Asthma in PakistanAsthma in Pakistan

Nayyar R. KazmiNayyar R. Kazmi

It’s a chronic inflammatory condition It’s a chronic inflammatory condition of the airways, characterized by of the airways, characterized by inflammation in the small airways, inflammation in the small airways, narrowing of airways and excessive narrowing of airways and excessive mucus production resulting in mucus production resulting in difficulty in breathing, cough and difficulty in breathing, cough and wheeze.wheeze.

Presents with a wide spectrum of Presents with a wide spectrum of signs and symptoms.signs and symptoms.

Burden of DiseaseBurden of Disease

More common in the developed More common in the developed countriescountries

Also increasing in the developing Also increasing in the developing countriescountries

PakistanPakistan• Adults prevalence 5-10%Adults prevalence 5-10%• Children 19% (ISAG Study)Children 19% (ISAG Study)

World map of the prevalence of clinical asthma

(Global Burden of Asthma, 2004).

Responsible for 70% of pediatric Responsible for 70% of pediatric hospital admissions in winter and hospital admissions in winter and spring season.spring season.

Responsible for approximately 40% Responsible for approximately 40% of emergency adult admissions in of emergency adult admissions in spring season.spring season.

EtiologyEtiology

Allergic disorderAllergic disorder Either caused by Atopy or bronchial Either caused by Atopy or bronchial

hyperresponsiveness in susceptible hyperresponsiveness in susceptible individuals.individuals.

Allergic FactorsAllergic Factors• Airborne PollensAirborne Pollens• Environmental ToxicantsEnvironmental Toxicants• MoldsMolds• House dustHouse dust• Animal danderAnimal dander• Feather pillowsFeather pillows• SmokeSmoke

Other FactorsOther Factors• Smoke and other pollutantsSmoke and other pollutants• Infections (viral)Infections (viral)• AspirinAspirin• ExerciseExercise• SinusitisSinusitis• GERDGERD• Sleep (PEFR lowest at 4.00 am)Sleep (PEFR lowest at 4.00 am)

Risk FactorsRisk Factors

Positive Family HistoryPositive Family History Viral Lower respiratory Infections Viral Lower respiratory Infections

during infancyduring infancy Lack of Breast FeedingLack of Breast Feeding Pets in the homePets in the home Dusty AtmosphereDusty Atmosphere

Why the Asthma Prevalence in Why the Asthma Prevalence in increasingincreasing

Increased in utero exposure to Increased in utero exposure to antigenic challengeantigenic challenge

Increased incidence of childhood and Increased incidence of childhood and infancy viral respiratory infectionsinfancy viral respiratory infections

Increased environmental pollution Increased environmental pollution

Screening criteriaScreening criteria

All cases of chronic cough All cases of chronic cough with/without wheezewith/without wheeze

Cases of seasonal exacerbations of Cases of seasonal exacerbations of respiratory infectionsrespiratory infections

Cases of cough not responding to Cases of cough not responding to conventional therapies.conventional therapies.

FLCF CriteriaFLCF Criteria

PEFR is a simple cost effective tool PEFR is a simple cost effective tool for assessing Asthma in FLCF’s.for assessing Asthma in FLCF’s.

Spirometry facilities at DHQ levelSpirometry facilities at DHQ level• FEV1/ FVC less than 80%.FEV1/ FVC less than 80%.

Mainstay of TreatmentMainstay of Treatment

SteroidsSteroids BronchodilatorsBronchodilators PreventionPrevention

Public Health MeasuresPublic Health Measures

A good reporting system on Asthma A good reporting system on Asthma (incorporation into the national HMIS)(incorporation into the national HMIS)

Asthma treatment centres at local Asthma treatment centres at local FLCF’s (Drugs, Equipment, training)FLCF’s (Drugs, Equipment, training)

Asthma health education Asthma health education ( incorporation into School health ( incorporation into School health system)system)

Public Health Measures (Contd)Public Health Measures (Contd)

Environmental sanitationEnvironmental sanitation Regulations on smoke and Tobacco Regulations on smoke and Tobacco

control.control. Promotion of use of nasal air filtersPromotion of use of nasal air filters Ban on growing of known severe Ban on growing of known severe

polligenic wild mulberry treespolligenic wild mulberry trees