Prioritizing asthma and improving ‘Asthma Care for All’

As one of the world’s most common chronic noncommunicable diseases, asthma is a serious yet often misunderstood and poorly managed condition.^1,2 Today on World Asthma Day, we join the Global Initiative for Asthma (GINA) and the global respiratory community in calling for “Asthma Care for All” via reforms that increase equitable access to quality care and improve outcomes for the estimated 262 million people living with asthma worldwide.¹ 

Asthma attacks are physically threatening and emotionally significant for many patients, and can be fatal. 

Asthma symptoms include coughing, wheezing and shortness of breath, which vary over time, and in severity and frequency.² Exacerbations (asthma attacks) are physically threatening and emotionally significant for many patients,³ and can be fatal.^1,4  There are an estimated 136 million exacerbations experienced globally every year.⁵  For up to 10 percent of people with severe uncontrolled asthma, patients can experience frequent exacerbations and significant limitations on their lung function and quality of life.^6-9  

In 2019, asthma caused an estimated 455,000 deaths, many of which were preventable.^1,10 It’s clear more needs to be done to address critical areas of unmet need in asthma. We are committed to transforming asthma care and working to drive earlier diagnosis and intervention than seen in current standards of care, as well as developing innovative medicines that can help eliminate asthma attacks and deliver major benefits to asthma patients. At AstraZeneca, our ambition is to ensure all people living with asthma receive the right care, at the right time and in the right setting, while also contributing to building a healthier population and planet. We believe such changes will help build resilient health systems that can withstand shocks and are sustainable when faced with long-term stress. 

In 2019, asthma caused an estimated 455,000 deaths, many of which were preventable.

Prioritizing asthma to ensure equitable access to treatment and care 

Studies highlight a gap between the patient outcomes achieved in controlled clinical trials and those experienced in real-world settings.¹¹ AstraZeneca’s PUMUA initiative, designed to redefine asthma care in Africa through government, physician and society partnerships, is one example of our commitment to increasing equitable access to quality care.¹² The initiative aims to improve asthma management with a focus on strengthening local health systems, building capacity of health care workers, asthma awareness and education, and equitable access to AstraZeneca’s respiratory medicines.¹³  

Asthma management rather than access alone needs to change: many asthma patients are reliant on treatments that relieve symptoms without targeting the underlying inflammation.

However, asthma management rather than access alone needs to change: many asthma patients are reliant on treatments that relieve symptoms without targeting the underlying inflammation.¹⁴  Over-reliance on short-acting beta2-agonist (SABA) inhalers is associated with poor asthma control and an increased risk of severe exacerbation and death.¹⁵ Real-world evidence has shown SABA reliever overuse is a global issue in asthma care and there is a need for asthma management that addresses the inflammatory nature of the disease and reduces exacerbation risk to improve outcomes for patients.^16,17 While GINA has updated its guidelines for mild asthma to recommend inhaled corticosteroid-containing relievers instead of SABAs alone,² the gap between evidence-based guidance and practice remains, and over-reliance on SABA continues. ^16,17 

We are committed to addressing this challenge in partnership with respiratory health care providers, such as in Argentina, where SABA-free asthma departments have been introduced in health care centers across the country.¹⁸ Supported by electronic alerts on patient records when SABA is prescribed, this initiative demonstrates how evidence-driven solutions to tackle SABA overuse can be implemented across health systems. 

Ending oral corticosteroid reliance in severe asthma 

Patients with severe asthma are at an increased risk of mortality and the cost to society for severe uncontrolled asthma is estimated to be 60 percent of all asthma costs.¹⁷ Oral corticosteroids (OCS) have been a mainstay of severe asthma treatment for decades,²⁰ but mounting evidence shows that overexposure to OCS carries the potential for serious long-term health risks, such as osteoporosis, metabolic and cardiovascular diseases and psychiatric disorders. ²¹ 

With the emergence of new treatments, we’ve seen a significant reduction in OCS use in other disease areas such as rheumatoid arthritis,²⁰ but in asthma we are only beginning to see change. Currently, it is estimated over 13.5 million people globally with severe asthma rely on OCS to control exacerbations and prevent hospitalizations.^1,6-8,22 Change is overdue and as part of our commitment to improving patient outcomes in asthma, AstraZeneca is working in partnership with health systems to embed OCS stewardship across all care settings — designed to protect patients with asthma from avoidable OCS use.²³ 

Poor quality air and extreme weather conditions pose a great risk to those living with asthma and increase the number of people developing the disease.

Early identification and a timely referral to specialists is also important for patients at risk due to severe asthma. In the U.K., for example, 72 percent of potential severe asthma patients had no referral or specialist review in the prior year.²⁴ PRECISION UK (organized and funded by AstraZeneca) collaborated with the NHS England to develop SPECTRA primary care resources to help identify adult asthma patients with suspected severe asthma.²⁵ As of April 2023, 1.74 million patient records had been proactively searched using SPECTRA to help identify patients taking two or more courses of OCS in the past 12 months and/or with other indicators of uncontrolled asthma. This initiative is designed to ensure patients receive optimal treatment for their severe asthma, minimizing OCS use.²⁵  

Improving asthma control benefits patients and the planet  

The interconnection between climate and health is undeniable and this is especially true for asthma.²⁶ Poor quality air and extreme weather conditions pose a great risk to those living with asthma and increase the number of people developing the disease.²⁷ 

We are proud to stand together with the global asthma community as we call on policymakers and health system leaders to prioritize urgent reforms and solutions.

A growing body of evidence has shown that poorly controlled asthma is associated with a higher carbon footprint stemming from greater medicines use, doctor visits and hospital care. ^28,29 Therefore, strategies that optimize disease management, such as implementing the latest evidence-based treatment guidelines, can both improve patient outcomes and reduce the environmental impact of asthma care. 

Achieving ‘Asthma Care for All’  

The theme for this year’s World Asthma Day advocates for improvement in all aspects of asthma care, for all patients and for the environment. This is fitting as we know preventing asthma attacks and improving disease control has the potential to transform outcomes for patients, reduce hospitalization and the risk of death, and minimize the environmental impact of asthma care. We are proud to stand together with the global asthma community as we call on policymakers and health system leaders to prioritize urgent reforms and solutions that improve the diagnosis and treatment of asthma and support equitable asthma care for all. 

For more information around the burden and societal cost of lung conditions including asthma and the case for change at national and international levels, visit Lung Facts, a tool developed by the International Respiratory Coalition,³⁰ of which AstraZeneca is proud to be a founding member. 

References  

1. The Global Asthma Network. The Global Asthma Report 2022. [Online]. Available at: http://globalasthmareport.org/resources/Global_Asthma_Report_2022.pdf. [Last accessed: April 2023]
2. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2022. Available at: https://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-07-01-WMS.pdf. [Last accessed: April 2023]  
3. Sastre J, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016; 9: 13  
4. Fernandes AG, et al. Risk factors for death in patients with severe asthma. J Bras Pneumol. 2014; 40 (4): 364-372.  
5. AstraZeneca Pharmaceuticals. Data on file. Budesonide/formoterol: Annual Rate of Exacerbations Globally. REF-173201.   
6. Wenzel S. Severe Asthma in Adults. Am J Respir Crit Care Med. 2005; 172(2); 149-60.  
7. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014; 43: 343-73.   
8. Peters SP, Ferguson G, Deniz Y, et al. Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment. Respir Med. 2006: 100 (7): 1139-51.   
9. Sullivan PW, et al. Oral corticosteroid exposure and adverse effects in asthmatic patients. Journal of Allergy and Clinical Immunology. 2017; 141(1): 110–6.e7.  
10. WHO/Asthma. Available at: https://www.who.int/news-room/fact-sheets/detail/asthma. [Last accessed April 2023]   
11. Price D, Uthaman T. What have we learnt from real-life research in asthma and COPD? Standards and novel designs for the future. Respirology. 2022;27(12): 1018-1021.  
12. Yes2PUMUA AstraZeneca initiative. Available at: https://yes2pumua.com/. [Last accessed April 2023].   
13. AstraZeneca Sustainability Report 2021. Available at: https://www.astrazeneca.com/content/dam/az/Sustainability/2022/pdf/Sustainability_Report_2021.pdf. [Last accessed April 2023] 
14. Worth H, Criée CP, Vogelmeier CF, et al. Prevalence of overuse of short-acting beta-2 agonists (SABA) and associated factors among patients with asthma in Germany. Respir Res. 2021; 22(1): 108.  
15. Nwaru BI, Ekström M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting β₂-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020; 55(4): 1901872.  
16. Quint JK, et al; SABINA North American and European Study contributors. Short-Acting Beta-2-Agonist Exposure and Severe Asthma Exacerbations: SABINA Findings From Europe and North America. J Allergy Clin Immunol Pract. 2022; 10 (9): 2297-2309.e10.  
17. Bateman ED, et al. Short-acting β2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. Eur Respir J 2021; Sep 24:2101402. doi: 10.1183/13993003.01402-2021. Epub ahead of print. PMID: 34561293.   
18. L.J. Nanini, S. Luhnin, R. A. Rojas, J.M Antunez, J.L. Miguel Reyes, C. Cano Salas & R. Stelmach. Position statement: asthma in Latin America. Is short-acting beta-2 agonist helping or compromising asthma management? Journal of Asthma. 2021; 58: 8, 991-994. 
19. Rönnebjerg L, Axelsson M, Kankaanranta H, et al. Severe Asthma in a General Population Study: Prevalence and Clinical Characteristics. J Asthma Allergy. 2021; 14: 1105-1115.  
20. Chung LP, et al. Rational oral corticosteroid use in adult severe asthma: A narrative review. Respirology. 2020; 25: 161-72.   
21. Volmer T, Effenberger T, Trautner C, et al. Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature. Eur Respir J. 2018; 52(4): 1800703. Published 2018 Oct 25.  
22. Voorham J, Xu X, Price D, Golam S, Davis J, et al. Health care resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma. Allergy. 2019, 74; 273-283.  
23. European Medical Journal Congress Review, EMJ Respiratory 10 Supplement Available at: https://www.emjreviews.com/respiratory/journal/emj-respiratory-10-supplement-2-2022-s160222/. [Last accessed April 2023]
24. Ryan et al. Potential Severe Asthma Hidden in UK Primary Care. J Allergy Clin Immunol Pract 2021; 9: 1612-1623. Available from: https://www.sciencedirect.com/science/article/pii/S2213219820313271. Last Accessed: April 2023.  
25. AstraZeneca Data on File. World Asthma Day DoF – AstraZeneca Level Reporting – SPECTRA overview across UK. REF-185965 
26. Kurt OK, Zhang J, Pinkerton KE. Pulmonary health effects of air pollution. Curr Opin Pulm Med. 2016;22(2):138-143.  
27. Deng SZ et al. Chinese Medical Journal. 2020 Jul 5;133(13):1552-60  
28. Janson C., et al. The carbon footprint of respiratory treatments in Europe and Canada: an observational study from the CARBON programme. Eur Respir J. 2022; 60:2102760.    
29. Wilkinson A. et al. Greenhouse gas emissions associated with asthma care in the UK: results from SABINA CARBON. Oral session presented at European Respiratory Society (ERS) International Congress, 2021 Sep 5-8.  
30. International Respiratory Coalition – Lung Facts. Available at:  https://international-respiratory-coalition.org/lung-facts/. [Last accessed April 2023].