Delhi, the vibrant metropolis known for its rich history, cultural diversity, and economic prominence has now also earned the unfortunate distinction of being the "asthma capital" of the nation. In 2020 alone, Delhi faced 54,000 premature deaths related to air pollution. This infamous title for the country’s capital is a reflection of the severe air quality challenges that many of the tier 1 and tier 2 cities face.
According to the World Air Quality Report 2022, India was the world's eighth most polluted country, with an annual average PM2.5 concentration of 53.3 micrograms per cubic metre, which is ten times more than the WHO recommended levels.
The concentration of harmful pollutants in the air, such as particulate matter (PM2.5), nitrogen dioxide (NO2), sulphur dioxide (SO2), and volatile organic compounds (VOCs), has reached alarmingly high levels, which in turn trigger asthma, bronchitis and other lung-related diseases. However, this isn’t a phenomenon restricted to Delhi alone, but throughout the nation.
Due to severe air pollution and poor air quality in households in India, almost 100 million people are suffering from respiratory diseases, with 1 million people dying yearly due to asthma and COPD. A disturbing trend is how deaths owing to asthma have increased steadily over the years in India but are seeing a gradual decline in other developed countries.
According to a report published in 2022, the total burden of asthma in India is 34.3 million, accounting for 13.09% of the global burden. Asthma accounted for 27.9% of the disability-adjusted life years (DALYs) in Indians. On the whole, India has three times higher mortality and more than two times higher DALYs compared to the global proportion of asthma burden. According to the WHO data published in 2020, asthma deaths in India reached 196,051 or 2.31% of total deaths.
Clear case for early-childhood detection
A closer examination of this data reveals that most Asthma-related deaths occur in adulthood. Apart from genetic predisposition, bad air quality, et al, I feel one of the most significant observations is that Asthma patients are not being diagnosed or adequately treated during childhood, leading to the persistence of the disease into adulthood. As a result, the narrowing of the airways worsens over time, making medications less effective.
How can nebulisers help?
A nebulizer is a device that can be used to deliver medications directly to the lungs to treat respiratory conditions such as asthma, and this in turn reduces inflammation, improves lung function, and allows for better breathing. The Melbourne Asthma Study showed that, for children with severe asthma at 7 years of age, only 14% achieved remission by age 50, suggesting that the changes in lung function associated with severe asthma occur early and may not be reversible.
An update to this study showed that 75% of patients with chronic obstructive pulmonary disease (COPD) at age 53 had one of three types of lung function trajectories. Childhood asthma was one factor that was associated with the risk of these three trajectories, and of interest, these were the only trajectories that were then associated with moderate to severe COPD later in life.
A May 2020 study showed how asthma patients had a mean 20% reduction in breathlessness with regular use of nebulisers, while 50% of patients with residual symptoms experienced additional benefits from using nebulisers at home.
One of the topmost advantages is precise medication delivery, as kids can be hypersensitive to dosages and slight variations in medication dosage can impact symptom control. Secondly, some children might struggle to coordinate their breaths with inhalers, this isn’t an issue with nebulizers, even for children across all age groups. Thirdly, with accurate and regular dosing protocols, the frequency of hospital visits could reduce as instances of severe flare-ups come down.
Apart from nebulisers, there are devices like dry-powdered inhalers and metered inhalers, however, these equipment types may not be suitable for young children, elderly people, and patients who cannot inhale and exhale with sufficient effort due to severe respiratory diseases. These devices require a certain technique and respiratory effort to inhale the medicine effectively.
More than adults, nebulisers need to be provided to children with asthma, so that they can go into remission at a young age. This becomes more important because often doctors prescribe medication to young children, their parents may not continue it and stop the medication once the symptoms seem to improve, often due to myths surrounding the side effects of these medications. The correct approach is for them to continue the medication until the doctor advises stopping, as stopping prematurely could lead to the recurrence of symptoms shortly and result in airway remodelling, leading to more severe asthma for children.
What interventions can be made?
Apart from choosing the right technology and devices, I feel education and awareness can come in handy and can create a real difference. We need education programs, especially in schools.
With a strong belief in this thought, organisations such as Omron Healthcare in India are actively engaging with schools to impart knowledge about asthma to parents and teachers alike and emphasise the importance of early detection and early treatment so that they are able to ensure respiratory wellness for their children with timely and right medication.
Simultaneously, we also aim to provide school children with simpler information using comics and other engaging materials, making it easier for them to understand what asthma is, and how they can help themselves and their parents manage it along with the care providers. If awareness of the significance of early detection and early treatment for managing asthma in children grows, parents and healthcare providers are encouraged to remain proactive in monitoring respiratory health.
I strongly believe in pursuing this direction and establishing model schools in many regions across the country to have an immensely positive impact on the respiratory health burden and its management in India. With ongoing research advancements and the development of improved nebuliser technology, the future for asthma management in children looks promising. By prioritising early detection and early treatment, we can provide a brighter future for young asthma patients, empowering them to live life to the fullest.
—The author, Tetsuya Yamada, is Managing Director, Omron Healthcare India. The views expressed are personal.
(Edited by : C H Unnikrishnan)
First Published: Nov 22, 2023 9:43 AM IST
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