Two of the biggest avoidable causes of illness and death in young children are asthma and pneumonia. They kill millions of children and adults every year, particularly in low- and middle-income countries (LMICs), where inequalities in access to affordable and high quality care can be a significant barrier to diagnosis and adequate treatment.
A special session titled ‘A breathless child: calling time on deaths from asthma and pneumonia’ explored current information on the diagnosis, treatment and challenges associated with these two diseases, with a specific focus on LMIC settings. Over 340 million people have asthma, the vast majority of whom live in LMICs where access to basic effective asthma care is limited.
Dr Innes Asher, Professor from the University of Auckland and Chair of the Global Asthma Network, said: “There have been highly effective asthma controlling treatments available for decades, and yet children die from asthma in LMICs because of the difficulty in diagnosing and treating them.”
Dr Asher highlighted the need for these essential medicines, which are very expensive, with inhalers costing between three and 14 times the average daily wage of people living in LMICs. She also explained the impact of environmental exposures associated with asthma, such as tobacco, open fires and truck traffic.
“Pneumonia is the leading infectious disease killer of children” said Dr Matthew Kelly from the Division of Pediatric Diseases at Duke University. “While child pneumonia deaths have declined by 50 percent since 2000, 99 percent of those child pneumonia deaths occur in LMICs, with almost half of those deaths coming from just five countries: India, Nigeria, Pakistan, DRC and Ethiopia.”
Dr Kelly also emphasised the need to have accessible and affordable diagnosis and treatment options in LMICs. He also raised the growing issue of drug resistance, saying “Vaccines are effective in preventing pneumonia, but they lead to higher rates of drug-resistance where vaccines do occur.”
Both speakers pressed for the need to have robust national policies to help support and improve health outcomes. For asthma, Dr Asher highlighted the difficult fact that national strategies are more common in high asthma symptom prevalence countries (85 percent) than in low prevalence countries (22.6 percent). She gave an example from Finland where a national asthma strategy that worked to increase spend on medicines led to a dramatic reduction in all other economic costs in the country, and deaths fell 5.4 fold in 20 years. She concluded: “we need widespread adoption of national policies to improve asthma outcomes”.
Also discussing the lack of robust policies in child pneumonia care, Dr Kelly called for the need to share best practice, saying “We already have low cost interventions, which have led to huge improvements in pneumonia outcomes around the world.
“We have these strategies but we need to implement them more widely and ensure the children who need them are able to access them.”