Michael Gwarisa in Cape Town, South Africa
Health experts have warned of a growing asthma burden among children in Cape Town, South Africa, with data showing that over 17 percent of teenagers in the city have a history of asthma and could still be showing symptoms well into their teenage years.
Major drivers of asthma in Cape Town include allergies, mainly from pollen and other plant and animal related triggers.
Speaking in Cape Town during a Media Workshop on Chronic Respiratory Diseases hosted by PACE University, Bob Mash, Professor of Family Medicine and Primary Care at Stellenbosch University in South Africa, said the asthma burden among children and teenagers in the city was high.
“According to research, 17 percent of teenagers in Cape Town at the age of 13 to 14 have some sort of history of asthma, translating to about 120,000 teenagers in Cape Town who might need care for asthma,” said Prof Mash.
To compound the situation in Cape Town, data from the same study also shows that 20 percent of adults over the age of 40 years have some form of COPD. That translates to potentially 406,000 people living with the disease in the city.
“Essentially, this is a primary care problem. The ability of primary care to actually deal with these issues is very limited. There has been a historic focus in primary care on acute infectious diseases and vertical programmes. In most countries in Africa, if you go to any primary care facility, you will struggle to get care for Non Communicable Diseases, especially for Chronic Respiratory Diseases.”
Some low and middle income countries in Africa do not have guidelines on managing Chronic Respiratory Diseases. Where the guidelines exist, they are either poorly implemented or often ignored.
“The issue is the lack of proper medication. If you go to some of these clinics, you will not find inhalers or you will only find the acute inhalers that you take when you are actually short of breath during an attack. You will not find inhalers that help you to control your asthma.”
Some countries still rely heavily on administering and prescribing tablets to asthma patients, which is not the recommended way of managing a chronic disease according to Prof Mash.
Following the drought between 2015 and 2018 in Cape Town, the province has experienced major waves of pollen after 2018. Experts say this has contributed to a spike in asthma and allergic rhinitis related conditions.
Michael Levin, a Professor of Paediatric Allergology at University of Cape Town, said Africa, including Cape Town, has lengthy pollen seasons.
“In other parts of the world, you can have hay fever for about one month. In Africa, we have different grasses and much longer growing periods. Our pollen seasons are therefore much longer. We do not really have seasonal allergic rhinitis. The new classification is persistent or intermittent allergic rhinitis to account for the fact that our pollen season is almost the entire year,” said Prof Levin.
Meanwhile, the Desmond Tutu Health Foundation Masiphumelele Research Site in Cape Town has commenced an ambitious pollen study known as the Climate Air Emissions and Respiratory Health Early Sensing Project (SA CARES). The project is funded by the Wellcome Trust and runs from 2025 to 2027.
Caryn Upton, the project lead for the SA CARES research, said the team was preparing to begin patient recruitment.
“We are hoping to start recruiting patients next week. The goal here is to look at how climate change is impacting the environment and, therefore, impacting health and asthma in children in our communities,” said Upton.
The project, a Wellcome Climate Impact Award running for three years, is currently in its second year. It monitors environmental conditions and collects data from various cities using universities across South Africa that are part of the consortium known as the South African Pollen Monitoring Network (SAPMNET), led by the University of Cape Town Lung Institute.
Information gathered is updated weekly on the network’s website. The consortium was established five years ago.
“This work is very important because pollen is one of the main reasons asthma is exacerbated. We estimate that between 10 and 15 percent of the population in South Africa has asthma, while between 40 and 60 percent of the population also suffers from allergic rhinitis,” Upton said.
SAPMNET creates a pollen calendar to understand how different pollen types behave throughout the year. Grass, trees, fungi and weed pollen are among the leading triggers of allergic reactions, including asthma symptoms, in South Africa.
The project aims to generate recommendations around health interventions and potentially develop early warning systems to help communities prepare for high pollen periods.
