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

被引:19
作者
Zeitouni, Mohamed Omar [1 ]
Al-Moamary, Mohamed Saad [2 ]
Coussa, Marie Louise [3 ]
Riachy, Moussa [4 ]
Mahboub, Bassam [5 ]
AlHuraish, Fatma [6 ]
Zidan, Mohamed Helmy [7 ]
Metwally, Mohamed Mostafa [8 ]
Aksu, Kurtulus [9 ]
Yavuz, Erdinc [10 ]
Kalla, Ismail Sikander [11 ]
Chakaya, Jeremiah [12 ]
Abdelmadjid, Snouber [13 ]
Ghedira, Habib [14 ]
机构
[1] King Faisal Specialist Hosp & Res Ctr, Pulm Med & Crit Care, POB 3354, Riyadh 11211, Saudi Arabia
[2] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Med, Dept Med, Riyadh, Saudi Arabia
[3] Lebanese Amer Univ, Rizk Hosp, Med Ctr, Div Pulm Dis, Beirut, Lebanon
[4] Hotel Dieu France Hosp, Dept Pulm & Crit Care Med, Beirut, Lebanon
[5] Rashid Hosp, Dubai Acad City, Dept Pulm Med, Dubai, U Arab Emirates
[6] Al Sabah Hosp, Dept Internal Med, Resp Unit, Minist Hlth, Kuwait, Kuwait
[7] Alexandria Univ, Fac Med, Dept Chest Dis, Alexandria, Egypt
[8] Assiut Univ, Dept Chest Dis, Assiut, Egypt
[9] Ankara Ataturk Chest Dis & Chest Surg Hosp, Clin Chest Dis Immunol & Allerg Dis, Ankara, Turkey
[10] Samsun Univ, Dept Family Med, Samsun, Turkey
[11] Ahmed Kathrada Private Hosp, Suite D2,K43 Highway,Lenasisa Ext 8, ZA-1827 Johannesburg, South Africa
[12] Fourth Floor Room 404 Fortis Suites,Hosp Rd, Nairobi 00100, Kenya
[13] CHU ORAN Univ Oran, Fac Med, Chest Clin, Oran, Algeria
[14] CHU Abderrahmen Mami, Dept Pathol, Ariana, Tunisia
关键词
Asthma; Global Initiative for Asthma; inhaled corticosteroids; management; overreliance; short-acting beta-agonists; MILD PERSISTENT ASTHMA; BUDESONIDE-FORMOTEROL; INHALED CORTICOSTEROIDS; FLUTICASONE FUROATE; GLOBAL BURDEN; PREVALENCE; ADULTS; COMBINATION; GUIDELINES; VILANTEROL;
D O I
10.4103/atm.atm_469_21
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 beta-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.
引用
收藏
页码:71 / 80
页数:10
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