Noncommunicable Diseases in India: asthma and COPD
In the previous blog post, the communicable diseases were discussed. Besides those communicable diseases, India also has to deal with the increase in non-communicable diseases (NCDs). In 2016, 63% of all deaths in India were caused by NCDs. Chronic respiratory disease were accountable for 11% of the deaths in india. COPD and asthma are two of the five biggest contributors to the global burden of respiratory disease. Therefore, this blog post will provide some background information on asthma and COPD.
Asthma
Asthma is a condition where the airways of patients are narrowed and swollen (see picture 1). In addition, the mucus production can be higher than normal. As a result, breathing can become difficult, resulting in coughing, a whistling sound when breathing and shortness of breath. The severity of symptoms varies per person; some people only experience some difficulty with breathing, while other people experience limitations in their daily activities.
In 2015, nearly 235 million people suffered from asthma and it caused 383,000 deaths worldwide. Asthma is the most common chronic respiratory disease in children worldwide. Estimates show that the overall morbidity burden of asthma in India in 2015 were around 65 million cases and 82,000 deaths. In addition, there was an increase in the overall prevalence rate in india from 41.9 (per 1000 populations) in 2004 to 54.9 (per 1000 populations) in 2011. Furthermore, asthma was accountable for 1,25% of all DALYs in India in 2019. In comparison, worldwide the DALYs due to asthma were only 0,8%. However, it is estimated that the real percentages may be higher, since there are still a lot of people undiagnosed. The underdiagnosis of asthma is partly a consequence of the stigma surrounding the disease, which makes people conceal the condition.
Currently, there is no cure for asthma, but the symptoms can be controlled with the right medication. Most widely used are the corticosteroid-, β -agonis- or combination inhalers. Even though these inhalers are widely available at pharmacies in India, only a selected group of people can actually afford to buy these inhalers. In addition, people believe that the inhalers are highly addictive. However, education increased the acceptability of the inhaler treatment.
The most common risk factor in India for developing asthma is the use of solid fuels in households, which will be further discussed in a separate blog post. It is estimated that by minimising the use of solid fuels, one third of all asthma cases in India could be eliminated. Furthermore, smoking, current alcohol use, underweight, overweight are also important risk factors. In addition, recent reports hypothesised that childhood asthma persistent into adulthood may be a predisposing factor to chronic obstructive pulmonary disease (COPD).
COPD
COPD is a progressive and chronic lung disease that causes breathlessness and predisposes to exacerbations and illness. Via the windpipe, air gets inside the lungs. The windpipe divides into many smaller tubes (bronchioles), like branches of a tree. These branches end in tiny air sacs which are called alveoli. These air sacs have very thin walls, so oxygen and carbon dioxide can be transferred to or from the blood.
When a person has COPD, the walls of the air sacs become damaged, causing an impaired airflow out of the lungs. Because of this impaired flow, the lungs contain more air when breathing in, which causes the feeling of shortness of breath. Another type of COPD is called ‘chronic bronchitis’, and it means that the bronchial tubes are continually infected, causing a chronic cough.
In 2015, it was estimated that 5% of all deaths globally were caused by COPD (3.17 million cases), and more than 90% of these deaths occured in low and middle income countries. In 2016, the prevalence of COPD appeared to be 251 million worldwide, which means COPD is not only a very big, but also a universal problem. In India, COPD accounted for 4,55% of DALYs (disability adjusted life years) in 2019, compared to 2,91% globally. This means India has a relatively large burden of COPD.
The most common cause of COPD is breathing in tobacco smoke, either through active or second-hand smoking. Another important risk factor for COPD is indoor and outdoor air pollution, which is why we decided to focus on this during our blog posts. Exposure to indoor air pollution can even affect an unborn child, causing an increased risk of developing COPD later in life.
COPD is not curable, but symptoms can be reduced through medical and physical treatment, with the most successful treatment being to quit smoking.
This blog post was co-written by Jippe Miedema and Marlou Groot
