Nikhil Chopra, India Business Head, Cipla speaks on busting myths on asthma and Cipla’s #BerokZindagi initiative to lead a better life in a conversation with Prabhat Prakash
What is the incidence rate of asthma in India? How huge is the disease burden?
In India, 93 million people suffer from chronic respiratory diseases, of which 38 million people are diagnosed as asthmatics. One must note that these chronic respiratory diseases cause the second largest mortality after cardiovascular diseases. (Source: https:// www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30409-1/fulltext) Doctors across the nation see an average of around 30-40 patients suffering from respiratory diseases like asthma on a daily basis, and there is absolutely no sign of reduction of the disease burden. In fact, last year saw a whopping 25 per cent increase in the number of people suffering from respiratory symptoms compared to the previous year. It is estimated that one-third of the population will develop asthma at some point, and mostly before the age of 20. Factors such as the rise of particulate matter in the air, pollen, smoking, food habits, nutritional deficiency, hereditary predisposition and largely ignorance amongst parents only increase the prevalence of the disease.
As asthma is a chronic disease it poses a lot of economic burden on the patient. Is cost a deterrent?
Higher initial costs tend to hinder the adoption of consistent therapy for asthma in the lower socio-economic groups. However, if one considers the price bracket of inhalers which is the mainstay for treatment, a patient needs to shell out a daily cost of less than ` 10. Also, the range of solutions that we offer for asthma in India is not available anywhere else at such accessible prices. Hence, we can say that in terms of reasons for not adopting inhalation therapy for asthma, the lack of awareness and prevailing misconceptions about it far surpass the factor of cost burden for non-adoption.
Campaign #BerokZindagi is to increase the awareness of the disease and deal with it better. Who are the KOLs you have tied up with? Have you roped in healthcare specialists for this campaign?
Yes, we have a large network of medical professionals in over 17 Indian cities, who have dedicatedly supported us in our initiative of generating and building awareness about the criticality of inhalation therapy for asthma patients by providing necessary counsel and guidance to the people at large. Medical experts have been our chief guiding sources for all the patient conversations driven to address and remove stigmas around asthma. I would like to add that #BerokZindagi is not the only initiative by Cipla where we have gone ‘Beyond the Pill’ to build a constructive approach for improving patient lives across India. For instance, ‘Breathefree’ was started as a public service initiative by Cipla for patients with chronic airway diseases. Today, it has become a comprehensive patient support system for respiratory care with a dedicated website and app. It has benefitted more than 2 million patients with a growing network of 640 counsellors and 4,000 Breathefree pharmacies. Besides ‘Breathefree’, in 2002, Cipla founded the Chest Research Foundation (CRF) in Pune, with the twin objectives of promoting respiratory research and training in India. They are currently working and will continue to play a vital role to create maximum noise for the community about the burden and impact of chronic respiratory disease. This has the potential to perhaps change government policies for directing healthcare fund allocation for vital diseases like asthma in the future. Additionally, our ‘Save Your Lungs’ campaign in Delhi and Kandy in Sri Lanka are also aimed at creating more awareness and access points for patients.
Many studies claim that inhalers are the best way to combat this chronic condition and yet they aren’t the mainstay. Can a comparison be drawn between alternative therapies?
India has a paradoxical problem with inhalation. In majority of developed markets, inhalation therapy is the preferred mode of treatment but in India it only makes up for a ~25 per cent share (Source: IQVIA IMS MAT 2017-18). Indians tend to ask for tablets over inhalers to treat symptoms related to breathing disorders. Unfortunately, while it provides temporary relief, it does not address the problem in the long term. Rather, these leave behind huge risks of side effects that can be detrimental for patients in the long run. There are alternative therapies like homeopathy that claim to be safe. However, there is no concrete evidence of their effectiveness. On the other hand, inhalation therapy is globally acclaimed with proven safety and efficacy. Most importantly, it is affordable. Inhalers are available at perfectly economic prices in India.
Majority of the population is still unaware of the benefits of inhalers. What are the gaps and how can your campaign #BerokZindagi bridge those gaps?
While the number of patients using inhalation therapy has increased in the last few years, an overwhelming majority of asthmatics discontinue inhaler use after some time. Market research indicates that of the sufferers who are aware of inhalation therapy, only 8 per cent of the patients are actually using inhalers currently, and just 13 per cent of the sufferers have actually ever used inhalers. Furthermore, 47 per cent of asthma patients are afraid of the social stigma associated with the disease more than the disease itself. There is a fear of social isolation due to asthma’s perception as a contagious disease and patients dread being inappropriately labelled, which would lead to avoidance by society and peers. There is the additional issue of a lack of suitable devices for proper diagnosis of asthma. Based on our findings, we concluded that today asthma, more than a physiochemical condition in the body is an issue of attitude and stigma. Consequently, our biggest challenge at hand was to change patients’ perception of respiratory conditions such as asthma and drive adoption of and compliance with inhalation therapy. Most importantly, our ambition was to change attitudes and make uninhibited living a habit. Our campaign is anchored around helping patients live a #BerokZindagi. It fosters the belief that asthma is not a big deal and asthmatics can live an unhindered life, that inhalers are the best choice to manage the problem, and that one should not be afraid to own up and accept asthma. This campaign is in line with our larger purpose of ‘Caring for Life’, and aims to go beyond drugs and devices to shape the respiratory health ecosystem with the eventual outcome of ensuring accurate diagnosis and prescribed treatment for respiratory conditions in India.
What is the way forward for asthma management in the future and how will Cipla play a role in optimising it?
The future has a definite need for a transformed society that is fearless about adopting treatments and is not held back by baseless apprehensions and misconceptions. Cipla has a 66.3 per cent market share in inhalation therapy (IQVIA IMS MAT 2017-18) but our leadership and contribution notwithstanding, much needs to be done and we see it as our duty at Cipla to fill in the gaps that exist. While respiratory ailments are on the rise, diagnosis is still an issue. An estimated 93 million people are afflicted with respiratory ailments but just about 38 million people get diagnosed. Our patient-centric efforts are therefore intensely focussed on diagnosis as well. Based on our thorough understanding of patient needs and doctors, some of the products are machines for pulmonary tests and digitally connected tabletop spirometers. We have even introduced a unique first-of-its kind breath actuated inhaler. Our understanding of people’s needs and our consequent actions are based on what we see on ground. Our biggest challenge and determination is changing people’s perceptions and increasing acceptance of appropriate treatments. Having said that, we are constantly investing in innovative technology to address the problems of poor device technique and patient adherence. Additionally, we continue to find better solutions in terms of drug formulations for asthma, keeping pace with the scientific advances globally.