04 April March 2016: Recent real-life data from 579 UK practices show that a high proportion of patients with asthma still have poor asthma control, and those in higher Global Initiative for Asthma (GINA) management steps are more likely to have uncontrolled asthma.
According to the 2014 Global Asthma Report by the Global Asthma Network, South Africa has the highest age adjusted asthma death rate per million population. Of the estimated 3.9 million South Africans with asthma, 1.5% die of this condition annually. In light of the alarming statistics, Cipla South Africa, South Africa’s leading pharmaceutical manufacturer, hosted the 2nd International Respiratory Crossroads Symposium on 3 April 2016 in Cape Town.
According to Paul Miller, CEO of Cipla SA, the conference brought together renowned experts from North America, Europe and Asia to discuss several pressing challenges in obstructive airway and allergy treatment, necessary clinical guidelines and considerations. “Asthma prevalence in Southern Africa is higher than any other area on the continent, with more than 20% of school children across the region suffering from this condition. In South Africa, asthma is the third most common cause of hospital admissions of children, yet only 2% of patients with asthma receive treatment.”
Miller also points to the issue of chronic obstructive pulmonary disease (COPD) and latest data which reveals that the disease ranks within the top three causes of mortality in the world, yet it still remains largely undiagnosed. “A recent survey by The Chest Research Foundation revealed that South Africa has the highest incidence of COPD in 24 countries. In addition, of over 30 000 adults surveyed globally (aged 55 and over) on COPD prevalence, revealed that, of the adults surveyed in Cape Town alone, 19% exhibited symptoms of COPD.
“As we are all interested and invested in the advancement of respiratory care, it is vital to collaborate on the latest information on asthma, COPD and allergy,” says Miller.
Speaker at the conference Professor David Price, Professor of Primary Care Respiratory Medicine at the University of Aberdeen, says that despite decades of comprehensive asthma guidelines and medical recommendations, lack of asthma control remains a serious problem for patients at all treatment levels. “Examining the reasons for suboptimal asthma control also reveals issues with patient factors including adherence to inhaler use, inhaler technique and device satisfaction.”
High-quality data is needed to determine the main reasons for poor asthma control and to monitor the efficacy of newly developed asthma interventions, he says. “Currently, the standard practice in assessing patients is Randomised Clinical Trials (RCTs), which also evaluates therapeutic efficiency. One of the main constraints with RCTs however, is the fact that these trials do not take into consideration real-life factors that may impact patient outcomes.”
Professor Price says it is crucial to delve deeper into discussions about the current RCTs which are an insufficient method to establish the effectiveness of treatments. “RCTs may not show the advantages of drugs that are better tolerated, faster-acting or easier to take using simpler regimes, and may not fully represent the therapeutic effects or costs in a wider clinical population.”
“Real-life, observational studies have an advantage here, as they consider lifestyle habits and comorbidities (the presence of one or more additional disorder or disease co-occurring with a primary diagnosis). Essentially, this offers us the opportunity to study the use and selection of inhaler devices in routine care settings, taking into account real-life factors that are typically excluded in strictly controlled RCTs.”
The main reasons for poor asthma control among patients are: incorrect diagnosis, rhinitis, smoking, poor adherence, or poor inhaler technique, possibly leading to suboptimal health outcomes. It is important to note that the last two listed are all device-related problems and could be improved through further research and studies, says Professor Price.
Currently, the global strategy by GINA is to tackle four key areas; namely, the difficulties associated with using inhaler devices, the usage of multiple different inhalers, patient education on inhaler device usage and cost-related issues.
Despite significant improvements in inhaler delivery efficiencies, incorrect inhaler technique remains a key reason for poor asthma control resulting in costly hospital admissions, emergency department visits, antibiotic and corticosteroid courses. “We need to examine the critical errors in inhaler use, as well as explore the comparative effectiveness of various inhaler devices and the value of breath actuated inhalers (BAIs) in routine care.”
“What is clear is that asthma control is poor and a major reason is inhaler technique. This needs to be addressed with real urgency and more scrutiny. Patients should at least be in a position where they have access to the most appropriate inhalers for their specific needs and be able to operate their personal devices, as this is quite an unavoidable issue,” urges Professor Price.
Professor, Chair of Primary Care Respiratory Med at the University of Aberdeen UK. David Price is the Primary Care Respiratory Society Professor of Primary Care Respiratory Medicine at the University of Aberdeen, Scotland. He is extensively involved in respiratory and allergy research. His areas of special interest are ‘real-life’ effectiveness and cost-effectiveness of interventions, clinical trial design, compliance, and patient attitudes to their disease. He has authored over 300 peer-reviewed publications since 2000 and is responsible for approximately $15 million dollars in research and clinical development grants. David Price is the founder and Managing Director of Research in Real Life (Singapore and the United Kingdom), an independent, research-driven organisation established to cultivate initiatives, provide evidence and drive quality standards within the growing field of real-life, pragmatic research. He is also the founder and Chairman of The Respiratory Effectiveness Group, a not-for-profit, investigator-lead initiative which uses an international collaborative approach to explore the roles of real-life research in informing clinical guidelines and improving patient care.
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