Asthma

Asthma is a common lung condition affecting people of all ages worldwide.

Learn more about asthma and its causes, symptoms and treatment so that you can take steps to keep as healthy as possible and enjoy life to the full.

What is Asthma?

Asthma occurs when the airways that conduct air into the lung tissue become inflamed and narrowed. Airflow is then reduced and it is harder to breathe. Sufferers experience wheezing, chest tightness, cough and sputum (phlegm). Try to imagine breathing through a straw: this is how some asthma sufferers describe having an asthma attack.

In Africa, which has a population of 1.2 bn people, it is estimated that 4% of the population (50 million people) suffer from asthma1. However, only 14% of asthma sufferers are using preventer medication2. There are an estimated 60,000 deaths from asthma each year in Africa. Therefore, there is great potential to improve this number through the wider provision of preventative treatment and education.

1. Kwizera R, Musaazi J, Meya DB, et al. Burden of fungal asthma in Africa: A systematic review and meta-analysis. PLoS One. 2019 May 16;14(5):e0216568. DOI: 10.1371/journal.pone.0216568. eCollection 2019.PMID: 31095641)

2. Kirenga B, Chakaya J, Yimer G et al. Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project. BMJ Open Respir Res. 2020 Feb;7(1):e000484. DOI: 10.1136/bmjresp-2019-000484.PMID: 3205464

What causes Asthma?

Many different genetic and environmental factors are thought to explain why asthma develops. These include:

  • A family history of atopic conditions
  • Allergies
    • Allergy to the house dust mite, which is prevalent in temperate and tropical environments, is one of the commonest global risk factors for asthma.
  • Air pollution
  • Respiratory infections
  • Smoking

Asthma can start at any age but usually starts either in early life (early childhood) or later adulthood.

Early-life asthma is much more likely to be associated with allergy: allergy  Many young asthmatics have allergies to the house dust mite, seasonal allergic rhinitis (e.g. pollen hayfever), allergy to furred pets and fungi, and the skin condition eczema are common in this age group.

Later onset asthma tends not to be associated with allergy, but the principles of treatment are in most cases the same. Adults who develop asthma should also have an occupational cause considered. Early removal from the workplace can stop asthma from worsening and causing permanent disability.

How to Live Well with Asthma

For most people, treatment is straightforward.

Using an inhaler with a low dose of steroid medication every day (‘preventer’) helps prevent asthma attacks while using a reliever inhaler relieves symptoms when they occur. Preventing asthma attacks is crucial because undertreatment can lead to severe asthma attacks and death. Having quick access to oral steroid tablets, relievers given by nebuliser (a mask providing misted therapies to the mouth and nose), oxygen and emergency medical care is important for severe asthma attacks.

For most asthmatics, having asthma means having periods of better control, interrupted by sudden asthma attacks. Many asthma attacks are triggered by a virus infection, including the common cold, or by exposure to allergens they may be allergic to, as discussed above. As a result, many countries see a peak in asthma attacks at times when viral infections are more prevalent and when pollen exposures are higher. There is now a large body of evidence which implicates airborne pollution as a causal factor in poorer asthma control and asthma attacks. As much of Africa becomes more urbanised, there is an increasing interest in non-communicable diseases across the continent and the burden of asthma is beginning to be recognised as a major continental priority.

Patient education is key to better asthma control. Behavioural change such as smoking cessation is crucial (smoking makes asthma much worse and means that treatments are less effective.) Asthma sufferers should have their treatment explained, a demonstration given as to how to use their inhalers, how to avoid recognised triggers, and be given a clear plan (either written or in pictures) of how to treat their asthma when symptoms occur. This means that asthma attacks can be treated early and a more severe asthma attack averted. Data from mature health systems shows that only 15% of patients have adequate asthma management plans and education packages, so this remains a major global unmet need.

Researchers working on programmes such as the African Severe Asthma Programme (ASAP) are now publishing evidence on the unmet need for asthmatics in large regions of Africa, which will help to raise the profile of suffers of this important, treatable and hitherto neglected disease.