Challenges and recommendations for the management of asthma in the Middle East and Africa
Mohamed Omar Zeitouni 1, Mohamed Saad Al-Moamary 2, Marie Louise Coussa 3, Moussa Riachy 4, Bassam Mahboub 5, Fatma AlHuraish 6, Mohamed Helmy Zidan 7, Mohamed Mostafa Metwally 8, Kurtuluş Aksu 9, Erdinç Yavuz 10, Ismail Sikander Kalla 11, Jeremiah Chakaya 12, Snouber Abdelmadjid 13, Habib Ghedira 14
Affiliations
Affiliations
- 1Pulmonary Medicine and Critical Care, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
- 2Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- 3Division of Pulmonary Diseases, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
- 4Department of Pulmonary and Critical Care Medicine, Hotel Dieu De France Hospital, Beirut, Lebanon.
- 5Department of Pulmonary Medicine, Rashid Hospital, Dubai Academic City, United Arab Emirates.
- 6Respiratory Unit, Department of Internal Medicine, Al Sabah Hospital, Ministry of Health, Kuwait.
- 7Department of Chest Diseases, Faculty of Medicine, Alexandria University, Egypt.
- 8Department of Chest Diseases, Assuit University, Assuit, Egypt.
- 9Clinic of Chest Diseases, Immunology and Allergic Diseases, Ankara Atatürk Chest Diseases and Chest Surgery Hospital, Ankara, Turkey.
- 10Department of Family Medicine, Samsun University, Samsun, Turkey.
- 11Pulmonologist, Suite D2 Ahmed Kathrada Private Hospital, K43 Highway, Lenasisa Ext 8, 1827, South Africa.
- 12Physician, Fourth Floor Room 404 Fortis Suites, Hospital Road, 00100, Nairobi, Kenya.
- 13Chest Clinic, Faculty of Medicine, CHU ORAN University of Oran, Oran, Algeria.
- 14Department of Pathology, CHU Abderrahmen Mami, Ariana, Tunisia.
PMID: 35651897- PMCID: PMC9150662
- DOI: 10.4103/atm.atm_469_21
Free PMC article
Abstract
Clinical presentation of asthma is variable, and its diagnosis can be a major challenge in routine health-care practice, especially in low-and-middle-income countries. The aim of asthma management is to achieve optimal asthma control and to reduce the risk of asthma exacerbations and mortality. In the Middle East and in Africa (MEA), several patient- and physician-related factors lead to misdiagnosis and suboptimal management of asthma. A panel of experts comprising of specialists as well as general health-care professionals met to identify challenges and provide recommendations for the management of asthma in MEA. The major challenges identified for diagnosis of asthma were lack of adequate knowledge about the disease, lack of specialized diagnostic facilities, limited access to spirometry, and social stigma associated with asthma. The prime challenges for management of asthma in MEA were identified as overreliance on short-acting β-agonists (SABAs), underprescription of inhaled corticosteroids (ICS), nonadherence to prescribed medications, and inadequate insurance coverage for its treatment. The experts endorsed adapting the Global Initiative for Asthma guidelines at country and regional levels for effective management of asthma and to alleviate the overuse of SABAs as reliever medications. Stringent control over SABA use, discouraging over-the-counter availability of SABA, and using as-needed low-dose ICS and formoterol as rescue medications in mild cases were suggested to reduce the overreliance on SABAs. Encouraging SABA alone-free clinical practice in both outpatient and emergency department settings is also imperative. We present the recommendations for the management of asthma along with proposed regional adaptations of international guidelines for MEA.
Keywords: Asthma; Global Initiative for Asthma; inhaled corticosteroids; management; overreliance; short-acting β-agonists.
Conflict of interest statement
There are no conflicts of interest.
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