Message from the Director

Gary Dexter

Asthma International was founded in 2010 to treat the asthma of children and adults in low-income countries. Many people reading this will have asthma, or know someone who has asthma: I invite them to imagine what it would be like to have asthma but no access to modern medications such as Salbutamol (the blue inhaler) or Symbicort (the combination steroid and reliever inhaler). 

Speaking personally, I don't need to imagine it. I was born in 1962, a time when no truly effective remedies for asthma existed. I suppose it is chiefly my childhood experiences of asthma that led me to found Asthma International. It is important to bear in mind that in low-income countries, asthma is a killer, taking the lives of over 1,000 people a day, many of them children.

In the early 2010s I and two trustees began to think of ways we could raise money to supply medications to people in countries where there was very little availability of affordable modern asthma treatment. We were generously assisted in this by Professor Martyn Partridge of Imperial College London, who became Asthma International’s Honorary President, and who introduced us to doctors in the asthma community worldwide. By around 2017 we had raised around £35,000, mainly from grant-awarding bodies and foundations, and were ready to begin our pilot project. 

The Vietnam project

Asthma International’s inaugural Vietnam project (2017-2019) treated 92 children aged between 3 and 15 from low-income backgrounds. Children in Vietnam aged 12-13 have the highest incidence of asthma in Asia, at 29%. As with children anywhere, children in Vietnam need to have control of their asthma to enable them to attend school, or, if already at school, to gain the greatest benefit from their education. Well-controlled asthma also facilitates good night-time sleep with consequent positive effects on day-time performance. 

Local partner

The outreach, prescribing and administration was conducted by our Vietnamese partners at the Community Health Centre, District 10, Ho Chi Minh City, Vietnam, under the supervision of our Vietnamese partner, Professor Le Thi Tuyet Lan PhD, Chairwoman of the University Medical Centre of Ho Chi Minh City Respiratory Care Centre. Professor Lan is an Assembly Member of the international campaigning and advisory group the Global Initiative on Asthma, as well as being one of the most respected figures in the worldwide asthma community.

The initial cohort

The initial cohort of 92 children were confirmed as having asthma by using spirometry (a diagnostic tool based on exhaled air volume and requiring a piece of equipment called a spirometer). They were then treated using up-to-date ‘combination’ therapies that include a reliever and a preventer drug (such as Seretide) and followed up over two years. After the two years of treatment had elapsed, their asthma in almost all cases was appropriately controlled. Subsequently their care was passed on to local ACOCUs, or Asthma/COPD Care Units, non-governmental Vietnamese clinics in which patients get treatment covered by basic (or free) insurance, and where the same level of treatment could be continued at low or at no cost. 

Asthma International's role

Asthma International's role consisted of 1) identifying children from difficult-to-reach poor communities, 2) intervening early in life, 3) giving them free treatment (i.e. not dependent on any form of insurance) and 4) ensuring this treatment was carried out under the World Health Organization Stepwise programme, which after two years meant that the participating children were receiving and using an appropriate dose of medication for their particular needs. These four points are often overlooked, leading to life-long adverse consequences for children. 

The programme budget

The budget was £21,570 in Vietnam directly, with a further £3,200 on fundraising and administration, including two trips to Vietnam for Asthma International volunteers. On these trips the programme could be seen in operation, patients could be interviewed and records could be inspected. The project delivery cost (i.e. diagnosis, medications, check-ups and training) was £117 per child per year. A spreadsheet detailing how the money was spent can be seen here. Sample patient records (names redacted) can be seen here.

Goals for improvement

The Vietnam project was considered by the board of Asthma International to be a successful learning experience in fundraising, administration and execution, given that 92 children who may not have received early or appropriate asthma treatment, or indeed any asthma treatment at all, had their clinical needs met, with consequent positive results for their development. However, emerging from it were six goals for improvement:

1. Asthma International should aim in future to decrease the cost per patient per year, which might mean increasing the number of patients;
2. It should work with poorer and more disadvantaged communities than those in Vietnam, with no access to health insurance and thus completely uncontrolled asthma;
3. It should scale the programme up from a pilot two-year programme to a larger and more ambitious rolling operation;
4. It should ensure that data is available in real time to trustees in the UK, helping in project evaluation;
5. It should ‘soft publish’ the project as a Quality Improvement project or audit. Later there could be a publication in an academic journal;
6. It should achieve match-funding, even if only as a small percentage of the total budget, either from governmental or other non-profit sources.

In 2021, Asthma International was about to embark on a new project in Bangladesh, but the Covid pandemic forced the organisation to call a halt to travel and fundraising. This state of affairs continued until early 2024, when operations were resumed. However, Bangladesh was ultimately not felt to be the right location due to a lack of ability to oversee operations effectively. Instead, Asthma International identified a new partner based in Kenya. This is the Dreamland Hospital, near Kimililli in Western Kenya. The Dreamland Hospital is part of IcFEM, a UK registered charity, number 1107038. 

Kenya project 2024

One advantage of this facility is that it is administered both from Kenya and from the UK by our prospective partner Dr Rebecca Nightingale, who works as a clinical academic at the Liverpool School of Tropical Medicine and has an interest in chronic lung disease in low- and middle-income countries. 

Dr Nightingale lived in western Kenya for many years while working with a community to develop a small health centre into a hospital. In those early days, a nine-year-old boy was brought to the health centre with acute asthma. At that time the health centre lacked the emergency medicines to treat him, and the boy died. This triggered a chain reaction, and the hospital was slowly developed into a 90-bed hospital, with dedicated acute respiratory equipment and medication, with 135 staff and over 50,000 patient contacts per year. Despite this, the hospital still only sees asthma patients on an emergency basis, with the result that rural workers and their children are currently living with uncontrolled asthma, leading to unacceptable morbidity and mortality.

Asthma International’s role

Asthma International therefore decided to partner with the Dreamland Hospital to supply just this missing service: an inhaler programme that would reliably treat, on a long term basis, the asthma of hundreds of people, especially children. 

Projected operational costs at the Dreamland Hospital would be reduced from £134 per patient per year (Vietnam) to £78 per patient per year. The project could also be written up as an academic paper by Dr Nightingale, who has many publications in peer-reviewed journals to her credit. Match-funding has also been promised with a starting grant of £5,000, from another non-profit organisation, to begin the project. Thus the six post-Vietnam goals above will be met. 

The budget for this programme will require about £38,010 per annum on a rolling basis. This figure includes on-the-ground programme costs, fundraising, UK salaries and reserve spending.  Please see here for more details of how this money is spent. Asthma International allows donors, simply by ticking a box, to ring-fence their donations, so they can be sure, if they wish, that their donation will go to on-the ground costs (e.g. medications, diagnostic tests, periodic check-ups, etc), or to any other charitable purpose (salaries, fundraising or reserves) - or to all charitable purposes.

Without Asthma International’s work to raise the amounts necessary by appealing to a wide range of prospective donors (governmental schemes, grant-making foundations, text-to-give, legacy funding, private individuals, etc), any inhaler programme at the Dreamland Hospital would struggle to find consistent year-on-year support. 

Many thanks for reading this. I and the trustees hope 2024 will be the beginning of a vigorous expansion of our work.

Gary Dexter