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20th Jul 2019

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Allergic disease and asthma on the rise in Europe

  • EU countries can save on their health budget if they do more to help asthma patients control their disease once they have it (Photo: Jack Lawrence)

Asthma is one of the most frequent chronic conditions in Europe, affecting more than 30 million Europeans – a number that is still growing.

"At some stage in the future almost half of the population may suffer from an allergic disease and asthma will be a considerable proportion of this," said Nikolaos Papadopoulos, professor of allergy and pediatric allergy at the University of Athens, in an interview. He added that it is also a global phenomenon.

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Asthma is a chronic disease of the airways that makes breathing difficult. An asthma attack inflames and narrows the airways that carry oxygen to the lungs, leading to coughing, wheezing, shortness of breath, and chest tightness. Its prevalence has been linked to industrial development.

There is currently no cure for asthma and the concrete causes for the chronic disease are still unclear, other than that the change of lifestyle and environmental factors such as pollution has an impact. Prevention is therefore difficult.

"Ideally, we would like to prevent the disease, as well as many other chronic diseases that are the main burden for 'western' societies. We are however far from achieving this, as it depends very much on our modern life-styles," said Papadopoulos.

"We do partly understand the 'causes', but reversing them is not as easy: for example, living in farms is associated with less allergy and asthma because of exposure to many microbes. However, microbe diversity also means more infections and these can be a serious problem as well."

"Therefore, we are steadily improving the quality of life of people with asthma using different medications and other strategies, while we are working on ways to target the disease at its roots," Papadopoulos told EUobserver. "It has to be both."

Asthma typically begins much earlier in life than other chronic diseases, and childhood asthma has historically been more prevalent in western than eastern Europe.

However, the difference is shrinking as rates in the eastern Europe rise, according to data from the European Respiratory Society. Ireland and the UK have some of the highest asthma rates in the world.

Breda Flood from Ireland was diagnosed with asthma in the early 80s as she was constantly hoarse and coughing.

And it was only eleven years after that diagnose that she saw a specialist consultant. There was no internet around back then, so the only information she had found on her condition was from public libraries.

Now, 30 years later, personalised medicine has made the difference for Flood. Three years ago she started a treatment that focussed on her exact kind of asthma that led to "a huge improvement of life", she said, resulting in her being able to finally take her first long haul flight to the US a few weeks ago.

"If I did not receive this treatment, I can imagine that I would not be in a good state now," Flood said. "Sadly people still die with asthma."

According to the latest figures from Eurostat, 7,100 people died from asthma across Europe in 2015.

She has also seen the increase in the number of asthma patients among her students: "When I started teaching there were no pupils at the school with asthma, and by the time I retired, there were several."

Despite having better control of her disease, tobacco smoke is still one of the worst triggers for her asthma attacks. Flood always carries a scarf with her to cover her mouth and nose whenever she passes people who are smoking.

Economic consequences

Most patients with asthma can be managed in primary care, but a significant proportion require a specialist referral and supervision.

Finland is at the forefront of best practice when it comes to asthma management strategies. "They have managed to reduce hospital expenses, mortality and health budget spent on asthma," said Mrs Flood who is also the former president of the European Federation of Allergy and Airways Diseases Patients' Associations (EFA).

"When people are informed and educated in controlling their disease, they are more cost-efficient," she said, adding that it makes human and economic sense if member states do more with national programs to help patients better control the disease.

The European Respiratory Society finds that the active participation of government health departments in countries like Finland and France has led to important improvements in asthma control, "demonstrating that focused, national programs can work and are probably cost-effective."

"Asthma needs additional attention," said Papadopoulos. "It has been relatively neglected in comparison to other chronic conditions with the same or smaller impact."

Asthma usually begins early in life and therefore imposes a high lifetime burden on individuals, especially in poorer areas.

"Asthma is still an increasing problem in terms of its burden: nowadays, due to challenges in health systems asthma is becoming more difficult to manage for low income communities. The trends are similitude worldwide, although there is wide variability between, and within, countries," said Mr Papadopoulos.

The European Commission recently announced a cooperation between 14 EU countries on linking national genomic databases across borders, that could facilitate more research into asthma.

Another public-private partnership project - CURE - is looking at novel ideas to in the long run find a cure for asthma; smart inhalers are being made that can give feedback on its use; and treatments are slowly becoming more personalised, which has a bigger effect on how patients can control their asthma.

"Putting information together can only be positive: we will be able to compare between countries and also allow big data methodologies to come up with new findings," Papadopoulos said, adding that collaboration and fresh new approaches are key to deal with the rise allergies and asthma.

"We do need new ideas to solve a problem that has not been solved so far and the variety of perspectives is needed for a disease so variable such as allergy or asthma," he said.

He is hopeful for the future: "Public-private partnerships, use of high-end technology, inclusion of all stakeholders, including patient representatives, in research decisions, public health programmes and radically innovative solutions will reform the field in the next decade," Papadopoulos said.

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