Journal of Allergy and Clinical Immunology: Global (May 2024)

The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project

  • Bruce J. Kirenga, MBChB, MMed, PhD,
  • Jeremiah Chakaya, MBChB, MMed,
  • Getnet Yimer, MD, PhD,
  • George Nyale, MBChB, MMed,
  • Tewodros Haile, MD,
  • Winters Muttamba, MBChB, MPH,
  • Levicatus Mugenyi, PhD,
  • Winceslaus Katagira, MBChB, MMed,
  • William Worodria, MBChB, MMed, PhD,
  • Hellen Aanyu-Tukamuhebwa, MBChB, MMed,
  • Njira Lugogo, MD,
  • Moses Joloba, MBChB, MS, PhD,
  • Tesfaye B. Mersha, PhD,
  • Amsalu Bekele, MD,
  • Fred Makumbi, PhD,
  • Amha Mekasha, PhD,
  • Cynthia L. Green, PhD,
  • Corina de Jong, PhD,
  • Moses Kamya, MBChB, MMed, MPH, PhD,
  • Thys van der Molen, MD, PhD

Journal volume & issue
Vol. 3, no. 2
p. 100209

Abstract

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Background: Severe asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown. Objective: We sought to determine the burden (prevalence, mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethiopia. Methods: Using the American Thoracic Society/European Respiratory Society case definition of severe asthma, we analyzed for the prevalence of severe asthma (requiring Global Initiative for Asthma [GINA] steps 4-5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4-5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA-recommended medications. Asthma control was assessed by the asthma control questionnaire (ACQ). Results: Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% confidence interval [CI], 23.1-28.3) and 4.6% (95% CI, 3.5-6.0), respectively. Patients with severe asthma were (nonsevere vs severe vs severe refractory) older (39, 42, 45 years, P = .011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, P = .004), had lower forced expiratory volume in 1 second percentage (81%, 61%, 55.5%, P < .001), had lower quality of life score (129, 127 vs 121, P < .001), and had higher activity impairment (10%, 30%, 50%, P < .001). Factors independently associated with severe asthma were hypertension comorbidity; adjusted odds ratio 2.21 (1.10-4.47), P = .027, high bronchial hyperresponsiveness questionnaire score; adjusted odds ratio 2.16 (1.01-4.61), P = .047 and higher ACQ score at baseline 2.80 (1.55-5.08), P = .001. Conclusion: The prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.

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