Some basic information regarding asthma within Central and South America. Information below taken from Global Burden of Asthma report (GINA).
Countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama.
Number of persons with asthma: 5.2 m
Total population: 137.3 m
Mean prevalence of clinical asthma: 3.8%
1. There is a wide range in the reported prevalence of asthma among different countries within Central America. Countries with documented high asthma prevalence rates include Costa Rica and Panama, whereas the prevalence of asthma is considerably lower in Mexico.
2. There has been a marked increase in the prevalence of asthma symptoms over the last 30 to 40 years within the region. In Mexico alone it has been estimated that in 1997, there were over 120,000 new asthma cases.
3. Persons from Central America who emigrate to the United States experience disproportionate morbidity from asthma in the United States.
4. Many asthmatics use the emergency room as primary health care centres for the management of their asthma. This highlights the importance of developing effective management programmes in primary care to reduce morbidity and mortality from asthma.
5. Inpatient hospital care represents a major component of asthma related health care costs within Central America. Management programmes focussed on treatment regimes which have been shown to reduce hospital admissions represent a cost-effective strategy for the management of asthma within the region.
6. In most but not all countries in Central America the rates of hospital admission due to asthma have increased markedly over recent decades. For example, in Mexico hospitalisations due to asthma have increased over 10-fold over the last 40 years. This represents a huge toll in terms of morbidity and economic cost. Countries such as Costa Rica, where hospital admission rates have decreased over the last decade, can serve as models of health care which can be established to reduce morbidity from asthma.
7. The cost and availability of asthma medications vary markedly within Central America. In some countries the government supplies all medications free, while in others there is limited government provision of medications and many patients are unable to afford medications through the private sector.
8. Poor socioeconomic status and limited access to health care are likely to be responsible for the frequent under treatment of asthma and inappropriate prescribing practices seen in the region, and contribute to the substantial morbidity and mortality from asthma.
9. An important cause of severe attacks of asthma requiring hospital admission is air pollution, particularly photochemical pollutants (of which ozone is an important component). Reducing air pollution remains one of the public health priorities for a number of countries, particularly Mexico, because of its potential to reduce not only asthma morbidity, but also overall mortality, particularly in the elderly.
10. Asthma mortality rates are generally high within Central America. For example, Mexico has a death rate of 5.6 per 100,000 with over 4,000 deaths per year due to asthma.
Countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, French Guiana, Guyana, Paraguay,Peru, Suriname,Uruguay,Venezuela.
Number of persons with asthma: 34.7 m
Total population: 350.4 m
Mean prevalence of clinical asthma: 9.9%
1. The prevalence of asthma in South America is generally above the average for countries worldwide. Countries with childhood asthma prevalence rates in the top quartile of countries worldwide include Peru, Brazil, Paraguay, and Uruguay.
2. The prevalence of asthma in childhood in many countries in South America is higher than that in Spain and Portugal, and other former Spanish or Portuguese colonies such as Macau, Cape Verde, and Madeira.
3. The prevalence of asthma in South America does not seem to relate to industrialisation or economic wealth. In contrast to the trends seen in other regions of the world, asthma prevalence is higher in poorer cities than in cities with a higher socioeconomic level. This suggests that lower socioeconomic status is a risk factor for asthma within the region.
4. The limited data available suggest that the prevalence of asthma has increased markedly in different countries in South America over recent decades.
5. Throughout the region the lack of adequate treatment of asthma remains a common problem, and is primarily due to the cost of medical care including pharmaceuticals. The lack of government funding of pharmaceuticals has resulted in a situation where the private sector constitutes about three-quarters of the total pharmaceutical market in South America.
6. Despite socioeconomic constraints, there are a number of examples in the region where the health of asthmatic children in low-income communities has been markedly improved through the implementation of adapted asthma management guidelines and related educational programmes.
8. Asthma mortality is generally high in South America, although there is a wide range of mortality rates in different countries in this region.
9. The effectiveness of modern management in reducing mortality in the region is illustrated by Argentina, where there has been a progressive decline in asthma mortality over the last decade in association with marked changes in management, particularly an increasing use of inhaled corticosteroid therapy.
10. Air pollution is sufficiently severe in some of the major cities in South America that it increases both general mortality rates and death rates due to respiratory disease, including asthma. The different government strategies to reduce air pollution represent important public health initiatives in many countries in South America.