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Asthma Around the World

By Thomas J. Kallstrom, BS, RRT, AE-C, FAARC

Asthma affects people in nations all around the world. How does asthma care there compare with care seen in the United States? Here are some snapshots based on studies published in medical journals.

Northern Europe: In Sweden, Norway, Germany, and the Netherlands, while the majority of physicians rely on appropriate pharmaceutical interventions, many are also concerned about their limitations. In Germany many physicians are even critical of conventional pharmaceutical management. In all four countries physicians strive to make the patient symptom free; but in Sweden, the specific goal is to control the underlying inflammatory process. This is certainly similar to recommendations in the U.S. National Institutes of Health's Expert Panel Report 3 and is part of the conventional wisdom of best practice. In order to maintain a symptom-free life, the asthma patient must first control the inflammatory part of asthma.

France: Like the U.S., France is facing questions regarding the oversight of asthma management by general practitioners and specialists. A French study that looked at 1,559 patients revealed differences in asthma care. Just as in the U.S., specialists were more likely to dispense long-acting beta agonists and inhaled corticosteroid combinations than general practitioners. Patients managed by specialists received short-acting beta agonists less often, with resultant decreases in dosages as control of symptoms was achieved. Interestingly, the general practitioners prescribed more anti-tussive expectorants and antibiotics than specialists. Asthma patients followed by specialists were less likely to declare themselves inadequately controlled than patients supervised in the primary care group.

Japan: Asthma management guidelines have been available in Japan since 2003, and a study of these guidelines conducted a year after they were released found that there was a high level of awareness of their existence by pulmonary specialists and non-specialists. This differs from the American experience where fewer primary care physicians were aware of or used the Expert Panel Report in asthma management. Despite this awareness, however, a survey of more than 803 Japanese households with an asthmatic member found over half of the asthmatics said they had had a daytime asthma attack in the previous month and a third had experienced an attack at night. As a result, 70% of adults and 60% of children had some limitation of activities, suggesting their asthma was not adequately controlled. Even more concerning was that 50% of adults and 80% of children had ever undergone any pulmonary function testing, and less than 10% of adults understood that airway inflammation was the major cause of asthma. All of this is very similar to what has been uncovered in the United States over the past two decades, despite the development of comprehensive asthma treatment guidelines.

Thomas Kallstrom is associate executive director and chief operating officer of the American Association for Respiratory Care (AARC) and a member of the National Asthma Education and Prevention Program Coordinating Committee.