Asthma in India: applying science to reality

The next generation of public health approaches to asthma in Asia and the Middle East

Chronic respiratory diseases now affect more than half a billion people worldwide and their importance as a global health problem has risen dramatically in recent years, prompting intense epidemiological investigation and the launch of numerous initiatives. Across Asia and the Middle East, a variety of environmental exposures increase the risk for the onset or exacerbation of chronic respiratory disease, resulting in a considerable burden of morbidity and mortality. This article outlines new possibilities for public health surveillance of environmental exposures and chronic respiratory disease built around an emerging model of participatory public health: a decentralized approach that involves citizens in the collection and analysis of data, harnesses pervasive technology such as mobile phones and distributed sensors, and provides an open platform for public-private collaboration.

A video-simulation study of the management of asthma exacerbations by physicians in India

INTRODUCTION

Despite efforts to improve the management of asthma worldwide, few options exist for evaluating the specific needs or the success of these activities in a manner free from bias.

OBJECTIVES

To examine the management of asthma exacerbations by physicians using standardized audiovisual presentations of asthma.

METHODS

Practitioners (n = 70) in Chennai, India were shown the International Study of Asthma and Allergies in Childhood video questionnaire and asked to describe the clinical investigations, emergency treatments and prescription therapy they would recommend for each of the five scenes.

RESULTS

Practitioners varied significantly in their investigation and treatment of the exacerbations. Those who identified asthma as a possible cause of the scenes were more likely to recommend investigations and treatment congruent with international guidelines, as were those with additional postgraduate training and with specialty training in respiratory disease. Approaches differed significantly for scenes depicting wheeze compared with those depicting cough.

CONCLUSION

The management of asthma exacerbations varies significantly depending on whether practitioners identify asthma as a possible cause of the presentation. Standardized audiovisual depictions of asthma offer a useful tool to assess patterns of clinical practice, and to design and evaluate activities to raise the quality of care for asthma.

Elevated levels of mannan-binding lectin [corrected] (MBL) and eosinophilia in patients of bronchial asthma with allergic rhinitis and allergic bronchopulmonary aspergillosis associate with a novel intronic polymorphism in MBL

Mannan-binding lectin (MBL), an important component of innate immunity, binds to a range of foreign antigens and initiates the lectin complement pathway. Earlier studies have reported high plasma MBL levels in allergic patients in comparison to healthy controls. In view of varied plasma MBL levels being determined by genetic polymorphisms in its collagen region, we investigated the association of single nucleotide polymorphisms (SNPs) in the collagen region of human MBL with respiratory allergic diseases. The study groups comprised patients of bronchial asthma with allergic rhinitis (n = 49) and allergic bronchopulmonary aspergillosis (APBA) (n = 11) and unrelated age-matched healthy controls of Indian origin (n = 84). A novel intronic SNP, G1011A of MBL, showed a significant association with both the patient groups in comparison to the controls (P < 0.01). Patients homozygous for the 1011A allele showed significantly higher plasma MBL levels and activity than those homozygous for the 1011G allele (P < 0.05). The 1011A allele also showed a significant correlation with high peripheral blood eosinophilia (P < 0.05) and low forced expiratory volume in 1 s (FEV(1)) (P < 0.05) of the patients. We conclude that the 1011A allele of MBL may contribute to elevated plasma MBL levels and activity and to increased severity of the disease markers in patients of bronchial asthma with allergic rhinitis and ABPA.