Providing feasible solutions for an asthmatic impoverished population

Abstract

Similar to multiple other chronic conditions, we are still in need for individualized interventions and management plans for asthma and allergies. This is particularly more important when dealing with the poverty and difficulties in the environment of the developing countries. Asthma guidelines have demonstrated their merits in countless scenarios; however, the implication of these guidelines in many areas of the world is questionable. There is an unmet need for culture-specific programs to improve the attitude of both providers and patients when dealing with asthma. Furthermore, alternative guidelines that are catered toward societies dealing with poverty might be needed, as the current guidelines and treatment plans are still in flux in many areas of the world. An example of this is medication dosing, such as in the case of inhaled steroids that need to be used multiple times per day, which becomes a major issue with compliance in children with less than optimal supervision. This can create an obstacle in asthma control strategy, to say the least. Conceptually, we are in need of specific strategies in populations dealing with poverty aiming to simplify the treatment plans and medical approaches. These plans can improve compliance, provider–patient relationship, and consequently, better outcomes in future. In this chapter, we will provide more details and examples of such simplified management plans that have been proven to be effective in our patient population dealing with the burden of living in low socioeconomic status. We have considered four alternative approaches to address specific conditions and situations of our patients in an attempt to overcome the financial obstacles of care: 1. Simplifying the medication regimen – once-a-day inhaled corticosteroid dosing 2. Using oral medications with lower cost that is more accessible as first line – employing leukotriene receptor antagonist earlier in the guidelines 3. Shortening the treatment for acute asthma in ambulatory settings – use of nebulized formoterol for acute exacerbations 4.Simplifying immunotherapy schedules with cost-saving intradermal administration.