By Mark Steedman, PhD, Manager, Centre for Health Solutions

Sunshine

I woke up in late March with a severe cough and could hear myself wheezing with each breath. It was worrying. The London Marathon was just over a month away, and I had spent the previous two months training for it; the next month was going to be critical. I needed to recover quickly to get back to training if I wanted to participate in the race. Similar asthma-like symptoms had been brought on by a cold a few years before, and although I know that I don’t suffer from asthma, I knew from experience it would be an uphill battle to get back to full strength. It also made me more sensitive to those people I know who do have asthma. For the next two weeks I struggled with intermittent coughing, sleepless nights and a general feeling of dread that I wouldn’t recover in time. However, as you learned from last week’s blog, I finished the marathon, but I also learned a lot about asthma and other respiratory diseases along the way. Earlier this week was World Asthma Day, so this week’s blog looks at the impact asthma has on people around the world.

What is asthma?
Asthma is one of the world’s major non-communicable diseases, affecting some 235 million people.1 It is a chronic disease, which enflames and narrows the air passages in the lungs and is a common disease among children. Sometimes the airways only narrow a little, resulting in mild symptoms. But some people’s airways can become so narrow that they can’t get enough oxygen into their lungs and their bloodstream. This is very dangerous and requires immediate medical attention. Attacks of breathlessness and wheezing can be recurrent, although they often vary in severity and frequency from person to person. Other symptoms can include sleeplessness, daytime fatigue, reduced activity levels and school and work absenteeism.
Although asthma has a relatively low fatality rate compared to other chronic diseases, the World Health Organisation estimates that 383,000 people died from asthma in 2015, mostly in low- and lower-middle income countries.2 Many of these deaths are due to under-diagnosis and under-treatment. However, asthma is also a public health problem in high-income countries. In the UK, 5.4 million people receive treatment for asthma, and 1,410 died from the disease in 2016 – approximately three people per day.3 Additionally, asthma prevalence rates among children in the UK are among the highest worldwide, and a child is admitted to hospital every 20 minutes due to an asthma attack. This care is expensive, and overall the NHS spends approximately £1 billion per year treating and caring for people with asthma.4

What causes asthma?
While the underlying causes of asthma are not completely understood, the strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways:

  • indoor allergens (e.g. house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander)
  • outdoor allergens (such as pollens and moulds)
  • tobacco smoke
  • chemical irritants in the workplace
  • air pollution.

Other common triggers can include:

  • cold air
  • extreme emotional arousal such as anger or fear
  • physical exercise.5

In rare cases an asthma attack can also be triggered by some medications, including non-steroid anti-inflammatory drugs and beta-blockers.

Reducing the burden of asthma
Asthma is currently incurable, but it is a disease that can be managed effectively, allowing people a good quality of life. Most symptoms are relieved by short term medications, including inhaled corticosteroids, which are anti-inflammatory sprays or powders that are usually only available via prescription and can sometimes be used to prevent symptoms.6 For those with more severe asthma, daily long-term medications can be prescribed, and avoiding asthma triggers such as those mentioned previously are the easiest ways to avoid persistent asthma attacks. However, due to the wide variety of asthmas triggers, it is important for patients to understand what specific triggers affect their asthma the most. Avoiding these triggers as much as possible can reduce disability and premature death from asthma.

Utilising technology to improve care
Although I was not diagnosed with asthma, my own symptoms leading up to the marathon were very similar to what many asthmatics face daily. I was even prescribed a temporary corticosteroid inhaler to combat my breathlessness and wheezing. The effects of the inhaler were often almost immediate, and without it I may not have recovered in time to race. Thinking about the marathon made me a very active and engaged patient, and therefore remembering to use the inhaler in the weeks prior wasn’t difficult. However, many asthma patients don’t respond the same way to the requirements of constant treatment or preventive care, although new technologies may be able to help.

Controlling lifestyle choices is paramount to preventing and managing asthma effectively. New smart devices for drug delivery and diagnostics have the potential to impact health outcomes for people with asthma. Early generation smart inhalers tracked adherence and delivery technique, and delivered data back to a physician for analysis. More recent smart inhalers offer integrated artificial intelligence that can individualise guidance to patients to remind them to take their medication or improve their inhalation technique.7

Diagnostic devices – spirometers – have also been developed with smart capabilities to help patients identify triggers, symptoms, trends and other insights. For example, some spirometers use machine learning to predict how environmental conditions can affect local asthma populations.8 However, while these types of devices could improve a number of aspects of diagnosis and treatment of asthma, awareness and patient engagement will still play a very important role going forward.

STOP for Asthma
Tuesday was World Asthma Day, which aims to raise awareness and improve the care of patients with asthma around the world. The theme for this year’s awareness day was STOP, which stands for Symptom evaluation, Test response, Observe and assess, and Proceed to adjust treatment.9 Following these simple steps could mean the difference between a sleepless night or being well rested – or in the worst case scenario, avoiding hospitalisation or even death.

Mark_Steedman

Dr Mark Steedman (PhD)- Research Manager, Deloitte UK Centre for Health Solutions

Mark is the Research Manager for the Deloitte UK Centre for Health Solutions. Until November 2016, he was the Institute Manager and a Policy Fellow at the Institute of Global Health Innovation at Imperial College London, where he supported research on palliative and end-of-life care, maternal and child health, design, philanthropy and electronic health records. Mark has a PhD from the UC Berkeley - UCSF Graduate Programme in Bioengineering, where he worked with Professor Tejal Desai on retinal tissue engineering and drug delivery. He also completed a Whitaker International Postdoctoral Fellowship with Professor Molly Stevens in the Departments of Materials and Bioengineering at Imperial College London.

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1 https://www.who.int/en/news-room/fact-sheets/detail/asthma
2 Ibid.
3 https://www.asthma.org.uk/about/media/facts-and-statistics/
4 Ibid.
5 https://www.who.int/en/news-room/fact-sheets/detail/asthma
6 https://www.nhs.uk/conditions/steroid-inhalers/
7 https://www.forbes.com/sites/shourjyasanyal/2018/11/26/4-ways-in-which-ai-is-revolutionizing-respiratory-care/#4c2db22d318d
8 https://www.forbes.com/sites/shourjyasanyal/2018/11/26/4-ways-in-which-ai-is-revolutionizing-respiratory-care/#4c2db22d318d
9 https://ginasthma.org/wad/

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