Why is this so important? For several reasons – outlined below:

• The most recent global estimate of asthma in adults and children (2008 - 2010) suggests that as many as 334 million people have asthma
• Our asthma prevalence in SA is among the highest in the world
• In South Africa, between six and 10% of adults have asthma - according to the South African Medical Journal
• Asthma is the most common chronic disease among children worldwide and there are 50-million children under the age of 15 living with asthma in sub-Saharan Africa – most of them are in South Africa
• South Africa is ranked fifth in the world for asthma mortality – yet this is a disease that can be controlled
• According to the World Health Organisation - over 80% of asthma-related deaths occur in low-and lower-middle income countries
• The burden is not only in human suffering, but it also represents a significant economic burden on societies and health systems; estimates are that a majority of this future burden will occur in developing, rather than developed, countries
• Treatment and effective management of asthma saves lives – but asthma treatment approaches need urgent re-examining – the case for better control is clear

Despite what appears to be a gloomy picture – there is actually cause for celebration this World Asthma Day – because we are entering a new era in managing this respiratory condition – an illness that can and should be controlled. After 30 years of doing it one way - revised asthma treatment guidelines have been published and they bring new hope for better control:

• New GINA guidelines indicate that over reliance and excessive use of the SABA blue over-the-counter asthma pump is dangerous and can do more harm than help
• To establish control and better manage asthma - it’s important to understand the difference between anti-inflammatory maintenance therapy and symptom reliever blue SABA inhalers. They have different functions, BUT, using a blue reliever inhaler three or more times a week can mask the worsening of symptoms, increase the risk of asthma attacks and possibly lead to increased hospitalisations
• Break Over-Reliance - a global public service announcement / health campaign - has been initiated to alert asthma sufferers to this breaking news. Important information that can save lives – the campaign encourages consumers to take a free digital test to check if they are over-reliant on their SABA reliever inhaler (www.rateyourreliance.com)
• The results are immediate and the information can be shared with the patient’s medical practitioner so as to rework their asthma action plan and in so doing – establish better control
• For asthmatics the battle to breathe is real and these new treatment recommendations provide hope for better quality of life and health for those living with the respiratory condition

* GINA - The Global Initiative for Asthma

WORLD ASTHMA MONTH 2021 

CARING FOR CHILDREN WITH ASTHMA

Every child deserves to breathe easy

There are 50 million children under the age of 15 living with asthma in sub-Saharan Africa, most of them are reportedly in South Africa.1For parents or caregivers of these children managing the illness can be complicated and stressful. Added to that, new information suggests that asthma treatment needs urgent re-examining, leaving parents with questions about the dangers of being over reliant on reliever pumps.

Doctor Marlin McKay, a GP at the Goldman Medical Centre in Johannesburg explains, “When children are diagnosed with the respiratory disease, they are normally prescribed with two different types of inhalers, a maintenance inhaler and a symptom relieving inhaler. 2,3 Findings show that patients with asthma - not precluding children, will frequently underuse the maintenance inhaler which contains an anti-inflammatory therapy, and instead, over-rely on the symptom reliever inhaler. It is usually blue in colour and contains an item which opens up the airways known as short-acting beta2 agonists (SABA) therefore providing rapid and temporary relief for children. The problem with this approach is it can mask the worsening of symptoms and actually increases their risk of asthma attacks.”4-7

The good news for parents concerned that their children may indeed be overusing the blue pump, is that over-reliance can easily be established, thanks to a first-of-its-kind digital assessment tool. Developed by leading experts in behavioural medicine, the evidence-based questionnaire measures potential overuse of SABA reliever therapy for those who live with asthma.

Empowering parents

Dr McKay explains, “By answering five short questions the test result will empower parents to assess their children’s over-reliance on their SABA blue reliever inhaler 8. The online Reliever Reliance Test will help parents to quickly identify if their little ones are in fact over-reliant.

“All it takes is answering five questions and the test will measure potential overuse of SABA reliever therapy when compared to maintenance therapy. The results are immediate and if your child is found to be over-reliant then I implore you to revisit their asthma management together with your health care professional. By doing so, your child’s risk of increased asthma attacks will be reduced. Anxiety about your child’s wellbeing will better controlled too.”

Breathing easy should not be an accomplishment

While there is no cure for asthma, it is important to work with your child’s doctor to treat it and prevent damage to their developing lungs. Controlled asthma in children is possible but it requires a solid asthma treatment plan and regular check-ins with a professional explains Dr McKay.

Seeing your child wheezy is not easy

Asthma is the most common chronic illness in South African children and its prevalence is increasing in both urban and rural areas.9 “It is very important to know your child’s triggers, and it’s even more important to manage and control the condition to minimise the risk of an attack and in some cases hospitalisations.  This includes having, and following an asthma action plan, knowing what to do in the case of an attack, and taking maintenance medication as prescribed to avoid flare ups,” advises Dr McKay. 

Khomotso Mashilane, Medical Director: African Cluster, at AstraZeneca adds, “Given the recent updates to global asthma management recommendations backed by leading expert opinion, AstraZeneca developed the Break Over-Reliance public health campaign to inform and educate patients, health professionals and policy makers. It centres around the potential dangers of SABA over-reliance and the urgent need to address this issue. As an established leader in respiratory care, we are committed to working with the respiratory community to provide tools that will help improve asthma control. Our aim is to eliminate preventable asthma attacks for the millions of children and adults who live with the illness in South Africa.”

Making the case for well-controlled asthma, Dr McKay concludes by asking South Africans to share the details of the reliever reliance test far and wide. “We all have to do more to reduce the prevalence of asthma mortality in our country. With an estimated 18.5 deaths per every 100,000 asthma cases10, we shouldn’t save our breath – we should share the test with everyone we know and love who lives with asthma.”

For more information about the Break Over-Reliance campaign and to take the Reliever Reliance Test, visit http://bit.ly/Yes2Breathe

-- ENDS --

References for Press Release 

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893990/(Sub-Saharan Africa has over 50 million children under the age of 15 living with asthma, mostly in South Africa.)
2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020 Update. Available at: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf Last accessed July 2020.
3. Burki TM. New asthma treatment recommendations. Lancet Respir Med 2019;7:479.
4. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the asthma insights and reality in Europe (AIRE) study. Eur Respir J. 2000; 16: 802–807.
5. Tattersfield AE, Postma DS, Barnes PJ, et al. on behalf of the FACET International Study Group. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. Am J Respir Crit Care Med. 1999; 160: 594–599.
6. Adams RJ, Fuhlbrigge A, Guilbert T, et al. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. J Allergy Clin Immunol. 2002; 110: 58–64.
7. Larsson, K., Kankaanranta, H., Janson, C. et al. Bringing asthma care into the twenty-first century. NPJ Prim. Care Respir. Med. 2020; 30, 25,
8. International Primary Care Respiratory Group. Blue Reliever Reliance Test. Available at: https://www.ipcrg.org/resources/search-resources/blue-reliever-reliance-test-english[Last accessed: July 2020]
9. http://www.globalasthmareport.org/management/southafrica.php(Asthma is the most common chronic illness in South African children and its prevalence is increasing in both urban and rural areas.)
10. Global Asthma Report: http://www.globalasthmareport.org/management/southafrica.php#:~:text=High%20mortality,%2C%20Figures%201%20and%202)

Notes to the Editor

Asthma

Asthma is a common chronic respiratory disease, and it affects the health and day-to-day lives of as many as 339 million adults and children worldwide.13 It is an inflammatory disease characterised by recurrent breathlessness and wheezing which varies over time, and which varies in severity and frequency from person to person.1

All asthma patients are at risk of severe attacks, regardless of their disease severity, adherence to treatment or level of control.14-16 There are an estimated 176 million asthma attacks globally per year;17 these attacks may be physically threatening and emotionally significant for many patients. 18 However, despite the fact that asthma is a chronic, variable inflammatory disease, patients often under-use their anti-inflammatory ‘preventer’ therapy and over-rely on their SABA reliever, which can mask symptom worsening.3-6 Taking a SABA inhaler alone does not address the underlying inflammation, leaving patients at risk of an asthma exacerbation. 3-6 and potential exposure to frequent bursts of oral corticosteroids.4,19

The Reliever Reliance Test

The Reliever Reliance Test (RRT) has been developed by leading expert in behavioural medicine, Professor Rob Horne, University College London (UCL), with colleagues from the International Primary Care Respiratory Group (IPCRG) and was fully funded by AstraZeneca UK Limited. The RRT is a five-item questionnaire adapted from the validated SABA Risk Questionnaire, which in turn is a derivation of the validated Beliefs about Medicines Questionnaire (BMQ), also developed by Professor Rob Horne, UCL. 20 The RRT is an evidence-based, practical tool that aims to assess patients’ reliance on their SABA inhaler.9 It is available in both print and digital format. Based on patients’ responses to the five questions, the RRT provides a score indicating whether the patient is likely to be at high, medium or low risk of over-relying on their SABA reliever.4 The score categories and associated feedback are aimed at helping patients understand their attitudes to SABA, and how these attitudes may be causing them to over-rely on their SABA.20 Patients are able to download their results via the digital tool and use them to discuss their asthma control with their HCP.

AstraZeneca in Respiratory & Immunology

Respiratory & Immunology is one of AstraZeneca’s three therapy areas and is a key growth driver for the Company.

Building on a 50-year heritage, AstraZeneca is an established leader in respiratory care across inhaled and biologic medicines. AstraZeneca aims to transform the treatment of asthma and chronic obstructive pulmonary disease (COPD) by eliminating preventable asthma attacks across all severities and removing COPD as a leading cause of death through earlier, biology-led treatment. The Company’s early respiratory research is focused on emerging science involving immune mechanisms, lung damage and abnormal cell repair processes in disease and neuronal dysfunction.

With common pathways and underlying disease drivers across respiratory and immunology, AstraZeneca is following the science from chronic lung diseases to immune-driven diseases. The Company’s growing presence in immunology is focused on five mid- to late-stage franchises with multi-disease potential in rheumatology (including systemic lupus erythematosus), dermatology, gastroenterology, and systemic eosinophilic-driven diseases. AstraZeneca’s ambition in immunology is to achieve disease control and ultimately clinical remission in targeted immune driven diseases.

AstraZeneca

AstraZeneca (South Africa) is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialisation of prescription medicines, primarily for the treatment of diseases in three therapy areas - Oncology, Cardiovascular, Renal and Metabolism, and Respiratory & Immunology. AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. For more information, please visit astrazeneca.co.za.

Contacts

Developed and to contact on behalf of AstraZeneca:
SIMONSAYS communications
Beverley Bradley | Melanie Stevens
072 272 5166 | 083 303 9667
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References for notes to the editor:

1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020 Update. Available at: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf Last accessed July 2020.
2. Burki TM. New asthma treatment recommendations. Lancet Respir Med 2019;7:479.
3. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the asthma insights and reality in Europe (AIRE) study. Eur Respir J. 2000; 16: 802–807.
4. Tattersfield AE, Postma DS, Barnes PJ, et al. on behalf of the FACET International Study Group. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. Am J Respir Crit Care Med. 1999; 160: 594–599.
5. Adams RJ, Fuhlbrigge A, Guilbert T, et al. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. J Allergy Clin Immunol. 2002; 110: 58–64.
6. Larsson, K., Kankaanranta, H., Janson, C. et al. Bringing asthma care into the twenty-first century. NPJ Prim. Care Respir. Med. 2020; 30, 25,
7. Asthma UK: Asthma Attacks. Available at: https://www.asthma.org.uk/advice/asthma-attacks/Last accessed July 2020.
8. Asthma UK. Reducing prescribing errors in asthma care. Available at: https://www.asthma.org.uk/support-us/campaigns/publications/nrad-one-year-on/Last accessed July 2020.
9. International Primary Care Respiratory Group. Blue Reliever Reliance Test. Available at: https://www.ipcrg.org/resources/search-resources/blue-reliever-reliance-test-english[Last accessed: July 2020]
10. Price D, et al. Asthma control and management in 8,000 European patients: the Recognise Asthma and Link to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014; 24: 14009.
11. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. Lancet. 2017; 391: 350-400.
12. Global Asthma Report: http://www.globalasthmareport.org/management/southafrica.php#:~:text=High%20mortality,%2C%20Figures%201%20and%202)
13. Global Asthma Network. The Global Asthma Report 2018. [Online]. Available at: globalasthmanetwork.org/publications/Global_Asthma_Report_2018.pdf [Last accessed: July 2020]
14. Papi A, Ryan D, Soriano JB, et al. Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol Pract 2018; 6: 1989-1998.e3.
15. Bloom CI, Nissen F, Douglas IJ, et al. Exacerbation risk and characterisation of the UK's asthma population from infants to old age. Thorax 2018; 73: 313–320.
16. Ding B, Small M. Disease burden of mild asthma: findings from a cross-sectional real-world survey. Adv Ther. 2017; 34: 1109–1127.
17. AstraZeneca Pharmaceuticals. Data on file. Annual Rate of Exacerbations Globally (February 2019; ID:SD-3010-ALL-0017).
18. Sastre J, Fabbri LM, Price D, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016; 9: 13.
19. Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018;11:193–204
20. Chan AHY, Katzer C, Kaplan A, et al. SABA Reliance Questionnaire (SRQ): a novel screening tool to identify patients’ beliefs underpinning over-reliance on short-acting beta2 agonists in the management of asthma. J Allergy Clin Immunol Pract. 2020; https://doi.org/10.1016/j.jaip.2020.07.014.