The incidence of asthma - a chronic inflammatory disorder of the airways that currently affects 300 million people globally - has risen steadily in the past 20 years and is predicted to worsen, with an additional 100 to 150 million sufferers likely by 2025, according to the World Health Report 1998.

The report said the Asia-Pacific region had the world's highest asthma fatality rates. China had the highest rate of 36.7 deaths for every 100,000 asthmatics, followed by Russia with 28.6, Singapore (16.1), Japan (8.7), Thailand (6.2) and Hong Kong (5.6).

The ACT is a questionnaire to help assess a patient's asthma control and provide doctors with more information on which to base their diagnosis and arrange suitable treatment. The test asks the patient to rate their condition in the previous four weeks regarding five factors - limitations on activity, shortness of breath, night-time awakening, use of relief medication and control of the disease. Each factor is rated on a five-point scale and the responses are added up to get a score from 5 (poor control) to 25 (total control).

A study conducted in the US found the overall agreement between the results of ACTs by

471 patients and separate assessments by asthma specialists ranged from 71 to 78 per cent. The test is also consistent with the Global Initiative for Asthma (GINA)'s newly revised guideline that focuses on the level of asthma control (controlled, partly controlled or uncontrolled) for doctors to base their treatment decisions instead of the severity of the condition.

The ACT will be helpful to doctors in busy clinics who may forget to ask key questions and enhance the doctor-patient dialogue, as they will know what to do to achieve total asthma control, said Dr Aziah Binte Ahmad Mahayiddin, director of the Malaysia Institute of Respiratory Medicine.

Pointing out that asthma was incurable but controllable, she said patients could live symptom-free lives with proper long-term control, including avoiding risk factors, constantly assessing symptoms and modifying treatments accordingly.

"There's a huge gap between the current level of asthma control and what can be achieved. Patient education has a role in helping to close this gap," said Prof Richard Beasley, chairman of the Asian Pacific Society of Respirology's Education Committee and member of the GINA Assembly.

"The overall aim of asthma management is for the patients to live as normal a life as possible by understanding symptoms, minimising attacks and achieving asthma control. However 255,000 deaths are caused by asthma and the highest death rates are found in the Asia Pacific," he said.

Patients and doctors in the region overestimate the level of asthma control and are not maximising management techniques, Beasley said, citing a finding that about 60 per cent - including those with severe and moderate persistent asthma - used quick-relief broncho-dilators only. A low 14.5 per cent of patients with persistent asthma used daily doses of inhaled anti-inflammatory corticosteroid as preventative medication, compared with 41.1 per cent in Europe and 35.4 per cent in the US, he said.

In Thailand, many asthmatics neither receive proper treatment nor understand their condition's needs and so depend on asthma-reliever inhalers, often bought over the counter, according to Prof Watchara Boonsawat, associate dean for Khon Kaen University's Faculty of Medicine's Research Affairs.

He cited the case a Khon Kaen man in his 40s who nearly died twice from asthma attacks and was saved by cardiopulmonary resuscitation before he went to see a doctor and was diagnosed with asthma.

Watchara said a 2001 survey of 12,000 Thais aged 20 to 44, conducted by KKU Asthma Clinic at Bangkok's Srinakarin Hospital and other clinics in the provinces, found that 9.6 per cent of people in Bangkok had asthma, 6.7 per cent in Khon Kaen, 6.9 per cent in Chiang Mai and 4 per cent in Songkhla.

With the serious asthma problem in the region, AAPC brings together asthma stakeholders from Australia, Bangladesh, Hong Kong, Malaysia, Korea, Singapore, Sri Lanka, Taiwan, Thailand and Vietnam.

"AAPC is dedicated to empowering and educating patients to be proactive in gaining control of their asthma," said Kristine Whorlow, AAPC president and CEO of Australia's National Asthma Council.

Besides encouraging proper methods of diagnosis, treatment and assessment of asthma control - such as ACT - the AAPC has also launched www.asianasthma.org to provide patient-focused information for people living in Asia, said Whorlow.

Premyuda Boonroj

 The Nation