Asthma control factors in the Gulf Cooperation Council (GCC) countries and the effectiveness of ICS/LABA fixed dose combinations: a dual rapid literature review

Abstract

Background: Asthma control is influenced by multiple factors. These factors must be considered when appraising asthma interventions and their effectiveness in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates [UAE]). Based on published studies, the most prevalent asthma treatment in these countries are fixed dose combinations (FDC) of inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). This study is a rapid review of the literature on: (a) factors associated with asthma control in the GCC countries and (b) generalisability of ICS/LABA FDC effectiveness studies.

Methods: To review local factors associated with asthma control and, generalisability of published ICS/LABA FDC studies, two rapid reviews were conducted. Review 1 targeted literature pertaining to asthma control factors in GCC countries. Eligible studies were appraised, and clustering methodology used to summarise factors. Review 2 assessed ICS/LABA FDC studies in conditions close to actual clinical practice (i.e. effectiveness studies). Eligibility was determined by reviewing study characteristics. Evaluation of studies focused on randomised controlled trials (RCTs). In both reviews, initial (January 2018) and updated (November 2019) searches were conducted in EMBASE and PubMed databases. Eligible studies were appraised using the Critical Appraisal Skills Program (CASP) checklists.

Results: We identified 51 publications reporting factors associated with asthma control. These publications reported studies conducted in Saudi Arabia (35), Qatar (5), Kuwait (5), UAE (3), Oman (1) and multiple countries (2). The most common factors associated with asthma control were: asthma-related education (13 articles), demographics (11articles), comorbidities (11 articles) and environmental exposures (11 articles). Review 2 identified 61 articles reporting ICS/LABA FDC effectiveness studies from countries outside of the GCC. Of these, six RCTs were critically appraised. The adequacy of RCTs in informing clinical practice varied when appraised against previously published criteria.

Conclusions: Asthma-related education was the most recurring factor associated with asthma control in the GCC countries. Moreover, the generalisability of ICS/LABA FDC studies to this region is variable. Hence, asthma patients in the region, particularly those on ICS/LABA FDC, will continue to require physician review and oversight. While our findings provide evidence for local treatment guidelines, further research is required in GCC countries to establish the causal pathways through which asthma-related education influence asthma control for patients on ICS/LABA FDC therapy.

Keywords: Asthma control factors; Clinical practice; Effectiveness studies; Evidence-informed policy-making; Gulf cooperation council (GCC) countries; ICS/LABA FDC; Rapid review.

Fig. 1

Asthma control factors in the GCC countries (Review 1): Flow diagram of search strategy/approach. SLR: Systematic Literature Review; GCC: Gulf Cooperation Council [–36]

Fig. 2

Asthma control factors in the GCC countries (Review 1): Total number of articles by country. GCC: Gulf Cooperation Council; UAE: United Arab Emirates reported; n = total number of articles representing results from country; bar counts number of reports from each country, some articles reported multiple asthma control factors; Bahrain was assessed per method but provided no reports. One article from Kuwait did not report any factor cluster

Fig. 3

Asthma control factors in the GCC countries (Review 1): Total number of articles by setting. ER: Emergency room; GCC: Gulf Cooperation Council; n = total number of articles representing results from each setting; bar counts number of reports from each setting. Some articles reported multiple asthma control factors

Fig. 4

Asthma control factors in the GCC countries (Review 1): Total number of articles by age classification (adult and paediatric). n = total number of articles results from each setting; bar counts number of reports for each age group

Fig. 5

Effectiveness studies of ICS LABA FDC (Review 2): Flow diagram of search strategy/approach. FDC: Fixed-dose combination; ICS: Inhaled corticosteroid; LABA: Long-acting beta-agonist; RCT: Randomised controlled trial. [43, 44]