Singapore faces high asthma burden

Singapore is disproportionately burdened by asthma, with related hospitalizations and emergency department (ED) visits occurring twice as often as the average of other developed countries, according to a study.

Between 2003 and 2019, the asthma hospitalization rate remained consistent at roughly 80 episodes per 100,000. The rate is projected to grow by 1.7 percent each year (95 percent confidence interval [CI], 0.7–5.0) from 2023 to 2040, contributing to a total of 163,633 episodes. This translates to a hefty price tag of USD 103 million, as calculated in 2022 dollars. [BMC Pulm Med 2023;23:502]

Meanwhile, the rate of asthma-related ED visit was 390 per 100,000 in 2019 and is expected to decline by 3.4 percent annually (95 percent CI, –5.8 to 0.0) from 2023 to 2040, leading to a total of 208,145 episodes. This corresponds to USD 15 million in cost.

“The current asthma-related ED attendance rate was 20 percent lower than that in the US but five times that in the UK,” the investigators noted. “These observations indicate a high burden of asthma acute care, consistent with recent evidence on excess asthma-related resource use and gaps in asthma primary care in Singapore.” [https://tinyurl.com/ys6tryd9; https://tinyurl.com/yp28psn2; Am J Emerg Med 2014;32:895-899; Eur Respir J 2018;52:3957]

Singapore’s mortality rate, on the other hand, paints a different picture. In 2019, only 0.57 in every 100,000 Singaporeans died from asthma-related causes, and this number is projected to stay consistently low in the coming years (change per year, –1.3 percent, 95 percent CI, –11.0 to 4.3). Approximately 638 asthma-related deaths are expected to occur between 2023 and 2040.

These estimates were based on 25-year data on asthma-related hospitalization and death as well as 15-year data on ED visits obtained from the Singapore Ministry of Health Clinical and National Disease Registry.

A positive outlook

With an asthma hospitalization rate double the OECD average of 40 per 100,000 per year, Singapore has a promising opportunity to reduce its asthma admission rate, as the investigators pointed out. [https://www.aihw.gov.au/reports/international-comparisons/oecd-health-care-quality-and-outcomes-indicators-2021/contents/primary-care-avoidable-hospital-admissions]

“If Singapore could also keep its asthma admission rate below 40 per 100,000 per year, the society might save USD 77,291,781 between 2023 and 2040, [that is] a 75-percent cost reduction,” they said.

Fortunately, recent advancements in the local healthcare system offer exciting possibilities in the fight against asthma and reducing its financial burden. For instance, the Singapore National Asthma Programme (SNAP) that initially promoted the regular use of inhaled corticosteroids nationwide has extended its goals to reinforce regular follow-up of asthma patients in primary care. Another nationwide initiative, “Healthier SG,” builds on SNAP’s efforts to improve chronic care by promoting closer patient–general practitioner (GP) relationships through “one family one doctor.” [Ann Acad Med Singap 2008;37:114; Eur Respir J 2018;52:3957; https://www.primarycarepages.sg/schemes-and-programmes/singapore-national-asthma-programme; https://www.healthiersg.gov.sg/resources/white-paper/]

The investigators are positive asthma primary care reinforcement can reduce the number of patients requiring specialized hospital care, resulting in substantial cost savings. Such an approach has been shown to be effective in other countries. The Finnish asthma programme which focused on early detection and treatment as well as good networking with GPs, for one, was able to reduce asthma hospitalisation days by 50 percent and asthma ED visits by 61 percent. Likewise, the Polish pilot asthma programme, which had similar scope as the Finnish programme, reduced asthma admissions by 43 percent and hospitalization length by 2.5 days. [Allergy 2010;65:415-419; Health Aff 2013;32:686-694; Thorax 2006;61:663-670; Allergy 2005;60:606-610]

“The existing national asthma programme in Singapore, together with the recent efforts in reinforcing primary care at the national level, provides opportunities to reduce avoidable asthma admissions,” the investigators said.