By Dylan Powell, Centre for Health Solutions
Despite advances in therapeutics and treatment, asthma affects over 262 million people worldwide and causes 455,000 deaths annually.1 In the UK one in five households suffer from the condition, yet over the past decade outcomes for people with asthma have not improved to the same extent as in other disease areas. This has led to many experts, including those in the newly formed Asthma and Lung UK (previously the British Lung Foundation and Asthma UK who merged in 2020) to renew their efforts to raise awareness of lung conditions and the importance of cleaner air to reduce morbidity and mortality. This week’s blog focuses on asthma and the steps necessary in improving the lives of people with lung conditions.
What is asthma and how much of a problem is it?
Asthma is just one example of several respiratory diseases that prevent normal lung function. These include narrowing or blockages of airways, which become inflamed and constricted, causing shortness of breath, wheezing and coughing. 2 The reduced airflow can be very debilitating, and in severe cases can significantly reduce people’s quality of life and shorten life expectancy. Asthma and other lung conditions require targeted interventions and treatments ranging from pharmacological medications to lifestyle and behaviour adaptations.
Unfortunately, despite improved understanding in the medical community, tragically four people die every day in the UK because of asthma attacks.3 This produces a huge economic and social cost with an estimated six million inpatient bed-days in the UK each year.4 Worryingly, the UK is lagging other countries in terms of outcomes with more people in the UK dying from serious lung conditions than anywhere else in western Europe.5
Why are asthma deaths on the rise?
Asthma is caused by a ‘combination of genetic and environmental factors, yet the symptoms of asthma are triggered by a range of behavioural and environmental factors.6 Despite better care outcomes, this improvement has plateaued partly due to challenges in medication or lifestyle adherence and more recently, concerns over elevated air pollution. Indeed, air pollution has been identified as one of the main contributors to increasing rates of asthma deaths in the UK.7 This has been validated by a recent report by Asthma and Lung UK, which found that more than half of people from a survey of 16,0000 people with asthma, reported poor air quality as serious triggers for their condition.8
It is thought the deterioration of some lung conditions could be avoided by improving the quality of air we breathe in our communities and homes. By reducing the exposure to pollutants and encouraging healthy behaviours, patients quality of life and outcomes will increase.
Where can impacts be made?
Research and Development: Increase research spend
Asthma care has been described as an exemplar of both the brilliance and the imperfections of innovation.9 The mass production of small and portable effective asthma inhalers provided a step change in the frequency and accessibility for those with asthma.10
However, Asthma and Lung UK want significant improvements in the diagnostic testing and treatments into asthma with huge funding required to meet the demands of patients. Lung disease accounts for two per cent of publicly funded research spending, despite making up 24 per cent of all deaths in the UK.11 This investment would serve to develop new innovations and management strategies to help improve quality of life for those living with asthma.
Health System: Adopting innovations such as the green inhaler can reduce carbon 37 fold12
The healthcare industry contributes nearly five per cent of all global greenhouse gas emissions and over four per cent of the NHS entire carbon footprint comes from asthma inhalers, second only to anaesthetic gases in surgery.13,14 Many asthma drugs come in the form of inhalers such as Salbutamol which although cheap, and have helped so many patients are significant contributors to climate change due to the aerosol propellant gases released.15 Moving to dry powder alternatives are considered environmentally friendly due to not requiring propellants and have been estimated to reduce carbon by a magnitude of 10 to 37 times.16 Overall, the production of less greenhouse gases will improve overall air quality and positively impact quality of life in those with lung disease. 17This creates a conundrum for patients, doctors and healthcare with medical products designed to help asthma, contributing significantly to climate emissions which in turn can trigger asthma. The net gains of using more sustainable products need to be carefully balanced against the primary benevolent goal of medicine in fighting disease and reducing mortality.
Patient Education: Improve things on an individual level
Not all initiatives need to be complex to have significant impact for patients. A review published in 2017 found that self-management for asthma can reduce unscheduled care and deliver more effectively for diverse demographic and cultural groups while not significantly increasing total healthcare costs. 18Several steps can be taken by patients to self-manage their condition such as maintaining preventative routines to reduce escalation of symptoms and patients’ risk of attacks whilst also lowering the carbon footprint of much more costly flare ups which often require active hospital intervention and medicine.19 Secondly using a good inhaler technique such as using a spacer device, can ensure the dosage required is used more efficiently as well as reducing the environmental impact.
Tackling wider health inequalities
While asthma can affect anyone, often the poorest in society and in the most deprived areas are hardest hit. The Marmot review found that air pollution is more prevalent in urban areas with higher levels of social deprivation with the top 10 per cent most deprived English city wards emitting over 66 per cent of the total carcinogens. 20 Therefore, despite focus on improving treatments for lung conditions over the past two decades, more emphasis should be placed on prevention to improve air quality which can trigger and worsen many lung diseases, whilst concurrently tackling deeper inequalities of health linked to deprivation.
Asthma represents a significant burden on healthcare systems, patients, and society. Despite significant advances in therapeutics and medicines, the sustained levels of air pollution are stunting progress and negatively impacting life expectancy and quality of life for many living with the condition.
Previously cost and accessibility were a driving and defining choice when prescribing medicines and interventions in asthma. Moving forward, the health of the patient still needs to be the top priority however the impact of any intervention on the planet need to be considered in conjunction. Tackling the above sustainability challenges associated with reducing air pollution and deep-rooted health inequalities will require all stakeholders to commit to adopting sustainability and health equity as a guiding principle alongside their primary focus on delivering high quality care to patients. Overall, renewed ambition and focus is required to improve both planetary and population health ideally in parallel.