World Asthma Day: India chokes, sales of medicines rise 43% in 4 years
India’s lungs has been choking and now we can put a number on that—by adding up the number of those salvaged. The sales of anti-asthma medicines in India went up 43% over the past four years, shows market data, with 2016 marking a 15% growth in anti-asthma prescriptions across children and adults.
Thirteen of the world’s 20 most polluted cities are in India, shows World Health Organisation’s ambient air pollution database. The air in Delhi, Patna, Gwalior and Raipur has the highest amounts of tiny suspended particles (PM2.5) that penetrate deep into the airways and lungs to cause asthma, bronchitis, heart disease, stroke and a clutch of other diseases.
With routine monitoring of air quality almost exclusively confined to large cities¸ it’s harder to come up with estimates on the effect of air pollution in rural areas. More than 700 million people, mostly women and children, inhale smoke from biomass and kerosene stoves that burn wood, dung, crop residues, coal and kerosene and spew out carbon particles, carbon monoxide, nitrous oxides, sulphur oxides (mainly from coal), formaldehyde and cancer-causing substances such as benzene.
Epidemic in the Making
“People being diagnosed with asthma for the first time with no family history is definitely going up. As for asthma among children, they may not remain asthmatic if the triggers are taken away,” explains Dr Neeraj Jain, chairman, department of chest medicine, Sir Ganga Ram Hospital, New Delhi.
“Pollutants are also adding to wheezy bronchitis and flare-ups in people with COPD (chronic obstructive pulmonary disease), which is controlled with asthma treatment.”
Prevalence is high at 10% and 15% in 5–11-year-old children who have smaller airways that get constricted when exposed to allergens such as pollutants, dust, weather changes, pollen, mites and hazardous gases in indoor and outdoor air. This makes asthma the most common chronic disorder in children in India.
“About half the children who have wheezing and asthmatic episodes outgrow it,” Dr Jain says.
Asthma is a chronic condition that is triggered by allergens that inflame and constrict sensitive (hyperallergic) airways and make breathing difficult. What makes airways sensitive is your immune system’s threat perception. An asthma attack occurs when an allergen or a stress factor causes an immune reaction that leads to inflammation (swelling) in the airways, narrowing the air passage and reducing air flow in the lungs. This causes wheezing, shortness of breath, chest tightness and coughing, which can last for a few minutes or up to days, depending on the severity and length of exposure. If not treated, asthma attacks lead to frequent hospitalisation and death.
Experts are struggling to understand why asthma rates worldwide, on average, are rising by 50% every decade. “Some blame it on hygiene hypothesis, which holds that children with lower exposure to bacteria and viruses in early childhood do not develop a robust immunity,” says Dr Mehal Shah, consultant pulmonologist at Mumbai’s Saifee, Bhatia and Wockhardt hospital.
Other triggers include sudden overuse and misuse of antibiotics, indoor and outdoor air pollution, pollen, food colour and additives, obesity, smoking, second-hand smoke, poorly ventilated homes and workplaces (10% of adult asthma is work-related), cold weather, exercise and stressors such as domestic violence and even relationships breaking down.
“The fact is that airway sensitivity is going up among people in urban and rural areas because of sustained exposure to a combination of these triggers, which are increasingly unmasking asthma cases that would otherwise have remained under control,” says Dr Shah.
Asthma can be controlled with medicines, but without the appropriate treatment, it can lead to frequent asthma attacks. In 2016, there was a 15% rise in anti-asthma prescriptions over 2015, as per IMS Health estimates. What’s alarming is that in 2016, the prescription growth rate escalated from 9% in 2014, indicating a spike in cases. Among the different forms of treatment, inhalants accounted for a 56% share of the prescriptions in 2016.
Out of Control
Since asthma is a chronic disease, it requires continuous medical care. Patients with moderate to severe asthma have to take long-term medicines such as anti-inflammatory drugs every day to prevent symptoms and attacks. If symptoms occur, short-term medicines such as inhaled short-acting beta2-agonists are used to relieve them.
Though prescriptions have been steadily rising over the past four years, two in three people with asthma (67%) in India have frequent attacks because of the use of bronchodilators, inhaled corticosteroids and preventive vaccination against infections such as influenza. “The goal of asthma therapy is to control asthma so that patients can live active, full lives while minimising their risk of asthma exacerbations and other problems,” says Dr Jain.
“Medication is not the only way to control asthma, but it’s as important to avoid asthma triggers—stimuli that irritate and inflame the airways such as fine dust, mouldy areas, second-hand smoke, sudden change in temperature and acid reflex. If you have asthma, avoid oily, spicy and fermented food, and do not lie down two hours after dinner,” says Dr Jain.