REVIEW – March 2005

Is asthma over- or underdiagnosed in Estonia?


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Respiratory disorders are the leading cause of death worldwide. In Europe, respiratory diseases rank second (after cardiovascular diseases) in terms of mortality, incidence, prevalence and treatment costs. In this context, the European Respiratory Society (ERS) and the European Lung Foundation (ELF) have published The European Lung White Book, a survey of respiratory health in Europe. In this report, as well as in the recent GINA publication, Global Burden of Asthma, Estonia has been referred to as a country with low prevalence of asthma among adults. Nevertheless, there are several methodological issues that should be considered before accepting the conclusions as valid. In particular, assessment of asthma in populations is not an easy task. There is no single simple instrument with which cases can be identified. Instead, there is a whole set of different measures, all of which have advantages and disadvantages. Detailed analysis of available data on asthma both in children and in adults in Estonia, allows to conclude  that, despite the high prevalence of respiratory symptoms and bronchial hyperresponsiveness (BHR), the prevalence of asthma is relatively low in Estonia and has not increased, although profound socio-economic changes have taken place in the society during the last decade. There is some evidence of underdiagnosis of asthma in Estonia. The ability of family doctors to perform spirometry in their own office would increase the likelihood of early diagnosis. Essential asthma drugs are readily available in Estonia, including combination therapy with ICS and LABA in one inhaler. The only group of registered asthma medication not included in the 75% reimbursement list for adult asthma patients is anti-leucotrienes. The reasons for the high prevalence of respiratory symptoms and BHR in Estonia are mostly unknown. High prevalence of smoking and environmental tobacco exposure is likely to have a strong impact on respiratory health in Estonia.