‘How to reduce burden of asthma in Nigeria’

Dr. Gregory Efosa Erhabor is a Professor of Medicine and a consultant chest physician. He is also the founder and project director of Asthma and Chest Care Foundation (ACCF) and chairman of the Asthma National Guideline instituted by the Nigerian Thoracic Society (NTS). Erhabor, in this interview with The Guardian, said the Society has developed a blueprint on how to reduce the burden of asthma in Nigeria. CHUKWUMA MUANYA Assistant Editor writes.

*New roadmap provides blueprint to tackle menace

Why is Asthma under-diagnosed and under-treated in Nigeria?
The reason is the lack of understanding of the pathophysiology of the condition. The basic pathology in asthma is inflammation of the airways and the result is bronchial obstruction. Bronchial obstruction is the expression of the inflammation clinically. Most doctors concentrate on the expression of the disease rather than the actual cause. Moreover, there is lack of facilities in many hospitals for the diagnosis of asthma and the lack of specialize centers for the management of asthma coupled with inadequate training of health professionals.

What informed the development of the guideline of asthma management in Nigeria?
Asthma is a lung condition that can cause breathing difficulties. It occurs when the breathing tubes to the lungs become inflamed and narrow. Symptoms include wheezing, breathlessness, coughing and a tight feeling in the chest. It may be triggered by exercise, cold air or cigarette smoke. There is no cure. Inhalers relieve symptoms and reduce inflammation. It can result in severe asthma attacks, hospital visits and even deaths. The causes are not completely understood.

So the guidelines provide the minimum standard for the management of a disease condition. It showcases best practices in line with current scientific and therapeutic developments globally. However, for guidelines to be practicable it has to be situated in a way to suit the peculiarities of different nations. Hence, the idea of having a national guideline that is peculiar to Nigeria.

There was a report last year that 100 million Nigerians may suffer asthma by 2025. Please throw more light?
This figure appears to be overestimated. Currently, it is assumed that there are 10-15 million asthmatics in Nigeria and this figure is expected to rise in view of increased urbanization and industrialization by the year 2025 but not up to the extent of 100 million.

Do you have the facility and resources to support internationally endorsed standard of asthma care?
There have been a lot of improvements when it comes to the availability of facilities in the management of asthma in the country however; this falls below the minimum required internationally endorsed benchmark.

The increase in burden of asthma has been attributed to environmental factors such as urbanization, industrialization and adoption of western lifestyle. Please explain?
There has been a long held hypothesis known as the hygiene hypothesis which simply alludes that those exposed to viral and bacterial infections in the young, those who have more siblings and those who have worked in farming environments tend to be protected from asthma as oppose to children who have less exposure to these agents and use antibiotics and adopt a western lifestyle. In a sense, the former develop what is known as a Th-1 immune response in contrast to the latter who develop a Th-2 response, which favors asthma development. As beautiful as this hypothesis is, it does not explain the overall pathophysiology of the disease. The simplest way to understand asthma is to know that its development and expression is dependent on genetic and environmental factors. Genetic factors predispose the patient to develop asthma while the environment factors determine the expression of the disease. It is a combination of nature (genetic) and nurture (environment).

How can these be addressed?
1. We have to identify the various types of asthma whether allergic or non-allergic in managing the condition.
2. We must identify the trigger factors in individuals and strategize ways to avoid them.
3. We have to institute and initiate an individualized self-management approach for each asthmatic.
4. We have to focus more on therapies that address the underlying inflammatory condition in asthmatics.
As a rule, I have advised asthmatics to study their own asthma, know what triggers attacks and partner with their physicians towards managing them.

What is your advice to the government and individuals?
As I said above, the government should make management of asthma a priority, create specialized centers for the management of asthma, subsidize medications and support organizations that are at the frontline in tackling the disease. The government should come to the aid of Nigerian Thoracic Society (NTS) to ensure this guideline is improved upon and distributed nationwide.

The current president of NTS, Prof. Etete Peters will be incorporating more committees within the association to expand this guideline to include other diseases like: pneumonia, tuberculosis and Chronic Obstructive Pulmonary Disease (COPD).

To address these issues, the NTS on May 2, 2017, which is the World Asthma Day, presented the guideline at the Citti Height Hotels, Opebi link road, by Sheraton, Ikeja, Lagos at 10am. All health practitioners were invited.

On May 3, 2017 there was a public awareness programme on asthma at Sickle Cell Centre Lagos Teaching Hospital (LUTH), Idi Araba, Lagos at 10am.

Is there any connection between the harmattan season, air pollution and asthma?
The scientific basis of a causal relationship between asthma and harmattan season has not been established. However, many asthmatics have been known to have flair-ups of asthma during the harmattan season and some study as reported increase in deaths from asthma during this season.
With regards to air pollution and asthma, the causal relationship has been established in many studies. In fact, in many parts of the world, increase in air pollution usually parallels exacerbation of asthma

New roadmap provides blueprint to tackle burden of asthma
A new roadmap has been published identifying key priority areas that need to be addressed to tackle the burden of asthma.

According to the document from the European Asthma Research and Innovation Partnership (EARIP), a unified approach to research, development and innovation is urgently needed to address the challenge of asthma in Europe, improve mortality and reduce morbidity.

The editorial is published in the European Respiratory Journal to coincide with World Asthma Day, and for the first time paints a picture of the coordinated approach required by researchers, funders, policy makers, people with asthma and the pharmaceutical industry to reduce the burden of asthma by 40% over the next decade.

EARIP, led by a consortium including the European Lung Foundation and Asthma United Kingdom (UK), carried out extensive literature reviews and a series of pan-European consultations to develop the recommendations, which are intended to inform researchers of the most effective ways to address the impact of asthma on the individual, healthcare systems, and national and European economies.

The roadmap identifies key areas requiring investment to enable a reduction in the number of asthma deaths and hospitalisations, and sets out 15 research priorities based on the overarching themes of: primary care and public health; triggers and risk factors for asthma and exacerbations; personalised medicine; and self-management and adherence.

Specifically, the consortium advise that regional and national asthma programmes must be reviewed across Europe to improve existing programmes, while primary-care professionals also called for the development of an accurate, low-cost tool to quickly diagnose and give information on treatment effectiveness/adherence in primary care settings.

It also recommends that more research is needed into the role of exposure to environmental factors, such as smoking and air pollution, on childhood development and long-term asthma management, in addition to investing more funding in to developing personalised medicines to tackle the complex needs of individual asthma patients.

The editorial is published alongside a review paper from the EARIP consortium looking at the unmet needs in understanding asthma mechanisms, and an additional editorial on the opportunities for innovation in asthma in Europe.

Free app may help asthmatics to avoid life-threatening attacks
Asthma attacks kill three people every day, but a new smartphone app may help sufferers to dodge their deadly symptoms.

The app, called MyAsthma, allows patients to monitor their condition and avoid life-threatening triggers.

By tracking the users’ location, MyAsthma provides information on the weather and pollen count of their surrounding area, as these can set off wheezing and breathlessness.

The free device also allows users to track any previous attacks and medication use.

The app’s appointment planner also allows patients to record any upcoming visits to the doctor.

Once a user has gathered their ‘asthma profile’ this can be shown to their doctor or synced with other health apps.

The app, created by GlaxoSmithKline, is the first pharma-supported service of its kind available on a smartphone, The Express reported.