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Providing Feasible Solutions for an Asthmatic Impoverished Population

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Health Disparities in Allergic Diseases

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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. 1.

    Simplifying the medication regimen – once-a-day inhaled corticosteroid dosing

  2. 2.

    Using oral medications with lower cost that is more accessible as first line – employing leukotriene receptor antagonist earlier in the guidelines

  3. 3.

    Shortening the treatment for acute asthma in ambulatory settings – use of nebulized formoterol for acute exacerbations

  4. 4.

    Simplifying immunotherapy schedules with cost-saving intradermal administration

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References

  1. Pearce N, Ait-Khaled N, Beasley R, et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007;62:758–66.

    Article  Google Scholar 

  2. To T, Stanojevic S, Moores G, Gershon AS, Bateman ED, Cruz AA, Boulet LP. Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health. 2012;12:204.

    Article  Google Scholar 

  3. Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis. 2014;18(11):1269–78.

    Article  CAS  Google Scholar 

  4. Luskin AT, Chipps BE, Rasouliyan L, Miller DP, Haselkorn T, Dorenbaum A. Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma. J Allergy Clin Immunol Pract. 2014;2(5):544–52.

    Article  Google Scholar 

  5. Centers for Disease Control and Prevention, National Center for Environmental Health Asthma-related missed school days among children aged 5–17 years. Available from: https://www.cdc.gov/asthma/asthma_stats/missing_days.htm. Accessed on 11 March 2016.

  6. Wang LY, Zhong Y, Wheeler L. Direct and indirect costs of asthma in school-aged children. Prev Chronic Dis. 2005:A11.

    Google Scholar 

  7. Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013;369(5):448–57.

    Article  CAS  Google Scholar 

  8. Von Mutius E. Childhood origins of COPD. Lancet Respir Med. 2018. pii: S2213-2600(18)30141-3.

    Google Scholar 

  9. Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F. Asthma care in resource-poor settings. World Allergy Organ J. 2011;4:68–72.

    Article  Google Scholar 

  10. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380:2163–96.

    Google Scholar 

  11. Wright R, Suglia S, Levy J, Fortum K, Shields A, Subramaniam SV, Wright R. Transdisciplinary research strategies for understanding socially patterned diseases: the Asthma Coalition on Community, Environment, and Social Stress (ACCESSS) project as a case study. Cien Saude Colet. 2008;13(6):1729–42.

    Article  Google Scholar 

  12. Haahtela T, Laatikainen T, Alenius H, Auvinen P, Fyhrquist N, Hanski I, von Hertzen L, Jousilahti P, Kosunen TU, Markelova O, Mäkelä MJ, Pantelejev V, Haahtela T, Laatikainen T, Alenius H, Auvinen P, Fyhrquist N, Hanski I, von Hertzen L, Jousilahti P, Kosunen TU, Markelova O, Mäkelä MJ, Pantelejev V, Uhanov M, Zilber E, Vartiainen E. Hunt for the origin of allergy-comparing the Finnish and Russian Karelia. Clin Exp Allergy. 2015;45(5):891–901.

    Article  CAS  Google Scholar 

  13. Asher MI. Urbanisation, asthma and allergies. Thorax. 2011;66(12):1025–6.

    Article  Google Scholar 

  14. Lim A, Asher MI, Ellwood E, Ellwood P, Exeter DJ. How are “urban” and “rural” defined in publications regarding asthma and related diseases? Allergol Immunopathol (Madr). 2014;42(2):157–61.

    Article  CAS  Google Scholar 

  15. von Mutius E, Vercelli D. Farm living: effects on childhood asthma and allergy. Nat Rev Immunol. 2010;10:861–8.

    Article  Google Scholar 

  16. Tabalipa F de O, Daitx RB, Traebert JL, Meyer AS, da Silva J. Indicators of violence and asthma: An ecological study. Allergol Int. 2015;64(4):344–50.

    Article  Google Scholar 

  17. Yonas MA, Lange NE, Celedón JC. Psychosocial stress and asthma morbidity. Curr Opin Allergy Clin Immunol. 2012;12(2):202–10.

    Article  Google Scholar 

  18. Bellin M, Osteen P, Collins K, Butz A, Land C, Kub J. The influence of community violence and protective factors on asthma morbidity and healthcare utilization in high-risk children. J Urban Health. 2014;91(4):677–89.

    Article  Google Scholar 

  19. Wright RJ, Mitchell H, Visness CM, Cohen S, Stout J, Evans R, Gold DR. Community violence and asthma morbidity: the Inner-City Asthma Study. Am J Public Health. 2004;94(4):625–32.

    Article  Google Scholar 

  20. Unger A. Children’s health in slum settings. Arch Dis Child. 2013;98(10):799–805.

    Article  Google Scholar 

  21. Observatorio Venezolano de la violencia (OVV). https://observatoriodeviolencia.org.ve/. Accessed on 5 April 2018.

  22. www.worldbank.org/en/country/venezuela/overview.

  23. www.elucabista.com/2018/.../resultados-encovi-2017-radiografia-la-crisis.

  24. http://cdc.gov/nchs/data/ahcd/nhamc_emergency/2011_ed_web_tables.pdf. Accessed 12 Nov 2016.

  25. Hulett AC, Yibirin MG, Brandt RB, García A, Hurtado D, Puigbó AP. Home/social environment and asthma profiles in a vulnerable community from Caracas: lessons for urban Venezuela? J Asthma. 2013;50(1):14–24.

    Article  Google Scholar 

  26. McQuaid EL. Barriers to medication adherence in asthma: the importance of culture and context. Ann Allergy Asthma Immunol. 2018. pii: S1081-1206(18)30222-9.

    Google Scholar 

  27. Song JU, Park HK, Lee J. Impact of dosage timing of once-daily inhaled corticosteroids in asthma: a systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2018. pii: S1081-1206(18)30222-9.

    Google Scholar 

  28. Capriles E, Do Campo A, Verde O, Pluchino S, Capriles Hulett A. Children’s asthma and the third world: an approach. J Investig Allergol Clin Immunol. 2006;16(1):11–8.

    CAS  PubMed  Google Scholar 

  29. Capriles Hulett A, Yibirin MG, Garcia A, Hurtado D. Montelukast for the high impact of asthma exacerbations in Venezuela: a practical and valid approach for Latin America? World Allergy Organ J. 2014;7(1):20, 29. 

    Article  Google Scholar 

  30. David Price, Todor A. Popov, Leif Bjermer, Susan Lu, Romana Petrovic, Kristel Vandormael, Anish Mehta, Jolanta D. Strus, Peter G. Polos, George Philip, (2013) Effect of montelukast for treatment of asthma in cigarette smokers. J Allergy Clin Immunol. 131;(3):763–71.e6.

    Article  Google Scholar 

  31. Price D, Musgrave SD, Shepstone L, Hillyer EN, Sims EJ, Guilbert RF, Juniper EF, Ayres JG, Kemp L, Blyth A, Wilson EC, Wolfe S, Freeman D, Mugford HM, Murdoch J, Harvey I. Leukotrienes antagonists as first-line or add-on asthma controller therapy. N Engl J Med. 2011;364(18):1695–707.

    Article  CAS  Google Scholar 

  32. Ducharme F, Noya FI, Allen-Rammey FC, Maisese EM, Gingres J, Blais L. Clinical effectiveness of inhaled corticosteroids versus montelukast in children with asthma: prescription patterns and patient adherence as key factors. Curr Med Res Opin. 2012;28(1):111–9.

    Article  Google Scholar 

  33. Abegunde DO, Shengelia B, Luyten A, Cameron A, Celletti F, Nishtar S, Pandurangi V, Mendis S. Can non-physician health-care workers assess and manage cardiovascular risk in primary care? N Engl J Med. 2013;369(5):448–57.

    Google Scholar 

  34. Rodriguez E, Vera V, Perez-Puigbó A, Capriles-Hulett A, Ferro S, Manrique J, Abate J. Equivalence of a single saline nebulised dose of formoterol powder vs three doses of nebulised Albuterol every twenty minutes in acute asthma in children: a suitable cost effective approach for developing nations. Allergol Immunopathol (Madr). 2008;36(4):196–200.

    Article  CAS  Google Scholar 

  35. Baena-Cagnani CE, Larenas Linnenman D, Gómez M, Díaz SG, Solé D, Borges MS, Bousquet J, Sisul JC, Canonica W. Immunotherapy Working Group Allergy training and immunotherapy in Latin America: results of a regional overview. Ann Allergy Asthma Immunol. 2013;111(5):415–9.

    Article  Google Scholar 

  36. Viera J, Capriles-Hulett A, Sanchez-Borges M, Fabiano F, Albarran-Barrios C. Intradermal immunotherapy with low dose house dust mite allergies: a proof-of-concept study. Rev Alerg Mex. 2018;65(1):41–51.

    Google Scholar 

  37. Sánchez-Borges M, Fernández-Caldas E, Capriles-Hulett A, Caballero-Fonseca F. Mite hypersensitivity in patients with rhinitis and rhinosinusitis living in a tropical environment. Allergol Immunopathol (Madr). 2014;42(2):120–6.

    Article  Google Scholar 

  38. Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F, Fernández-Caldas E. Mite and cockroach sensitization in allergic patients from Caracas, Venezuela. Ann Allergy Asthma Immunol. 2003;90(6):664–8.

    Article  Google Scholar 

  39. Pearce N, Asher I, Billo N, Bissell K, Ellwood P, El Sony A, García-Marcos L, Chiang CY, Mallol J, Marks G, Strachan D. Asthma in the global NCD agenda: a neglected epidemic. Lancet Respir Med. 2013;1(2):96–8.

    Article  Google Scholar 

  40. The Collapse of the Venezuelan Health System. The Lancet. Published on April 07, 2018.

    Google Scholar 

  41. Souza-Machado C, Souza-Machado A, Franco R, Ponte EV, Barreto MC, Rodrigues LC, Bousquet J, Cruz AA. Rapid reduction in hospitalizations after an intervention to manage severe asthma. Eur Respir J. 2010;35(3):515–21.

    Article  Google Scholar 

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Acknowledgments

We thank Carolina Urdaneta Benítez, certified English public translator, for her thoughtful review of the manuscript and important contributions to the English syntax of this chapter.

Author information

Authors and Affiliations

  1. Hospital San Juan de Dios, Caracas, Venezuela

    Arnaldo Capriles-Hulett

  2. Centro Medico de Caracas, Centro Medico Docente La Trinidad, Caracas, Venezuela

    Arnaldo Capriles-Hulett

  3. Allergy and Clinical Immunology Department Centro Medico Docente La Trinidad, Caracas, Venezuela

    Mario Sánchez-Borges

  4. Clinica El Avila, Caracas, Venezuela

    Mario Sánchez-Borges

Authors
  1. Arnaldo Capriles-Hulett
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  2. Mario Sánchez-Borges
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Editors and Affiliations

  1. Rush University, Chicago, IL, USA

    Mahboobeh Mahdavinia

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Capriles-Hulett, A., Sánchez-Borges, M. (2020). Providing Feasible Solutions for an Asthmatic Impoverished Population. In: Mahdavinia, M. (eds) Health Disparities in Allergic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-31222-0_10

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  • DOI: https://doi.org/10.1007/978-3-030-31222-0_10

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