Asthma is the most common paediatric chronic disease.1
In
2006, approximately 14% of the world’s children experienced
asthma symptoms.2,3
In African countries, the prevalence of
asthma ranges from approximately 10% to more than 20%.2–4
Poorly treated asthma can lead to school absence, hospitalization
and death.5
Yet, effective medical management of patients
with asthma is available. During acute exacerbations, inhalation
of short-acting β2
-agonists is recommended to provide
relief. Long-term control of the disease is normally achieved
using inhaled steroids, but long-acting β2-agonists, oral
leukotriene modifiers or injectable anti-immunoglobulin E
antibodies are also used in more severe cases.6,7
The paediatric clinic of the main teaching hospital in
Zambia often sees children with severe asthma. However, these
children are rarely diagnosed as having asthma and most have
not been treated with β2
-agonists or steroid inhalers. Until
recently, asthma inhalers have not been readily available in
the country, in part because the national guideline preferentially
endorsed oral and intravenous treatments for asthmatic
children (Box 1).8
When inhalers were offered, patients were
often reluctant to use them because of misconceptions about
efficacy and addiction.
The prevalence of paediatric asthma in Zambia is unknown
and there is a poor understanding of disease progression
and management on the part of patients, families and
health-care providers. Hence, we were faced with the complex
problem of disease recognition, misconceptions about diagnosis
and therapy and poor access to asthma medicines.