World Asthma Day is being observed in over 80 countries. It is a partnership between health care groups and asthma educators organized by the Global Initiative for Asthma (GINA) programme. GINA was launched as a collaborative effort in 1993 between the National Heart, Lung and Blood Institute, National Institutes of Health, USA, and the World Health Organization.

For the first time, people throughout the world can participate in World Asthma Day on the internet through the World Asthma Day WebVention available at http://www.WebVention.orgor at http://www.ginasthma.com. Mr Nelson Mandela, former President of the Republic of South Africa will be participating in the internet convention as Chairman of the South African National Asthma Campaign. Ministers of Health from Japan, Malaysia and other countries will be available to discuss asthma treatment in their countries.

Asthma, a chronic inflammatory disease of the airways, is on the rise practically everywhere in the world with rates increasing in all age groups, particularly in children. WHO believes asthma to be the most common chronic disease in children. (Asthma symptoms vary from day to day. They are often worse at night. The severity of asthma varies from individual to individual.)

The rapid rise of asthma around the world is one of the biggest mysteries in modern medicine. The most striking increases occurred in Australia where about one-quarter of children is diagnosed with asthma. In the United States of America, the number of asthmatics has more than doubled in the past 15 years from 6.8 million in 1980 to 14.6 million in 1995. A survey of schoolchildren in Israel (13-14 years of age) showed a highly significant increase in the prevalence of asthma from 5.6% in 1980 to 11.2% in 1989. In Western Europe as a whole, asthma has doubled in ten years. In Brazil, Costa Rica, Panama, Peru and Uruguay, prevalence of asthma symptoms in children varies from 20% to 30%.

The exact reasons for the increase still evade scientists and researchers. In the past, various theories were put forward: diesel fuel exhaust, allergies, diet, smoking, viral infections, cold air, and physical exercise. Today, the scientific community seems to agree that a combination of genetic and environmental factors is largely responsible for the onset of the disease. Some people are genetically predisposed to asthma. Others suffer from the early-life allergen exposure, be it to air pollution, damp housing, poor ventilation, dusty carpets, furry pets, cockroaches or indoor chemicals. Even passive or second-hand smoking by parents and especially mothers increases the risk of asthma in children. Infants born of mothers who smoke have smaller lungs and higher risk of developing asthma.

Athletes such as cross-country skiers, swimmers and track-and field runners not infrequently suffer from asthma. Cross-country skiers suffer the most. In the course of a race they pump through their lungs thousands of cubic metres of cold air. Surprisingly, it is the combination of cold air and physical exercise that lead to asthma attacks. But true athletes control the disease. There are even Olympic champions among asthma sufferers.

Economic burden of asthma is very substantial indeed. In 1998, the cost of asthma care was estimated to be US$ 11.3 billion in the United States of America, nearly a double increase from US$ 6.2 billion estimated in 1990. Hospitalizations account for the single largest portion of the cost. And that is in spite of the fact that on average, up to 10% of the family budget should go towards meeting the costs of treatment for asthma sufferers.

There is good evidence that economic burden is decreased by proper management. The major costs are in hospital admissions and emergency room visits. In Finland, in the 15-year period 1981 to 1996, the number of asthmatics increased threefold. However, the number of deaths and hospital days decreased by 75%. Costs are going down, even though prevalence is going up.

"Regular management of asthma is cost-effective including certain preventable measures", says Dr Nikolai Khaltaev, WHO Asthma Project Manager. "People save money by not smoking, by not having carpets or pets like dogs or cats at home. The seeds of allergy leading to asthma are sown in very early life. Patients should be better informed and actively involved in asthma treatment. Remember, asthma is a continuing, not episodic, problem". Up to 25% of the childhood asthma patients may outgrow the disease, however, 10 – 15 years later it is likely to re-emerge. The good news is that 95% of asthma is controllable, given continuous medical care. Guidelines and recommendations provided by GINA help to halve the cost of asthma.