Challenges and recommendations for the management of asthma in the Middle East and Africa

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.

Figure 1

Factors Responsible for Poor Control of Asthma in the Middle East and Africa Region. SABA = Short-acting β-agonists

Figure 2

Cardinal Elements for Assessment of Asthma

Figure 3.1

Approach for Management of Asthma in Adults and Adolescents as per GINA Guidelines.[1] HDM-SLIT = House dust mitesublingual immunotherapy, ICS = Inhaled corticosteroid, IgE = Immunoglobulin E, IL = Interleukin, LABA = Long-acting bronchodilator, LAMA = Long-acting muscarinic antagonist, LTRA = Leukotriene receptor antagonist, OCS = Oral corticosteroid, SABA = Short-acting beta-agonist

Figure 3.2

Approach for Management of Asthma in Adults and Adolescents as per SINA Guidelines.[69] ICS = Inhaled corticosteroid, IgE = Immunoglobulin E, IL = Interleukin, LABA = Long-acting bronchodilator, LAMA = Long-acting muscarinic antagonist, LTRA = Leukotriene receptor antagonist, SABA = Short-acting beta-agonist