MINI-SYMPOSIUM: THE BURDEN OF ASTHMA
The burden of asthma in children: a European perspective

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Summary

Asthma is the most common chronic disease in childhood, imposing a huge burden on the patient, their family and society. It is a worldwide disease with variable expression between countries and between different populations in a country. There is evidence that its prevalence has increased considerably over the last two decades and is still increasing, despite there being some indications that the increase in prevalence may have plateaued in some countries in the last few years. Better understanding of the natural course of asthma and improved asthma control can lead to a decreased burden on the patient, their family and society. The burden of asthma consists mainly of a decreased quality of life for the patient and their family, as well as high costs for society; the healthcare expenditures for asthma in developed countries are 1–2% of the total healthcare costs.

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INTRODUCTION

Depending on disease characteristics, such as prevalence, natural course and disease control, the burden of a disease can have a major impact on the patient, their family and society.

Bronchial asthma is a major cause of morbidity in children in developed countries. Over recent decades, a large number of epidemiological studies investigating the prevalence of childhood asthma have documented an increase in prevalence.1 Asthma affects about 8.6 million children in the USA.2 In Westernised

BURDEN OF ASTHMA – DIFFICULT TO DEFINE

It is impossible to develop a single estimate for the ‘burden’ of asthma.5 Several surrogate single parameters have been used in order to quantify the burden of asthma, such as data on prevalence, severity, lung function, general practitioner and hospital attendances, treatment regimens, morbidity and mortality, quality of life, limitations in normal life, direct/indirect costs and a few other asthma-related measures. However, these parameters only address the burden in regard to some limited

PARAMETERS IN THE ASSESSMENT OF THE BURDEN ON THE PATIENT

Derived from recently published surveys on disease burden, a number of different parameters may be used to assess the impact of asthma on those who have it, as follows:

  • number of asthma-symptom days;

  • number of night-time awakenings;

  • number of asthma attacks;

  • number of emergency department visits/urgent physician visits;

  • number of hospitalisations;

  • use of quick-relief medicines/rescue medication;

  • number of oral prednisone courses;

  • number of prescriptions;

  • number of missed days from school;

  • effect on

PARAMETERS IN THE ASSESSMENT OF THE BURDEN ON THE FAMILY

  • Missed work of adult caretakers – due to the child's asthma.

  • Effect on quality of life of siblings, parents and caretakers.

  • Effect on lifestyle and activity of siblings, parents and caretakers.

  • Consequences on professional career of parents and/or caretakers.

  • Direct expenditures for medical care and medical costs.

  • Indirect costs arising from morbidity and mortality including the value of time lost from work by parents/caretakers.

Again, this list nicely reflects the urgent need for an overall

PARAMETERS IN THE ASSESSMENT OF THE BURDEN ON SOCIETY

Healthcare costs arising from asthma may be the major burden on society. Socio-economic factors are integral to asthma care. However, they do not only affect society but also the patient and their family. There are other important factors, such as the patient's absence or his or her physical or psychological limitations, which not only have a major impact on the patient and/or their family but also on group dynamics in school activities and in extracurricular activities and hence on society.

HOW TO REDUCE THE BURDEN OF ASTHMA

It could be expected that by understanding and reducing the factors contributing to the burden of asthma, the overall burden, as well as the specific burden on the patient, their family and society, could be greatly reduced.

The prevalence of asthma varies worldwide, most likely due to different genetic backgrounds as well as different exposure to various risk factors such as respiratory infections, indoor/outdoor pollution and diet. Understanding the interaction of risk factors and genetic

CONCLUSION

Childhood asthma exerts a tremendous burden on patients, families, caretakers, society and healthcare providers. Recognising the sizeable disease burden should establish asthma as a priority area in national healthcare strategy. A better understanding of aetiology, pathogenesis, risk factors and protective influences for asthma development may improve primary, secondary and tertiary preventive measures. Improved individual targeting of existing therapies and facilitating the development of

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    Citation Excerpt :

    Asthma is one of the major medical challenges worldwide and the most common chronic disease in childhood (1–3).

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