RT Journal Article
SR Electronic
T1 Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project
JF BMJ Open Respiratory Research
JO BMJ Open Resp Res
FD British Thoracic Society
SP e000484
DO 10.1136/bmjresp-2019-000484
VO 7
IS 1
A1 Bruce Kirenga
A1 Jeremiah Chakaya
A1 Getnet Yimer
A1 George Nyale
A1 Tewodros Haile
A1 Winters Muttamba
A1 Levicatus Mugenyi
A1 Winceslaus Katagira
A1 William Worodria
A1 Hellen Aanyu-Tukamuhebwa
A1 Njira Lugogo
A1 Moses Joloba
A1 Amsalu Bekele
A1 Fred Makumbi
A1 Cindy Green
A1 Corina de Jong
A1 Moses Kamya
A1 Thys van der Molen
YR 2020
UL http://bmjopenrespres.bmj.com/content/7/1/e000484.abstract
AB 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.