Global Alliance Against Chronic Respiratory Diseases
The Global Alliance against Chronic Respiratory Diseases contributes to WHOs work to prevent and control chronic respiratory diseases. GARD is a voluntary alliance of national and international organizations and agencies from many countries committed to the vision of a world where all people breathe freely.
People At Risk Of Ncds
People of all age groups, regions and countries are affected by NCDs. These conditions are often associated with older age groups, but evidence shows that more than 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years. Of these “premature” deaths, 85% are estimated to occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol.
These diseases are driven by forces that include rapid unplanned urbanization, globalization of unhealthy lifestyles and population ageing. Unhealthy diets and a lack of physical activity may show up in people as raised blood pressure, increased blood glucose, elevated blood lipids and obesity. These are called metabolic risk factors that can lead to cardiovascular disease, the leading NCD in terms of premature deaths.
The Socioeconomic Impact Of Ncds
NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing premature deaths from NCDs by one-third by 2030.
Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services.
In low-resource settings, health-care costs for NCDs quickly drain household resources. The exorbitant costs of NCDs, including treatment which is often lengthy and expensive, combined with loss of income, force millions of people into poverty annually and stifle development.
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What Is Bronchial Asthma
Bronchial asthma is a common lung disease affecting millions of people worldwide. Like COPD, it is characterised by narrowing of the airways in the lungs, but there are some major differences. First, bronchial asthma is an allergic reaction to certain particles in the air, known by the general term allergens, which usually come from other animals or plants. Examples of allergens include:
- Pollen from trees, crops and flowers
- House dust mites
- Animal hairs
The muscles in the walls of the bronchioles constrict if a person with asthma breathes in an allergen that he or she has become sensitive to. Most people are not sensitive to these common allergens, so people who develop bronchial asthma may have genetic factors that make their lungs react so strongly. The narrowing of the bronchioles can begin very suddenly and is called an asthmaattack. The symptoms of an asthma attack are similar to COPD and include wheezing, coughing, chest tightness and shortness of breath. If the person uses an inhaler , the narrowing of the bronchioles can usually be reversed quite quickly, so they can breathe normally again.
Can you see one big difference between asthma and COPD?
Asthma symptoms can be reversed by breathing in the correct medicine, but COPD symptoms cannot be reversed the damage to the lungs is permanent.
A person with an asthma attack should go urgently to a health centre or hospital.
In the next study session, we turn to chronic conditions affecting vision and hearing.
Childhood Asthma Rates Stable In Western Countries But Increasing In Lower
The prevalence of asthma in children was found to have decreased in low-income countries, but increased in lower-middle income countries, according to the latest phase of the largest face-to-face health survey ever conducted, published in The Lancet.
The prevalence in upper-middle and high-income countries was stable, found the Global Asthma Network study, which shows how the worldwide burden of childrens asthma symptoms is changing.
Led by the University of Auckland with partners including the London School of Hygiene & Tropical Medicine , the Phase 1 study included nearly 120,000 children and adolescents from 27 centres in 14 countries, and continues a series of global surveys over 27 years .
Three phases of data collection have overall included more than 300 centres in more than 100 countries. The first two phases were conducted by the International Study of Asthma and Allergies in Childhood , which has now continued as the Global Asthma Network.
Asthma is the most common non-communicable disease in children, representing a large burden of disease globally with about 10-15% of children globally having had asthma symptoms in the last year. The overall prevalence in the centres that took part in the new survey had changed little in the last 15-20 years. Prevalence increased by about 1% every 10 years in Europe, and by more than 2% in Africa and the Middle East, whereas prevalence had fallen by about 1% in Asia-Pacific, and was unchanged in the Americas.
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Reducing The Burden Of Asthma
Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life.
There are two main types of inhaler:
- bronchodilators , that open the air passages and relieve symptoms and
- steroids , that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death.
People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.
It can be difficult to coordinate breathing using an inhaler especially for children and during emergency situations. Using a spacer device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. A spacer is a plastic container with a mouthpiece or mask at one end, and a hole for the inhaler in the other. A homemade spacer, made from a 500-ml plastic bottle, can be as effective as a commercially-manufactured inhaler.
Access to inhalers is a problem in many countries. In 2019, only half of people with asthma had access to a bronchodilator and less than one in five had access to a steroid inhaler in public primary health-care facilities in low-income countries .
When To See A Gp
See a GP if you think you or your child may have asthma.
Several conditions can cause similar symptoms, so it’s important to get a proper diagnosis and correct treatment.
The GP will usually be able to diagnose asthma by asking about symptoms and carrying out some simple tests.
Find out more about how asthma is diagnosed.
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Why Do People Get Asthma
Research has yet to show a definitive cause of asthma. However, researchers have determined several risk factors that can lead to asthma development.
Family History and Genetics
Children of mothers with asthma are three times more likely to suffer from asthma, and 2.5 times more likely if the father has asthma. More than 30 genes have been linked to asthma so far, and gene-gene interactions, gene-environment interactions and epigenetic modifications also play a part. Genetic differences also play a role in differences in response to treatment.
People are more likely to have asthma if they have certain types of allergies, such ones which can affect the eyes and nose. However, not everyone who has allergies will get asthma and not everyone who has asthma is affected by allergies. Respiratory allergies and some types of asthma are related to an antibody called immunoglobulin E , which the immune system produces in response to allergens. To protect the body, the IgE causes allergic reactions that can affect the eyes, nose, throat, lungs and skin.
Children born before 37 weeks are at increased risk of developing asthma later in life.
Babies or small children may be at risk of developing asthma later in life if they had certain lung infections at a very early age.
Women can develop adult-onset asthma during or after menopause.
Environment Air Quality
Is Asthma An Allergic Disease
Asthma is often described as anallergic disease in which allergens or certainworkplace exposures can trigger attacks ofairway narrowing and, through continuedexposure, lead to airway inflammation andenhanced airway responsiveness. However,this paradigm came from observationspredominantly in western high-incomecountries, and the association betweenallergy and asthma is much weaker in LMICs.Some occupational causes of asthma do notappear to involve allergy. It is now widelyrecognised that allergic mechanisms areinvolved in half, or less, of the people withasthma. In many people, asthma probablyinvolves non-allergic inflammation of theairways, although we do not understand wellthe mechanisms involved.
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Prevention And Control Of Ncds
An important way to control NCDs is to focus on reducing the risk factors associated with these diseases. Low-cost solutions exist for governments and other stakeholders to reduce the common modifiable risk factors. Monitoring progress and trends of NCDs and their risk is important for guiding policy and priorities.
To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed requiring all sectors, including health, finance, transport, education, agriculture, planning and others, to collaborate to reduce the risks associated with NCDs, and to promote interventions to prevent and control them.
Investing in better management of NCDs is critical. Management of NCDs includes detecting, screening and treating these diseases, and providing access to palliative care for people in need. High impact essential NCD interventions can be delivered through a primary health care approach to strengthen early detection and timely treatment. Evidence shows such interventions are excellent economic investments because, if provided early to patients, they can reduce the need for more expensive treatment.
Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions. NCD management interventions are essential for achieving the global target of a 25% relative reduction in the risk of premature mortality from NCDs by 2025, and the SDG target of a one-third reduction in premature deaths from NCDs by 2030.
The Impact Of Conflict On Asthma
Yousser Mohammad1,2, Grace Brough3,4,5
Syria 2National Center for Research in Chronic Respiratory Diseases and Comorbidities, Tishreen University School of Medicine, Tishreen University, Latakia, Syria Global Violence Prevention Special Interest Group , Faculty of Public Health UK , Public Health Specialty Registrar University Hospital of Derby and Burton Foundation Trust ,
Submitted May 20, 2019. Accepted for publication Jun 14, 2019.
Asthma is a public health problem worldwide, showing high incidence, high prevalence and causing social and economic damage this condition may be more prevalent in areas of conflict . The evidence on asthma in conflict affected areas and recommendations to improve asthma treatment and prevention are talked about in this editorial.
The Global Asthma Network report 2018 estimates there are 339 million asthma patients worldwide a mean prevalence of 14% . Asthma is ranked 16th for disability adjusted life years of all causes. This is because asthma can lead to premature death, hospital stays, reduced productivity and quality of life .
Asthma can present more severely in some people, this can often be impacted by how well controlled it is. The WHO define severe asthma as Uncontrolled asthma which can result in risk of frequent severe exacerbations and/or adverse reactions to medications and/or chronic morbidity .
This paper considers asthma in all its forms, severe and not severe.
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Who’s Leadership And Coordination Role
The 2030 Agenda for Sustainable Development recognizes NCDs as a major challenge for sustainable development. As part of the Agenda, Heads of State and Government committed to develop ambitious national responses, by 2030, to reduce by one-third premature mortality from NCDs through prevention and treatment . This target comes from the High-level Meetings of the UN General Assembly on NCDs in 2011 and 2014, which reaffirmed WHOs leadership and coordination role in promoting and monitoring global action against NCDs. The UN General Assembly will convene a third High-level Meeting on NCDs in 2018 to review progress and forge consensus on the road ahead covering the period 2018-2030.
To support countries in their national efforts, WHO developed a Global action plan for the prevention and control of NCDs 2013-2020, which includes nine global targets that have the greatest impact on global NCD mortality. These targets address prevention and management of NCDs.
GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 19902015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016 388:1659-1724
Video: WHO – uniting UN Agencies against NCDs in Kenya
There Are Many Different Types Of Asthma Brought On By Many Different Triggers
If youre struggling with asthma symptoms trouble breathing, a persistent cough or tightness in the chest an allergist can help you take control by providing a diagnosis and identifying the underlying causes.
Learn about the triggers and treatment for allergic asthma and how an allergist can help you manage allergy and asthma symptoms.
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Course Of Asthma Over The Lifespan
It is not possible to define a single naturalhistory for asthma and it can develop at anystage in life, including adulthood. However,asthma symptoms most commonly developfor the first time in early childhood. Youngchildren of pre-school age often wheeze withviral infection, but only about half of themgo on to have characteristic asthma at schoolage. Children who have frequent or persistentwheeze are more likely to have evidenceof airway inflammation and remodelling,impaired lung function, and persistentlytroublesome symptoms into adulthood.Recent reports raise the possibility thatchildhood asthma, persisting into adulthood,may predispose people to chronic obstructivepulmonary disease .
Summary Of Study Session 4
In Study Session 4, you have learned that:
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Other Health Impacts Of Childhood And Adult Asthma
Another major impact of asthma is through its associated additional morbidities, including a predisposition to serious infections such as bacterial pneumonia from a higher nasopharyngeal carriage of Streptococcus pneumoniae . Although not well-understood, asthma-related chronic airway inflammation with damaged airway mucosa and immunomodulating treatments such as inhaled corticosteroids have been implicated, and lower antibody levels in response to the Pneumococcal vaccine have also been observed . In addition to a 2.4-fold increased risk for invasive pneumococcal disease , susceptibility to respiratory and non-respiratory infections in never smokers with asthma has been compared with the relative risk of diabetes . This susceptibility to infection supports the hypothesis of weaker TH1 immune responses associated with TH2-related disease. However, recommendations for Pneumococcal immunization are inconsistent suggesting more evidence is needed to gain consensus of its benefits .
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease is a progressive respiratory disease that makes it hard to breathe. The long name of this condition tells you a lot about the problem if you know what each of the words means.
What does chronic mean when applied to a disease? You should know it already from earlier study sessions in this Module.
A chronic disease is one that begins slowly, gradually gets worse over time and lasts for a long time, usually for the rest of the persons life.
Obstructive means that the disease involves blockages somewhere in the body, and pulmonary tells you that the disease affects the respiratory system.
4.2.1 The lungs in COPD
People with COPD have inflammation in their lungs that causes the production of large amounts of mucus a clear slimy fluid secreted by cells lining the inside of the lungs. The mucus is a very good place for bacteria to grow, so lung infections are common in people with COPD. The mucus blocks the fine bronchioles and causes wheezing squeaky breathing you can often hear a quiet whistling or squeaking sound coming from the lungs when the person breathes in.
4.2.2 Emphysema and chronic bronchitis
The symptoms we have just described are known as chronic bronchitis . Because the airways are constantly irritated and inflamed, the lining of the bronchioles becomes thicker and the space in the middle of the tube becomes smaller . This further restricts the amount of air that can get into and out of the lungs.
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The Human Respiratory System
Before we can teach you about respiratory diseases, you need to know more about the respiratory system and how it works. Look carefully at Figure 4.1. The air that you breathe in passes down your windpipe into tubes in your lungs called bronchi, which branch into fine bronchioles that carry air into all parts of the lungs.
Trachea is pronounced trak-ee-yah bronchi is pronounced bronk-ee and bronchioles are bronk-ee-oles.
The bronchioles end in bunches of tiny round air sacs called alveoli . The airways and alveoli are elastic . When you breathe in, each air sac fills up with air like a small balloon, and when you breathe out, it gets smaller again as the air leaves.
Small blood vessels called pulmonary capillaries cover the walls of the alveoli . When air enters the air sacs, the oxygen in the air passes through the very thin walls of the alveoli into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the alveoli and is breathed out . This process is called gas exchange.
With this information in your mind, we can move on to describe how the respiratory system is affected in COPD first and then in bronchial asthma.