was compared with the expected sales of inhaled corticosteroids. For the 34.3 million asthmatics in India, the total sales of inhaled corticosteroids should be 384 million units, but the actual sales in 2020-21 were only 26.4 million units. This means that more than 90% of asthmatics in India do not receive the right asthma medication, Dr Salvi pointed out.
According to the latest data from the Global Burden of Diseases (GBD) study in 2019, states of Uttar Pradesh, Bihar, Odisha are among the top three with the highest number of asthmatics. However, the number of ICS units sold here were clearly inadequate for the number of patients with the disease. For instance, the number of asthmatics in Uttar Pradesh is 40.83 lakh. While the expected sales of ICS should have been 49 million units according to the study, only four million units were sold. Similarly, Bihar has 31.42 asthmatics and the expected sale of ICS is around 37.7 million units. According to the study, the sale was only 1.9 million units.
Inhaled corticosteroids (ICS) are the mainstay of asthma treatment in the world. They reduce the underlying inflammation in the airways, which is the characteristic feature of asthma, and reduce the airway swelling, spasm and mucus hypersecretion. ICS use has been shown to reduce asthma deaths and suffering in the western world. The number of asthma deaths in the world are actually declining, but in India asthma deaths have increased significantly over the past three decades, most likely due to underuse of ICS, and overuse of the inhaled bronchodilator drugs, Dr Salvi said.
In most cases, doctors treating asthma patients do not prescribe ICS. When prescribed, many patients do not take it because of myths, misbeliefs and fears associated with ICS. Among those who take ICS, they do so on an irregular basis. Also, most public hospitals do not have ICS in their formulary. Therefore, doctors cannot or do not prescribe ICS for asthmatics. Most medical college hospitals do not have ICS in their pharmacy and according to Dr Salvi, undergraduate and postgraduate students do not learn to prescribe the right medications for the asthma patients.
It is inhaled bronchodilators which give immediate relief that are the most widely used inhaled medications for asthma. However, they do not reduce the underlying inflammation and therefore make the disease more chronic. May 3 is recognized as the world asthma day to create awareness about this important disease that causes immense suffering and death. All asthmatics must receive inhaled corticosteroids as a standard treatment. This not only reduces the risk of dying, but also improves quality of life and reduces suffering, Dr Salvi added.