Real prevalence of severe asthma in developing countries – Is the diagnosis correct?

Introduction: The prevalence of severe asthma in developing countries like India has been reported to vary between 5-8%. With the availability of newer modalities like bronchial thermoplasty (BT) & biologicals the trend of diagnosing severe asthma cases requiring these modalities for management is also increasing. Is this increased prevalence of severe asthmatics true or pharma driven, requires evaluation? Thus, the present study was carried out at a tertiary care chest centre of Indian Armed forces which treats severe asthmatics of Indian Armed forces personnel & dependents. Aims & Objectives: To assess actual prevalence of severe asthmatics in all cases referred as severe asthma cases. Methods: A 3-year prospective study was carried out from 2016-18 wherein all the referred cases with diagnosis of severe asthma were evaluated for confirmation of diagnosis of asthma, asthma mimickers, unaddressed comorbidities, optimum management of asthma and other causes of difficult to treat asthma. Results: 10,811 patients were enrolled, 68.7% males 31.3% females. 33.7% patients had asthma mimickers, 46.3% cases were not being optimally managed, including poor inhalation technique or management of comorbidities. 10.8% had other eosinophilic lung disorders, 5.6% had ABPA and only 3.6% cases had severe asthma. Conclusion: The developing countries like India are witnessing pharma driven run for diagnosing severe asthmatics requiring utilization of modalities like newly introduced biologicals or BT leading to asthma mimickers or difficult to treat asthma cases being labeled as severe asthmatics. Improved awareness regarding asthma management especially diagnosing and managing severe asthma is required.