Rationale The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.
Methods Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.
Results A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.
Discussion The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.
- asthma mechanisms
- asthma epidemiology
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Contributors BK conceived the initial idea of the ASAP project and BK, TvdM, JC, GY, MK, MJ and CdJ designed the study. WM, WW, HA-T, WK, GN, GY, JC, AB, TH and BK participated in data acquisition. CdJ coordinated data quality control. BK wrote the original draft of the manuscript. BK, NL, FM, CG and LM conducted the data analysis. All authors contributed to the drafting and finalisation of the manuscript.
Funding The study was funded by a project grant from the GSK Africa Non-Communicable Disease Open Lab (Project number: 8019). The funder provided in-kind scientific and statistical support in the study design but had no role in data collection, analysis or decision to publish. Authors retained control of the final content of the publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Overall ethics approval was obtained from the Mulago Hospital research and ethics committee (MHREC 875). and from local ethics committees in each country.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Data used in this manuscript is available in hard paper copy and soft copy data files at Makerere University Lung Institute and each participating institution.
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