Bronchial asthma

Causes of the spread of the disease: environmental pollution and smoking

Bronchial asthma has been known for a long time - in ancient Greece more than two thousand years ago, signs of this disease were described. The constant study of a "strange" disease, which can suddenly manifest itself by suffocation attacks, and then for some time do not reveal itself in any way, has given a lot of new information about the nature of this disease. Doctors learned to achieve longer remissions.

Bronchial asthma is a non-infectious disease, they cannot be infected. Internal (mainly genetic) and external factors (allergens, tobacco smoke, industrial dust, atmospheric pollution). Allergens include house dust, animal wool, mold fungi, plant pollen, etc. It was also found that the risk of asthma in children is 2.5 times higher if one of the parents suffers from pathology, and 6.6 times higher if both parents are sick.

Other provoking factors include: cold air, intense emotional agitation such as anger or fear, and physical exertion.

Asthma can be provoked by drugs, such as aspirin and other non-steroidal anti-inflammatory drugs, as well as some medicines used to treat hypertension, heart disease and migraine.

Asthma has been widespread since the mid-1980s. The reason for this was a sharp deterioration in the environmental situation - air pollution by oil refining products, poor-quality nutrition, as well as a progressive sedentary lifestyle.

The widespread use of tobacco smoking among Russians supports the incidence of asthma at a high level: in 2018, up to 60% of men and 16% of women constantly smoke.

Previously, it was believed that the predisposition to asthma is associated only with the habits of the mother: if she smokes, the risk of developing asthma in the child is high. But in the course of a study by an international research group of European scientists, the results of which were published in early March 2018 in the authoritative British medical publication International Journal of Epidemiology, published under the auspices of the University of Oxford in the UK, it turned out that the tobacco dependence of fathers also affects the health of descendants, and, regardless of whether they smoked during the conception of the child or long before that. Even father smoking in adolescence is a risk factor for asthma in their offspring. Moreover, the habit of smoking in men and women can provoke the appearance of asthma in their grandchildren.

Prevalence of the disease

2024

Asthma incidence reaches 348m worldwide

As of 2024, the number of people suffering from bronchial asthma has reached 348 million globally. Such data are given in materials published on December 19, 2024.

According to estimates by the World Health Organization (WHO), in 2019 the number of asthma patients was about 262 million people, and approximately 455 thousand deaths from this disease were registered. According to WHO, bronchial asthma is one of the most common chronic non-communicable diseases (CNID).

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It is emphasized that asthma cannot be cured, but there are a number of available treatments to combat it. The most common of these is the use of an inhaler that delivers the medicine directly to the lungs. Asthma is included in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases, as well as the UN Sustainable Development Agenda 2030.

In Russia, according to the Ministry of Health, respiratory diseases are in second place after diseases of the circulatory system among the reasons for citizens' appeal to medical institutions. Among the main risk factors for the development of asthma are tobacco smoke, exposure to allergens and irritants present in the environment (including air pollution in the premises and atmosphere), the presence of mites, house dust, mold, etc. Research data suggests that the prevalence of asthma increases in urbanization: this can be explained by the impact of various lifestyle factors. Asthma is more likely to develop in people suffering from other allergic diseases, in particular eczema and rhinitis (hay fever).^[1]

8.5 million residents of Russia have bronchial asthma

About 8.5 million residents of Russia have bronchial asthma, but they are not observed anywhere and do not receive any therapy. Sergei Avdeev, chief freelance specialist-pulmonologist of the Ministry of Health of the Russian Federation, cited such data at the end of August 2024. The prevalence of asthma is 6.9% of the total population, he said.

Imagine about 150 million people in our country, 7% - there should be at least 10 million people with bronchial asthma, - added Avdeev (quote from TASS).

2018

Unfortunately, despite all the efforts of medicine, both domestic and world incidence of bronchial asthma is growing every year and especially rapidly among children.

According to experts, the real number of asthma patients in Russia greatly exceeds the official data; according to their calculations, 5.9 million people suffer from asthma in our country instead of 1.3 million, according to the reporting data. Asthma is a disabling and dangerous disease, with about 41% of asthma patients receiving a disability pension.

For 2018, according to WHO statistics, bronchial asthma is the most common chronic disease among children. Asthma affects about 235 million people worldwide, or 4 to 10% of the world's population. According to other sources, which also refer to WHO estimates, in 2018 in the world about 300 million people suffer from bronchial asthma (from 1 to 18% of the population in different countries). At the same time, in preschool children, the disease occurs twice as often as in adults (in half of the cases, the disease develops at 5-10 years old).

According to the WHO, in 2016, 339 million people were registered with a confirmed diagnosis of asthma^[2]

2021: There are 360 million people with asthma worldwide

By September 2021, there are about 360 million people in the world who have been diagnosed with bronchial asthma. This was announced by Associate Professor of the Department of Propaedeutics of Internal Diseases, PF FSAEI in RNIMU named after N.I. Pirogova Ministry of Health Russia, Ph.D. Dmitry Polyakov.

According to him, in Russia the prevalence of bronchial asthma among adults is 6.9%, among children and adolescents ranges from 10.6 to 16.9% in different regions of Russia.

In September 2021, the host of the program "Live Great!" On Channel One, Andrei Prodeus named the main sign of asthma - bronchobstructive syndrome, which includes several signs characteristic of asthma: coughing attacks, difficulty breathing with whistling or wheezing on exhalation, as well as a feeling of tightness or heaviness in the chest. At the same time, in children under two years old, coughing can cause vomiting.

There are 360 million people diagnosed with bronchial asthma in the world

According to Prodeus, by September 2021, asthma affects about 10% of all children, with 80% of them showing the disease before the age of five.

Dmitry Polyakov says that asthma develops from internal (genetic and sexual) and external (allergens, infectious agents, adverse occupational factors, diesel fuel combustion products, tobacco smoke) factors. In childhood, bronchial asthma develops more often in boys, in adolescence - on the contrary, in women. The development of the disease is also influenced by the presence of obesity.

The prevalence of asthma does not decrease or even increase over the years. Medical scientists are trying to explain this with the help of a hygienic hypothesis. Its essence is that if in childhood a person lives in purity and rarely encounters bacteria and viruses, then his immune system develops incorrectly and subsequently reacts violently even where it is not necessary. Also, dirty air, heredity and the presence of allergies affect the development of the disease.^[3]

2019: Creation of a register of patients with severe bronchial asthma in the Russian Federation

On December 19, 2019, AstraZeneca announced that in 2018 the Russian Respiratory Society, with the support of AstraZeneca, initiated a 5-year study to create a "Register of patients with severe bronchial asthma in the Russian Federation" who are being treated/monitored in outpatient clinics, medical and preventive institutions and dispensaries of the Russian health care system. Read more here.

Diagnostic technologies

2023: The beginning of the use of Russian devices for the early diagnosis of the risk of developing bronchial asthma in children

Specialists of the Department of Childhood Diseases of the Clinical Institute of Children's Health. N.F. Filatov, Sechenov University, created a device for early diagnosis of the risk of developing bronchial asthma in children. The product has passed clinical trials and is already used by pediatricians in Moscow, Moscow and Yaroslavl regions and the Komi Republic. This became known in July 2023. Read more here.

Mild bronchial asthma

At the heart of bronchial asthma (AD) of any severity is inflammation. Even in patients without any symptoms of AD, signs of subclinical inflammation are detected, as confirmed by recent studies, according to the international biopharmaceutical company AstraZeneca on April 19, 2019.

According to experts, the prevalence of mild AD is 50-70% among all AD patients. At the same time, disease control in this group is observed in less than half of patients. According to a study conducted in Spain among patients receiving treatment, according to Steps 1 and 2, the disease is controlled only in 52.4 and 43.4%, respectively. In the well-known REALISE study, the level of AD control was also quite low, and 25% of patients had severe asthma exacerbations in the previous 12 months.

According to the Russian study of NIKA, the level of control in patients with mild AD was observed only in 39% of patients.

An analysis of asthma deaths in the UK found that 9% of patients who died from AD were treated with mild AD. Thus, it becomes apparent that patients with mild AD are still at risk of developing severe asthma exacerbations, and new approaches to therapy to achieve overall AD control are valid and necessary.

And this is consistent with the guidelines prescribed in the GINA 2019 Brief Guide (pocket-guide) available on the ginasthma.org website, which recommends the use of a combination of low-dose inhaled glucocorticosteroids (ICS) formoterol for the treatment of AD as a preferred therapy for the management of attacks and symptoms in patients with any AD severity. The use of monotherapy with short-acting beta-2 agonists (CDBA) is no longer recommended as a preferred symptomatic therapy, according to AstraZeneca.

Exacerbations of bronchial asthma (AD) often pose a threat to physical health and create a high level of emotional stress in patients. Despite the fact that AD is a chronic disease based on inflammation, patients with AD are either not prescribed often enough, or they do not often use anti-inflammatory basic therapy, overly relying on CDBA, the use of which can "mask" the deterioration of disease symptoms. CDBA monotherapy during or after worsening of AD symptoms does not affect the inflammatory processes underlying the pathogenesis of the disease. Thus, the risk of exacerbations of AD and the need for frequent administration of pulse therapy with oral glucocorticosteroids remain.

Economic losses

Asthma brings huge losses to the economy: The CDC estimates for 2018 that countries lose up to 1% of national GDP each year due to the costs of treating sick people, absences and downtime at work due to sick days.

The direct costs of Russian health care related to the treatment of asthma amount to about 8.5 billion rubles, including 66.6%, which are spent on inpatient treatment, another 21.5% are allocated for the purchase of drugs, 10.9% cover outpatient treatment, 0.9% - ambulance calls. But most of all expenses are related to indirect costs, 64% are payments on disability certificates, 27.3% are paid as disability benefits.

Treatment

Asthma cannot be cured, but thanks to modern methods of diagnosis and treatment, the disease can be controlled. With proper treatment, most asthmatics can achieve control over asthma, free themselves from its symptoms, significantly less often experience attacks or not have them at all, less often need special drugs - that is, be able to live a full life and practically not experience symptoms and exacerbations.

"Treating bronchial asthma is a long and painstaking task. Complex therapy is usually recommended, with the patient having to exclude factors that stimulate the development of the disease, such as smoking, from his daily life. No less drug therapy in the process of treatment is important diet and proper nutrition, active lifestyle. The patient is prescribed a whole set of drugs, which consists of basic drugs that provide supportive and anti-inflammatory therapy, as well as drugs that stop asthmatic symptoms. The range of asthma drugs available to a wide range of patients today has become much wider, largely due to the emergence of generic drugs on the market. 64% of patients use them, and 60% of them prefer domestic analogues, "said Alexander Malin, General Director of the pharmaceutical company Nativa, in April 2018

World Asthma Day

One of the preventive measures aimed at combating asthma is the annual World Asthma Day.

World Asthma Day was initiated in 1998 as part of the Global Bronchial Asthma Initiative (GINA) and has since been held on the first Tuesday in May.

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