It is time for Canadians to breathe easy. Breathing is something that most people take for granted, but for those living with asthma it is often a struggle. Asthma is a major public health concern in Canada, with more than 3.8 million individuals living with the disease. As a lifelong respiratory illness, asthma affects the quality of life, work productivity and mental health/psychological well-being of 10.8 per cent of the Canadian population.
Asthma Canada’s first Annual Asthma Survey was open to all individuals with asthma residing in Canada (as well as parents and caregivers). The focus was to raise the voices of our community to highlight the gaps within the health care system and the challenges associated with living with this chronic disease.
The survey has brought to light some of the challenges and issues that Canadians with asthma face everyday. Difficulties in accessing medication and a lack of proper asthma management are leading to regular disruptions to day-to-day lives. People with asthma are having to forego activities and make unwanted compromises because of their asthma symptoms. Feelings of isolation and stigmatization are prevalent. Personal lives as well as professional and school performance are being affected. More needs to be done to support the Canadian asthma community to aim for zero symptoms and zero quality-of-life disruption.
Asthma is a major public health concern in Canada, with more than 3.8 million individuals living with the disease.
Asthma and mental health
Asthma is a lifelong condition. Presently, there is no cure; however, with proper management, symptoms can be kept under control and a good quality of life can be achieved. There has been little focus on managing issues that are associated with asthma, such as anxiety and other mental health conditions. Comorbid conditions can have a major impact on the overall management of asthma and thus strategies must be developed to alleviate their influence. Reduced incidences of mental health concerns and improved overall quality of life must be included as key indicators of success in any asthma treatment plan.
In the Asthma Survey, nearly three quarters (74 per cent) of people with asthma reported having some form of health-related anxiety. The challenges of living with basthma often lead to feelings of stigmatization, isolation, stress and hopelessness. Limiting activities, exercise and social engagements, and missing school and work (or having to completely withdraw), can have a devastating impact on the individual, their family and society at large.
Medication and care
Access to medications is crucial for proper asthma management and to keep symptoms under control. Yet close to one-third (30 per cent) of survey respondents reported that their current drug coverage is insufficient, and 21 per cent reported skipping filling a prescription because they were not able to afford it.
Family doctors are the primary source of care and management for those living with asthma (51 per cent), followed by respirologists (37 per cent). The survey also uncovered that most respondents who had received emergency care were dissatisfied with the information they received for follow-up care. Issues of access, wait times, referrals and follow up after emergency care are all priorities for our community. Provincial support to cover the cost of these activities must be expanded, specifically to vulnerable groups.
There is a disparity between people’s perception of their asthma control versus the clinical definition of control. While 47 per cent of respondents believed their asthma is controlled, 60 per cent reported trouble sleeping due to asthma symptoms and 65 per cent reported avoiding exercise or physical activities because of asthma symptoms. The goal of asthma management is to ensure that every Canadian with asthma is in control of their disease, which means zero symptoms.
Combined with other social determinants of health, our survey results showed that three groups are disproportionally impacted by asthma, resulting in poor health outcomes:
• those with an annual income of $19,000 or less
• younger Canadians between the ages of 18 and 34 years
• people living with severe asthma
Lower annual income not only makes it difficult to afford prescription medicines but also leads to circumstances that can exacerbate asthma, such as poor-quality housing and longer working hours.
Adults in the 18–34 years age group had the highest proportion of respondents reporting mental health conditions, poor quality of life and overall dissatisfaction with their family doctor and specialist. This age group also expressed the highest dissatisfaction with the information/education received for managing their asthma. The several anomalies observed in this age group could be explained by the fact many of these individuals enter post-secondary education and start living and working independently, and consequently their health is relatively ignored. The transition period into adulthood and independence is critical with regards to personal health and must be given due importance in policy-making.
Lastly, people with severe asthma clearly require additional support to help them improve their overall quality of life, as well as with the cost of medications.
Improved access to proper and accurate testing and diagnosis, comprehensive management (including the use of an asthma action plan) and affordable medicationswill lead to more empowered patients and improved quality of life.
Access to medication
The inability to access and afford medications has adverse effects on already vulnerable populations and leads to poor health outcomes. It is essential that all levels of government work to eliminate this barrier and establish consistent support across the country that enables access to prescription medications and offers a choice of treatments based on health outcomes, not cost.
Improvements in asthma management
It is vital that efforts to improve asthma management are made across Canada. We would like to see greater investments in patient education leading to better self-management through the increased use of asthma action plans, and a joint physician–patient effort to aim for zero symptoms. Specialist care must be made available in a timely fashion for those who require it. In addition, those who attend the emergency department need an automatic referral to a specialist. Increased use of certified respiratory educators would lead to improved management and patient education.
Developing and implementing clear and uniform standards for diagnosis through pulmonary function testing such as spirometry must become an established protocol in basic asthma care. Our study found that only 53 per cent of respondents received spirometry testing prior to diagnosis. This is unacceptable. Everyone with asthma or suspected asthma must have ready access to objective lung function testing, and adequate training must be provided to all health care providers to conduct such tests.
Specialized care for vulnerable groups
Improved support and care must be provided to vulnerable groups, such as low-income populations, young adults and those living with severe asthma. The prevalent models of care are not sufficient to meet the unique needs and challenges of these groups. An effort must be made to eliminate the use of oral corticosteroids among people with severe asthma and move towards personalized treatments. The care of young adults must be tailored to meet their needs and situation. Access to care and medications must be expanded for those in low-income brackets.ϖ
Reprinted with permission from Asthma Canada, asthma.ca