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Childhood asthma remains poorly managed in India due to non adherence to ICS therapy

Laxmi Yadav, Mumbai
Thursday, April 13, 2017, 08:00 Hrs  [IST]

Despite increased understanding of pathophysiology of asthma, availability of better diagnostic instruments, effective and affordable inhaled medicines and national and international asthma management guidelines, childhood asthma management in India remains poor due to low rates of patients' adherence to inhaled corticosteroid (ICS) therapy, the most effective treatment of asthma available today.  

In India, an estimated 15-20 million people suffer from asthma, of which 10-15 per cent is children in the age group of 5-11 years. Asthma imposes a heavy physical and emotional burden on the patients. So far only 25 per cent of children suffering from asthma in the country are adherent to ICS therapy.

According to updated guidelines of The National Asthma Education and Prevention Programme (NAEPP), use of ICS is recommended for the treatment of mild, persistent asthma across all age groups, including children.

A significant number of children's non-adherence to asthma medication stems from a lack of adequate understanding as well as misconception that inhalers are addictive. The mindset of Indian asthmatic patients needs to be changed to improve treatment outcome. They need to be educated about the importance of use of inhaled medications which help them lead a normal and healthy life, said Dr Dhiren Gupta, paediatrics and senior consultant Sir Ganga Ram Hospital, New Delhi.

“The effectiveness of ICS in treating children with severe and persistent asthma is well established. The small particles of ICS offer a potential benefit and reduced risk of side-effects among children due to their favourable spray characteristics (about 25 to 100 micrograms) as the required dosage directly reaches the site of action, thus limiting absorption by other parts of the body where the drug is not required,” said Dr Gupta.

“On the contrary, when a drug is administered in tablet or syrup form, an unnecessarily large quantity (approx forty times more) is administered in the body and absorbed by various body parts where the drug is not needed. As a result, the risk of potential side-effects increases,” he said.

Asthma responds favourably to effective drug treatment. Earlier the warning signs are recognised, better the response to the treatment thus helping bring great relief to children suffering from asthma. Carefully observing symptoms and working with the doctor to adjust treatment plan can help the asthma “quiet down”, changing child's symptoms and triggers over time, said Dr Vivek Nangia, director and head, department of pulmonology, Fortis Flt Lt Rajan Dhall Hospital, New Delhi.

Apart from recognising warning signs and seeking drug treatment, reducing air pollution inside and outside households, improving sanitation and hygiene, protecting pregnant women from second-hand tobacco smoke, and building safer environments, can prevent children’s burden of respiratory ailments, including paediatric asthma, said Dr Nangia.


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