Prevalence of asthma in Saudi adults: findings from a national household survey, 2013

The association of serum 25-OH vitamin D with asthma in Saudi adults

The study aimed to assess the differences and associations of serum 25 (OH)D levels in Saudi adults with and without asthma. A total of 1070 Saudi adults aged 22 to 28 years (359 with known asthma and 711 matched nonasthmatic controls) were selected randomly from the Riyadh Cohort, Saudi Arabia. Serum 25(OH)D serum levels were measured. Asthma diagnosis was taken from questionnaires. In all participants, 359 (33.6%) were known asthmatic and 711 (66.5%) were nonasthmatic. The overall incidence of vitamin D deficiency (serum 25(OH)D <25 nmol/L) was 29.6% in controls and 35.6% in asthma group (P = .01). The asthma group have a significantly lower serum 25(OH)D than the control group (P = .01) but lost significance after adjusting for age, body mass index (BMI), and sex. Nonasthmatic and asthmatic females had a higher incidence of vitamin D deficiency (33% and 46%) than nonasthmatic and asthmatic males (17% and 33%). Vitamin D deficiency is significantly high among Saudi adults with asthma, but more so among women. Whether vitamin D deficiency exacerbates asthma attack remains to be proven in this population.

Potential causes of asthma in the United Arab Emirates: drawing insights from the Arabian Gulf

There is considerable concern on the rise in the incidence of asthma worldwide with statistics in the United Arab Emirates (UAE) indicating that at least 13% of schoolchildren, particularly of Emirati descent, suffer from asthma. With its high rates of hospital admissions, negative socioeconomic impact and significant morbidity, this is a disease that requires optimal guidelines for control and awareness. In this article, we review the current knowledge of asthma in the UAE and draw on studies, especially from the surrounding region, to identify its contributing factors within this population. The most frequently identified agents pertinent to the UAE include outdoor and indoor environmental causes exacerbated by the country's rapid urbanization, genetic factors aided in transmission by consanguineous marriage, the patient's socioeconomic status and a rise in vitamin D deficiencies. This evidence aims to inform healthcare professionals and governmental agencies in order to best create guidelines for controlling the burden of this debilitating disease.

Prevalence of asthma among male 16 to 18-year-old adolescents in the Northern Borders Region of Saudi Arabia

Background

Asthma is a common chronic disease in adolescents, and has led to a significant morbidity and disability. Few studies have estimated the prevalence of asthma in the Northern Borders Region of Saudi Arabia. Only limited data has been available about prevalence of asthma in adolescents’ age.

Objectives

The objectives of this study were to assess the prevalence of asthma and associated symptoms in 16 to 18-year-old adolescents, and to assess the level of asthma control among students with physician-diagnosed asthma, in the Northern Borders Region of Saudi Arabia.

Methods

A cross-sectional study was carried out on 511 male 16 to 18-year-old students in the Northern Borders Region of Saudi Arabia during the academic year 2017–2018. An International Study of Asthma and Allergies in Children (ISAAC) questionnaire and Asthma Control Test (ACT) were used as the measurement tool. The data were analyzed by SPSS version 20, using descriptive statistics and Chi-square test. A p-value of 0.05 or less was considered, statistically significant.

Results

Among the 511 students, the prevalence of physician-diagnosed asthma was 11.4%. The prevalence of lifetime wheeze, and exercise-induced wheeze were 30.3% and 19% respectively. The prevalence of night cough and wheezing attack in the past 12 months were 17% and 16.8% respectively. A total of 51.8% of asthmatic students have poor asthma control.

Conclusions

The prevalence of asthma and associated symptoms in 16 to18-year-old students is high in the Northern Borders Region. Uncontrolled asthma was observed in half of asthmatic students.

Time Trends and Regional Variation in Prevalence of Asthma and Associated Factors in Saudi Arabia: A Systematic Review and Meta-Analysis

BACKGROUND

Asthma is the most common reason for emergency visits to hospital and loss of productive hours. In Saudi Arabia, asthma affects more than 2 million people and majority of them have uncontrolled asthma with their quality of life adversely being impacted. It is well known that the prevalence of asthma has been increasing in many places around the world in the last few decades. The present review attempted to identify studies on asthma and associated factors in Saudi Arabian population and assess their time trends and regional variation.

METHODS

The titles and abstracts of retrieved articles were compared to delete duplication and irrelevant data. A data collection form was designed to extract several key components from selected articles like bibliographic information on the article, study population, and sample size. Extracted information was grouped appropriately for data analysis. Database search retrieved 71 articles. Applying inclusion and exclusion criteria, 40 articles were excluded and 31 qualified full articles were included for the review.

RESULTS

Among 31 retained studies, Riyadh had the highest publication output followed by Jeddah. Ten studies were based on ISAAC and 5 on non-ISAAC questionnaires while 5 studies were genetic studies conducted to unravel the genetic basis of asthma. Most of the studies were conducted on pediatric subjects of less than 16 years of age. Sample sizes ranged from less than 150 to more than 10000 with study settings being predominantly urban (22 studies). The pooled weighted prevalence rates of asthma, lifetime wheeze, and rhinitis were 14.3% (95% CI: 13.4-15.2), 16.5 (95% CI 15.5-17.4), and 21.4 (95% CI 20.5-22.3), respectively. An increase in asthma prevalence from 1990 to 2000 along with a stabilized or not so significant decline in the prevalence from 2010 to 2016 was observed.

CONCLUSION

The prevalence of asthma varied in different regions without any disparity in prevalence in the rural and urban areas of Saudi Arabia. The understanding of genetic variability and recognition of risk factors in asthma patients can greatly help in individualizing the therapy for the management and control of asthma.

Prevalence of asthma among the adult general population of five Middle Eastern countries: results of the SNAPSHOT program

BACKGROUND

Asthma is a common chronic respiratory disease leading to morbidity, mortality and impaired quality of life worldwide. Information on asthma prevalence in the Middle East is fragmented and relatively out-dated. The SNAPSHOT program was conducted to obtain updated information.

METHODS

SNAPSHOT is a cross-sectional epidemiological program carried out in five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia, and the United Arab Emirates, the latter three grouped into a Gulf cluster) to collect data on asthma, allergic rhinitis, benign prostatic hyperplasia and bipolar disorder. The survey was carried out by telephone in a random sample of the adult general population with quotas defined according to country demographics. The analysis presented in this paper focuses on asthma. Subjects were screened for asthma based on criteria from the global Asthma Insights and Reality studies. Current prevalence (last 12 months) was estimated. Multivariate logistic regression analyses were used to investigate risk factors related to asthma and the association with allergic rhinitis and other co-morbidities. Quality of life was assessed using the three-level EQ-5D questionnaire.

RESULTS

2124 out of the 33,486 subjects enrolled in the SNAPSHOT program fulfilled the criteria for asthma. The adjusted prevalence of asthma ranged from 4.4% [95% CI: 4.0-4.8%] in Turkey, to 6.7% [95% CI: 6.2-7.2%] in Egypt and 7.6% [95% CI: 7.1-8.0%] in the Gulf cluster. Prevalence was higher (p < 0.0001) in women than men and increased with age (p < 0.0001). Co-morbidities occurred more frequently in asthma subjects compared to the non-asthma population (38% vs. 15% p < 0.0001). Subjects with asthma reported a lower (p < 0.0001) EQ-VAS score (68.2 ± 22.9) compared to the general population (78.1 ± 17.5). The risk factors associated with asthma were age, gender, country, and certain co-morbidities, namely respiratory, cardiovascular, gastrointestinal, nervous, and neurological diseases.

CONCLUSION

The observed adjusted prevalence of asthma in the Middle East ranges from 4.4% to 7.6%, which is comparatively lower than the reported prevalence in Europe and North America. Asthma has a negative impact on quality of life, and is associated with high levels of co-morbid diseases, indicating a need for physicians to check for co-morbidities and ensure they are managed correctly in all asthma patients.

Burden of disease associated with asthma among the adult general population of five Middle Eastern countries: Results of the SNAPSHOT program

BACKGROUND

Asthma affects millions worldwide resulting in a significant disease burden. However, data on asthma burden from the Middle East is limited. This analysis describes the asthma burden in Egypt, Turkey and a Gulf cluster (Kuwait, Saudi Arabia and United Arab Emirates) as part of the SNAPSHOT program.

METHODS

SNAPSHOT was an observational, cross-sectional program carried out by telephone in a random sample of the adult general population of the five above mentioned countries. Quotas were defined per country demographics. Subjects were considered to have asthma if they fulfilled the screening criteria, based on the global Asthma Insights and Reality studies. Data collected included demographics, physician consultations, and asthma control (measured by the Asthma Control Test; ACT). Quality of life was assessed using the EuroQol Five-Dimension questionnaire (EQ-5D); and limitations to daily activities using the modified Sheehan Disability Scale (SDS).

RESULTS

939 subjects answered questions related to asthma burden. Overall, 367 (44.2%) reported uncontrolled asthma (ACT≤19), and reported significantly lower EQ-5D-3L utility values (0.6 ± 0.4) and EQ-VAS scores (60.7 ± 24.2) compared to controlled subjects (0.8 ± 0.3 and 75.3 ± 19.8 respectively) (p < 0.0001). A significantly higher proportion with uncontrolled asthma also reported experiencing impact on activities of daily living compared to subjects with controlled asthma (p < 0.0001). Overall, 355 (37.8%) asthma subjects were followed by a physician. However, most visits were unscheduled (695;78.0%).

CONCLUSION

Uncontrolled asthma imposes a significant burden in these Middle Eastern countries resulting in increased frequency of healthcare use, lower quality of life, and a higher impact on daily life compared to controlled asthma.

Assessment of knowledge and education relating to asthma during pregnancy among women of childbearing age

Background

Misconceptions about medications’ safety can lead pregnant women with asthma to stop their medications, resulting in asthma-related neonatal morbidity and mortality. Our aim was to assess the level of pregnancy-related asthma knowledge and education about asthma medications’ safety, among women of childbearing age with a history of bronchial asthma.

Methods

A cross-sectional survey of convenience sample of outpatient clinic attendees of Pulmonary, Family Medicine and Obstetrics & Gynecology among women of childbearing age with history of asthma at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Participants (n = 171) completed a questionnaire to determine levels of education and knowledge, as well as attitudes and practice relating to asthma treatment.

Results

Among participants, 77.1% were pregnant at the time of the survey, 77.8% had used asthma medications during current or previous pregnancy, 70.8% of all respondents who ever been pregnant believed in the safety of asthma medications during pregnancy, 49.1% had received education about asthma, and 46.8% had been educated about the safety of asthma medications during pregnancy. Responses indicated that 46.8% had stopped (or expressed the desire to stop) asthma medications during pregnancy, and 48% believed asthma medications would harm them and their babies more than asthma itself, but 92.4% expressed that they would be willing to use asthma medications during pregnancy if their safety was confirmed by a physician. Education level and employment status were both associated with an increased likelihood of having received asthma education (p values <0.001 and <0.001 respectively), and with awareness of the safety of the medications during pregnancy (p values <0.001 and <0.003 respectively).

Conclusion

Further efforts is to be taken to develop a program where female asthmatic patients are taught about asthma and its medications’ safety during pregnancy.

The association between body mass index and frequency of emergency department visits and hospitalization for asthma exacerbation in a pediatric population

BACKGROUND

The prevalence of both asthma and obesity are increasing. Although some studies suggest an association between body mass index (BMI) and frequency of emergency department (ED) visits and hospitalization for asthma exacerbation, any association remains unproven.

OBJECTIVE

Estimate the frequency of asthma exacerbation in obese children, and identify any relationship between BMI and frequency of ED visits and hospitalization for asthma exacerbation.

DESIGN

Retrospective review of medical records.

SETTINGS

Tertiary children's hospital, Riyadh.

SUBJECTS AND METHODS

All children aged 2-15 years who attended the ED for asthma exacerbation between January 2015 and January 2016 were included. Children with comorbidities or undocumented asthma were excluded. The Centers for Disease Control and Prevention BMI-for-age growth charts for boys and girls aged 2 to 20 years were used to classify underweight, normal, overweight, and obese.

MAIN OUTCOME MEASURES

The frequency of ED visits and the rate, frequency, and duration of hospitalization.

RESULTS

Of the 1000 cases reviewed, 64.6% were boys and the mean age (standard deviation) of all sub.jects was 5.6 (3.3) years. The proportions of overweight and obese children was 11.8% and 12.1%, respectively. There was no association between increased BMI and frequency of ED visits for asthma exacerbation (P=.84), duration of hospitalization (P=.41) or frequency of hospitalization (P=.89).

CONCLUSION

There was no evidence of an association between BMI and frequency of ED visits and hospitalization for asthma exacerbation among children.

LIMITATIONS

This study included patients as young as 2 years, while asthma is only well-defined in children > 5 years. Asthma triggers that can cause exacerbation despite body weight were not included. We included only frequency of ED visits and hospitalization, which may be inadequate to measure asthma severity.

Medicinal benefits of Nigella sativa in bronchial asthma: A literature review

Nigella sativa L. (NS) seeds, known as black seed, is a spice and a traditional herbal medicine used in various diseases including bronchial asthma. This review aimed to assess the studies supporting the medicinal use of NS in asthma and to highlight future research priorities. Various medical databases were searched for the effects of NS and its active secondary metabolites in asthma inflammation and outcomes. There were fourteen preclinical studies describing multiple effects of NS in animal or cellular models of asthma including bronchodilation, anti-histaminic, anti-inflammatory, anti-leukotrienes and immunomodulatory effects. Furthermore, seven clinical studies showed improvements in different asthma outcomes including symptoms, pulmonary function and laboratory parameters. However, often these studies are small and used ill-defined preparations. In conclusion, NS could be therapeutically beneficial in alleviating airway inflammation and the control of asthma symptoms, but the evidence remains scanty and is often based on poorly characterised preparations. Accordingly, well-designed large clinical studies using chemically well characterised NS preparation are required.

Indicators of Asthma Control in Asthmatic Patients: Are they related to Depression?

BACKGROUND:

Many patients with chronic illnesses suffer from depression. A poorly controlled asthma that presents with repeated attacks of breathlessness is a recognised risk factor for bipolar disorders. On the other hand, depression can aggravate asthma symptoms.

AIM:

The aim of this study is to determine the indicators of the asthma control test (ACT) among the asthmatic patients who attend the outpatient clinic for follow-up and to investigate the relation between these indicators and clinical depression, using a standardised depression scale.

METHODS:

A total of 38 adult asthmatic patients (29 women, age 17–85 years), with variable levels of control, were assessed using the ACT and the Beck Depression Inventory (BDI). Data obtained were analysed with the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 20. The association of depression with the various indicators of asthma control was analysed with the Chi-Square test. Statistical significance was determined at p< 0.05.

RESULTS:

The uncontrolled asthma is associated with depression in 37% of all participants compared to 0% in the well-controlled group (p = 0.002). Depression is significantly related to asthma interference with daily activities (p = 0.003), breathlessness (p < 0.001), night symptoms (p = 0.036), use of bronchodilators (p = 0.007), and poor compliance with medical treatment (p = 0.003). The poor educational attainment and comorbidities have significant relations to both uncontrolled asthma and clinical depression (p < 0.05).

CONCLUSION:

All indicators of the poor asthma control are associated with clinical depression. A significant proportion of the uncontrolled asthma patients suffers from depression. The possibility of improving asthma control with a pharmacological treatment of depression has to be considered.

The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the Middle East, and North Africa

Noncommunicable diseases (NCDs) are a major and increasing global health issue. The World Health Organization (WHO) estimates that NCDs represent 63% of all global deaths of which 3.9 million are due to chronic respiratory diseases (CRDs) and Chronic Obstructive Pulmonary Disease (COPD) in particular. COPD is now the third most common cause of death globally; 90% of these deaths occur in Low and Middle Income Countries (LMICs). COPD affects 329 million people, almost 5% of the world's population. In addition, asthma affects 334 million people, again representing almost 5% of the world's population. There is limited literature published on the epidemiology of COPD and Asthma from Sub-Saharan Africa (SSA) and Middle East and North Africa (MENA). Both diseases are under-diagnosed and underestimated in both SSA and MENA regions. The burden of COPD in sub-Saharan Africa is disputed and reports offer variable prevalence estimates, ranging from 4.1% to almost 22.2%. SSA and MENA countries report similar mortality rates from COPD of 18 per 100,000 population (2001 data). Asthma is a less common cause of death than COPD but is a major cause of morbidity; WHO estimates that there are 250,000 deaths per year from asthma, mainly in LMICs and it remains in the top twenty causes of disability in children globally. Risk factors for CRD are genetic and environmental; the latter dominated by air pollution exposures including tobacco smoke, household air pollution, outdoor air pollution and occupational exposures.

Lower prevalence and greater severity of asthma in hot and dry climate

OBJECTIVE

To estimate asthma prevalence, severity, and associated factors in adolescents who live in a low relative humidity environment.

METHODS

In this cross-sectional study, adolescents aged 13-14 years from the city of Petrolina located in the Brazilian semiarid region answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The possible explanatory variables of the study were gender, family income, mother's education, smokers in the household, parental history of asthma, personal history of allergic rhinitis or atopic dermatitis, and physical activity level. Poisson regression analysis was used to assess the association between asthma and the explanatory variables.

RESULTS

A total of 1591 adolescents participated in the study, of whom 49.7% were male. The prevalence of active asthma, severe asthma, and physician-diagnosed asthma were 14.0%, 10.4%, and 17.8%, respectively. Adolescents with asthma missed more school days than their peers (33 vs. 22 days/year; p<0.03). Associated factors that remained significant after adjustment were history of asthma in parents (PR=2.65, p<0.001) and personal diagnosis of allergic rhinitis (PR=1.96, p<0.001) and/or atopic dermatitis (PR=2.18, p<0.001).

CONCLUSION

Asthma prevalence in this low-humidity environment was lower, but more severe than those reported in other Brazilian cities. The dry climate might hamper disease control and this may have contributed to the higher school absenteeism observed. The association of asthma with allergic rhinitis and atopic dermatitis as well as a history of asthma in parents suggests that atopy is an important risk factor for asthma in this population.

Chronic disease prevalence among elderly Saudi men

OBJECTIVE

Saudi demographic composition has changed because of increased life expectancy and decreased fertility rates. Little data are available about health conditions among older adults in Saudi Arabia, who are expected to represent 20% of the population by 2050. The study aim was to assess the prevalence and risk factors for chronic conditions among older Saudi men.

METHODS

The sample pertained to 400 men (age ≥55 years) from Buraidah, Al-Qassim. Research assistants recruited participants in all the mosques from the randomly selected neighborhoods (16 of 95). They administered a structured questionnaire that assessed self-reported disease history (heart disease, hypertension, diabetes, asthma, gastric/peptic ulcer, and cancer), and medication use; participants' height, weight, blood pressure, and random blood glucose (glucometer) were measured. Multinomial logistic regressions were employed to assess correlates of number of chronic diseases.

RESULTS

The mean and standard deviation for age and body mass index (BMI) were 63.0 ± 7.5 years and 28.9 ± 4.8 (kg/m²), respectively. 78% (77.8%) were overweight or obese, 35.0% were employed, 54.5% walked daily, 9.3% were current smokers, and 85.0% belonged to the middle class. The prevalence of hypertension, diabetes, heart disease, asthma, ulcer, and cancer were: 71.3% 27.3%, 16.4%, 9.7%, 8.9%, and 2.0%, respectively. Of the participants, 31.0% had one, 34.5% had two or more, and 34.5% did not have any chronic diseases. The likelihood of chronic diseases increased with increased age, higher BMI, and current smoking.

CONCLUSION

The chronic disease prevalence among the Saudi elderly men is substantial.

Prevalence and Occupational and Environmental Risk Factors of Self-Reported Asthma: Evidence from a Cross-Sectional Survey in Seven Chinese Cities

OBJECTIVE

Asthma is one of the most common chronic diseases and associated with significant morbidity and mortality. However, few data on occupational and environmental risk factors of asthma are available, particularly in Asian adults. Based on a national cross-sectional survey, we assessed the prevalence and risk factors of asthma in Chinese adults.

METHODS

A total of 9974 participants aged 15 years and over in seven Chinese cities were selected using a stratified four-stage random sampling. All participants were interviewed face-to-face in their homes using a standardized self-administered questionnaire. Multivariate logistic regression analyses were adopted to determine various risk factors for asthma.

RESULTS

The prevalence of self-reported lifetime asthma was 2.46% among the entire adult population, 3.02% among males and 1.93% among females. The prevalence varied by age group, ethnicity, marital status, education, and floor space per person (p < 0.05). After adjusting for socio-demographic variables and smoking, we found independent occupational and environmental determinants of asthma, including a clearance-related job (OR = 2.28, 95%CI: 1.07-4.89), occupational exposure to industrial or occupational poisonous gas (OR = 4.21, 95%CI: 2.43-7.30), having large amounts of carpet in the workplace (OR = 2.61, 95%CI: 1.20-5.69) and using coal for cooking (OR = 2.65, 95%CI: 1.26-5.57).

CONCLUSIONS

Asthma is a serious public health problem in China. Our study provides important updated information on the prevalence of asthma and its associated risk factors, which may help us better understand the epidemiology of asthma and prevent this disorder.

Asthma quality of life in Saudi Arabia: Gender differences

OBJECTIVES

To explore potential gender differences in the factors associated with asthma-specific quality of life (AQL).

METHODS

A cross-sectional study of consecutive series of adult patients attending primary care centers at three major hospitals in Riyadh, Saudi Arabia, was performed. AQL was measured using a standardized version of the AQL questionnaire (min = 1, max = 7), with higher scores indicating a better AQL. Multiple linear regression analysis was performed.

RESULTS

The mean AQL was 4.3 (standard deviation [SD] = 1.5) for males and 4.0 (SD = 1.3) for females (p = 0.113). With each unit increase in asthma control, the AQL improved by 0.19 points (95% confidence interval [CI] = 0.14-0.23) in men and by 0.21 points (95% CI = 0.16-0.25) in women. Daily tobacco smoking was associated with a 0.72 point (95% CI = 0.14-1.30) decrease in the AQL among males. Women who had a household member who smoked inside the house had a significantly lower AQL (B = -0.59, 95% CI = -1.0 - -0.19). A monthly household income of 25,000 Saudi Riyals or more was associated with a better AQL among men (B = 0.51, 95% CI = 0.01-1.01), whereas being employed exhibited a protective effect in women (B = 0.48, 95% CI = 0.11-0.84). Higher levels of perceived asthma severity were associated with better AQL in women (B = 0.82, 95% CI = 0.36-1.28).

CONCLUSIONS

Our findings revealed gender-specific differences in the correlates of AQL in Saudi Arabia, particularly in tobacco exposure, socio-economic factors and perceived asthma severity.