Nigeria needs to improve asthma control and management

Eranga Isaac, CNS Correspondent, Nigeria
The most recently revised estimates of asthma suggest that as many as 334 million people are living with asthma worldwide, and that the burden of disability is high. Asthma is a chronic long term lung condition that is genetic in origin and can be affected by a host of environmental factors.

An asthma attack occurs when the bronchial tubes become inflamed, producing mucus that impairs breathing, resulting in fatigue, shortness of breath, and sometimes even death. The historical view of asthma being a disease of high-income countries no longer holds as most people affected are in low- and middle-income countries, where its prevalence is estimated to be increasing fastest.

Asthma can be called a condition of management. While there is no cure, proper treatment and routine check-ins with health professionals can provide patients with a higher quality of life. On going monitoring on proper distribution of essential drugs for addressing the disease is needed in order to follow the epidemic of asthma and its management.This is where the National Reimbursement List (NRL) plays a very important role.

According to the Global Asthma Report 2014, Nigeria has no NRL for essential asthma controlling drugs, such as Beclometasone and Salbutamol. This has brought about inappropriate, unnecessary, and very expensive asthma medicines in the Nigerian drug market. People often speak about high prices being a barrier to accessing medicines. However, there are other factors too that can affect the availability and affordability of quality-assured essential asthma medicines.

Countries need to work on how the availability of asthma medicines is addressed in their national policies, programmes, guidelines, budgets and teaching curricula, as well as how medicines are procured and made available to patients. The following measures would go a long way in improving access to quality-assured medicines for asthma care and control:
  • Include the essential asthma medicines in national Essential Medicines List (EMLs) and NRLs, and stop reimbursements for  inappropriate, unnecessary, and very expensive asthma medicines
  • Ensure EMLs and NRLs include products propelled by hydro fluoro alkanes (HFA) , and also ensure that product strengths have been updated where appropriate HFA propellants replaced chlorofluorocarbons, as required by the1987 Montreal Protocol on Substances that Deplete the Ozone Layer.
  • Check that national asthma management guidelines are based on medicines that are available and affordable, and that the guidelines explicitly address the need to ensure access to medicines at all levels of health care, especially among poor and marginalised populations.
  • Add essential asthma medicines to the list of the WHO Pre qualification Programme (a centralised quality assessment initiative that has improved access to quality-assured medicines for selected diseases for millions of patients).
  • Standardise the dosages of active ingredients in combined inhalers marketed in both high- and low- and middle-income countries to facilitate quality assessment, procurement, prescribing practices and the achievement of affordable prices globally.
  •  Harmonise quality requirements across the international reference documents such as the pharmacopoeias.
  • Facilitate the development of independent laboratories for the testing of generic products that are not already approved by a stringent regulatory authority or relevant global mechanism.
  • Encourage low- and middle-income populations to demand quality-assured, affordable essential medicines for asthma as part of the health care provided by their governments.
  • Support in-country implementation of sustainable cost recovery programmes such as Revolving Drug Funds (after an initial capital investment, medicine supplies are replenished with money collected from the sale of medicines). Such funds become self-financing and build demand for quality-assured,affordable essential asthma medicines. 
  • Monitor and strengthen country capacity in pharmaceutical policy and procurement.
  • Monitor factors that influence availability, affordability, and access to essential asthma medicines.
Dr Gani Owoeye, from the Department of Community Health, University of Benin Teaching Hospital, feels that the Federal Government of Nigeria should make asthma care and control a health priority so as to improve the management of the disease in the country. In an interview with CNS he said that people die from asthma due to poor management of the condition and lack of treatment facilities in most schools and hospitals.  According to him there was a need for government to provide asthma management equipment such as nebulisers, oxygen cylinders and other equipment in hospitals, including Primary Health Centres.Even where these facilities are available, the supply and inventory management are crucial for making the facilities available to the targeted populace.
Dr Owoeye said 14% of the world’s children experience asthma symptoms while low and middle income countries suffer the most severe cases. “According to the World Health Organisation (WHO), asthma is under-diagnosed and under-treated, creating a substantial burden to individuals and families and possibly restricting individual activities for a lifetime.’’

The physician advised people living with the disease not to trivialise their condition, but seek medical attention on how to manage it. He called on schools’ authorities to have a small clinic where first aid treatment could be given to children who suffer from the disease. Owoeye added that when the condition was properly managed, patients could live normal lives.

According to Professor Guy Marks, of Sydney University who is also on the Board of Directors, at the International Union Against Tuberculosis and Lung Health, in most countries the main challenge is that patients cannot access (afford) regular treatment with "preventer/controller" medications. The main challenge is to enable patients to take this class of medications regularly. He added that with no long term cure on the horizon, the best we can hope for in the short-term is better access to, and better targeting of preventer/controller medications that can reduce the symptoms and disability and, most importantly, reduce risk of future poor outcomes (such as hospitalisation, permanent disability and/or premature death). In controlling asthma attack, Professor Guy advised thus: “In most cases, the triggers are ubiquitous and unavoidable (exercise, cold air, allergens, viruses etc). However, some triggers should be avoided (eg exposure to cigarette smoke and certain occupational sensitisers). Air pollution is also a trigger that requires community action”.

Even though asthma usually develops during early childhood, over 75% of the children developing the condition before age 7 no longer have symptoms by age 16. That said, asthma can develop and/or worsen at any stage in life, including adulthood. Therefore, in order to stay healthy, those diagnosed must always be aware of proper management of their individual case and the fact that it can become more serious at any point.

Eranga Isaac, Citizen News Service - CNS
27 May 2015