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"From understanding the disease comes the understanding of how to treat the disease."
- Alexandre Holanda

Responses by country

Alexandre Holanda (Brazil):

Are there any special problems in diagnosing asthma in children? Do they vary by age?

I think one of the major problems is the lack of spirometers, the technology, the lung function tests. Even peak flow meters, which are very cheap, we don't have here on a regular basis, which, while not the best, would help us in controlling asthma at home. A functional diagnosis of asthma is very rare in the public sector. In the private sector, with your health insurance, you're able to have a lung function test really easily. In the public sector, we don't have the machines. As an example, in the city of Fortaleza here, there are 2.3 million people. In the public sector I estimate there are two or three places here that can do lung function testing. And those places probably have only one machine. Brazil has universal health-care access, and the majority of people use the public sector health-care system.

What do you think are the special issues and challenges in treating children with asthma? Do they vary by age?

I think that education is a big issue in terms of how to understand the disease and to use the devices correctly. I think that's the major thing for the youngest children, and probably for everybody really. Illiteracy in the public sector is a problem; it's hard to explain the disease and also how to use the devices-if they are able to have the devices as well-and to explain that the disease is recurrent, that there's no cure. The understanding of the disease probably is the biggest problem. Because then from understanding the disease comes understanding how to treat the disease of course.

What questions do parents/carers and patients ask of you?

The first time they hear the word 'asthma,' they ask what is it? Is there any cure? If they come in during an attack, they are just afraid of dying, feeling as though they're under water. When patients ask what asthma is, I pick another chronic condition well known to the public, as an example that this is chronic. I do not use the word 'chronic' of course. I explain that this is a disease that has control but no cure, plain and simple, and I have to tell them this, that's for sure. Even though this is frightening, I have to tell them. Then from that point forward, I push the topic of 'this has control, this has control,' that's the major thing, even though they're under an attack at that time. Then when they come back when they're a little bit better without the attack, I would explain what really happens to the body: allergens, triggers, trigger avoidance. But this is usually a second visit. During an attack they're afraid and, secondly, there are time constraints.

Which in your opinion are the top three problems children and parents/carers face in managing asthma in daily life?

In the public sector, 1) the lack of correct medication, and 2) lack of education about asthma. If you have both [correct medication and education], it's completely controlled.