Is your child at risk? How climate change is worsening asthma and what you can do – Firstpost

Asthma affects over 260 million people worldwide, causing significant health and economic challenges particularly in low- and middle-income countries. While inhaled corticosteroids remain the cornerstone of treatment, underdiagnosis, stigma and unequal access to care hinder effective control.

Emerging therapies and digital health tools show promise but addressing environmental triggers and ensuring equitable access to treatment are essential to reversing the growing global burden. Coordinated public health strategies, climate action and localised interventions are believed to be crucial for improving asthma outcomes worldwide.

To delve deeper into its various facets, we spoke to Dr. Satyanarayana Mysore, Chairman, HOD & Consultant – Pulmonology, Lung Transplant Physician & Sleep Medicine Specialist at Manipal Hospital to understand the evolving trends, challenges and advancements in asthma care.

Asthma prevalence trends and key factors

Dr Satyanarayana: Globally, asthma affects approximately 3–6% of the population. According to the World Health Organization (WHO), about 262 million people had asthma in 2019. Recent analyses indicate a modest decline in age-standardized prevalence in many regions, attributed to improved management and environmental controls. However, the absolute number of affected individuals remains high and continues to grow with the global population. High-income countries report higher asthma rates, often due to better diagnostic capabilities, while low- and middle-income countries (LMICs) may underreport cases due to limited resources.

Factors contributing to asthma prevalence include urbanization, lifestyle changes, environmental pollutants, and genetic predisposition. Urban living and early-life exposures, such as tobacco smoke and indoor pollutants, increase asthma risk. Worsening air quality, damp housing conditions, and rising obesity rates further exacerbate the issue.

How pollution, climate change exacerbate asthma

Dr Satyanarayana: Poor air quality and climate change significantly impact asthma incidence and severity. Rising temperatures increase ground-level ozone and pollen levels, while extreme weather events contribute to smoke and particulate matter, worsening air quality. This leads to more frequent and severe asthma attacks, especially among vulnerable populations. Proactive climate action, including emissions reductions and environmental health policies, is essential to mitigate these long-term health consequences.

Climate change exacerbates asthma triggers by increasing pollen production and lengthening allergy seasons. Extreme weather events such as heat waves and wildfires, release pollutants that worsen asthma symptoms. Without intervention, these environmental factors will continue to elevate asthma cases and exacerbations.

Asthma care access in low-income populations

Dr Satyanarayana: Asthma outcomes are poorest in regions with limited healthcare access. Challenges include underdiagnosis due to a lack of diagnostic tools, medication shortages, inadequate healthcare infrastructure, and low patient education.

To address these issues, strategies involve strengthening primary care systems, improving medication availability, educating patients and communities, and implementing school-based programs. Integrating asthma care into national health initiatives and leveraging international support can enhance care delivery in low-resource settings.

Pandemic’s impact on asthma management

Dr Satyanarayana: The COVID-19 pandemic reshaped asthma care, with many clinics adopting telemedicine and suspending routine tests to minimise viral exposure. Interestingly, asthma control improved for some due to increased medication adherence and reduced exposure to common triggers during lockdowns.

Long-term effects are still being studied but current evidence suggests that well-controlled asthma does not increase the risk of severe COVID-19 outcomes. However, some patients experienced worsened control post-infection, and reports of new-onset asthma-like symptoms in “long-COVID” patients have emerged.

New therapies for severe asthma and affordability

Dr Satyanarayana: Advancements in biologic therapies have transformed severe asthma treatment. Monoclonal antibodies targeting specific inflammatory pathways have significantly reduced exacerbations. Tezepelumab, approved in 2021, offers benefits across various asthma types.

Despite their efficacy, high costs limit accessibility, especially in low-resource settings. Strategies to improve affordability include developing biosimilars, pooled procurement, inclusion in national insurance schemes, and ensuring appropriate patient selection to maximize value.

Dr Satyanarayana: Digital health tools, such as smart inhalers and AI-based platforms enhance asthma self-management by improving medication adherence and providing personalized insights.

However, barriers like cost, limited technology access, data privacy concerns, and integration challenges hinder widespread adoption. Addressing these issues requires investment in infrastructure, clear regulatory guidelines, and education for both patients and healthcare providers.

Childhood asthma management and school support

Dr Satyanarayana: Effective childhood asthma management emphasizes regular controller therapy and trigger avoidance. Guidelines recommend inhaled corticosteroids over reliance on short-acting bronchodilators. Tools like spacer devices, routine monitoring, and asthma action plans are crucial.

Schools play a vital role by maintaining individualised action plans, training staff, ensuring quick medication access, controlling environmental triggers, and supporting physical activity with precautions. Collaborative efforts between families, healthcare providers, and schools are essential for optimal asthma control in children.

A global approach to asthma: Key strategies for better outcomes

Dr Satyanarayana: Improving global asthma outcomes requires a multifaceted approach. This includes strengthening primary care, ensuring access to affordable medications, and adhering to evidence-based treatment guidelines. Additionally, expanding community education, promoting clean air initiatives, and leveraging technology for remote monitoring are key strategies. Focused public health efforts, tailored to local needs and supported by global commitment, are essential to reducing the burden of asthma worldwide.

Key steps for improving asthma care globally:

*Strengthening primary care and healthcare worker training

*Ensuring reliable access to affordable essential medications

*Promoting guideline-based treatment

*Expanding community education

*Investing in environmental improvements and clean air initiatives

*Leveraging technology for remote monitoring and support

Public health initiatives tailored to local contexts and sustained global commitment are crucial in reducing the asthma burden and improving outcomes for affected individuals worldwide.