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Al Busaidi N, Alweqayyan A, Al Zaabi A, Mahboub B, Al-Huraish F, Hameed M, Al-Ahmad M, Khadadah M, Al Lawati N, Behbehani N, Al Jabri O, Salman R, Al Mubaihsi S, Al Raisi S. Gulf Asthma Diagnosis and Management in Adults: Expert Review and Recommendations. Open Respir Med J 2022. [DOI: 10.2174/18743064-v16-e2205230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The prevalence and incidence of asthma are increasing globally because of genetic and environmental influences. Prevalence of asthma in the Gulf has been reported to range from 4.7% to 32.0% and has a substantial economic burden. In this paper, we summarize current asthma management guidance for adults, present insights, and recommendations by key opinion leaders (KOLs) in the Gulf region, and key performance indicators for guiding clinical practice for asthma diagnosis, management, and treatment in the Gulf. While it is recommended that the Global Initiative for Asthma (GINA) guidelines should be followed wherever possible for the management of asthma, KOLs in the Gulf region have presented additional recommendations based on regional challenges and insights. There is a need for better diagnosis using objective testing, increased efforts in tackling the burden of comorbidities in the region, and greater provision of the necessary tools for phenotyping severe asthma. Furthermore, there is a need for greater education for physicians regarding asthma treatment, including the importance of inhaled-corticosteroid-containing controller medication. Regionally, there is also a need for specialist asthma clinics and asthma educators, which would serve to educate physicians and their patients as well as to improve the management of patients. Finally, the use of asthma registries, digital devices, and electronic templates would be of benefit in the management of asthma patients in the region.
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Errors in Aerosol Inhaler Use and Their Effects on Maternal and Fetal Outcomes among Pregnant Asthmatic Women (Subanalysis from QAKCOP Study). Can Respir J 2018; 2018:7649629. [PMID: 30662579 PMCID: PMC6312601 DOI: 10.1155/2018/7649629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/17/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022] Open
Abstract
Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient's understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient's cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient's education is imperative.
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Ibrahim WH, Rasul F, Ahmad M, Bajwa AS, Alamlih LI, El Arabi AM, Dauleh MM, Abubeker IY, Khan MU, Ibrahim TS, Ibrahim AA. Asthma knowledge, care, and outcome during pregnancy: The QAKCOP study. Chron Respir Dis 2018; 16:1479972318767719. [PMID: 29621888 PMCID: PMC6302965 DOI: 10.1177/1479972318767719] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Asthma is the most common chronic medical condition affecting pregnancy.
Optimizing asthma management in pregnancy is paramount for the well-being of
both the mother and the baby. The primary objectives of this study were to
assess patient’s knowledge about asthma, the level of asthma care, and fetal and
maternal outcomes among pregnant asthmatic women in this wealthy country with
tremendous improvement in maternal and fetal health care. The secondary
objective was to identify barriers to asthma control. This was a
cross-sectional, face-to-face, prospective study of 80 pregnant women with
physician-diagnosed asthma. About 56% of patients reported worsening of their
asthma control during pregnancy, of which 52.3% felt this worsening in the third
trimester. About 65% of patients had uncontrolled asthma during their pregnancy,
and inhaler technique was incorrect in 64.4%. Only 38% of patients knew the
difference between controller and reliever asthma medications, 12.7% of patients
had received written asthma action plan, 17% had a spirometry done in the
previous 5 years, and 3.8% had peak expiratory flow meter at home. The main
reasons for uncontrolled asthma were lack of knowledge about right asthma
medications in 30% and fear of side effects of inhaled corticosteroids in 19% of
patients. No financial reason was reported. Significant associations between
total number of pregnancies, poor perception of asthma medications, asthma
exacerbation during delivery and poor asthma control were observed. Preeclampsia
and congenital anomalies occurred at higher rates than previously reported among
general population in this country. The tremendous improvements in maternal
health care and socioeconomic status do not seem to be a barrier to the globally
recognized poor asthma care in pregnancy. Important strategies are much
needed.
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Affiliation(s)
- Wanis H Ibrahim
- 1 Department of Medicine, Hamad General Hospital and Weill-Cornell Medical College, Doha, Qatar
| | - Fatima Rasul
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mushtaq Ahmad
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Abeer S Bajwa
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Laith I Alamlih
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Anam M El Arabi
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | | | | | - Muhammed U Khan
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Azdin A Ibrahim
- 3 Department of Obstetrics and Gynecology, St. Josefs Hospital, Wiesbaden, Germany
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Tarraf H, Al-Jahdali H, Al Qaseer AH, Gjurovic A, Haouichat H, Khassawneh B, Mahboub B, Naghshin R, Montestruc F, Behbehani N. Asthma control in adults in the Middle East and North Africa: Results from the ESMAA study. Respir Med 2018; 138:64-73. [PMID: 29724395 DOI: 10.1016/j.rmed.2018.03.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low levels of asthma control are reported in many countries worldwide. Improved knowledge of asthma control in the Middle East and Africa and predictive factors is needed to address this major public healthcare burden. OBJECTIVE To assess the level of asthma control in patients attending a routine consultation for asthma in the Middle East and North Africa, and the relationship between level of control and patient and disease characteristics, adherence, and quality of life (QoL). METHODS A large-scale cross-sectional epidemiological study (ESMAA: Assessment of Asthma Control in Adult Asthma Population in the Middle East and North Africa) was performed in adults suffering from asthma for at least 1 year and without an acute asthma episode within 4 weeks. Asthma control was assessed per the 2012 GINA guidelines and the ACT questionnaire. QoL and adherence were assessed with the SF-8 and Morisky questionnaires respectively. Predictive factors of asthma control were analysed with univariate and multivariate logistic regressions analyses. RESULTS Overall 7236 eligible patients were included in 577 sites between June 2014 and December 2015 (median 10 patients/site). Mean age was 45 years (±14), 57% were female, mean BMI was 28.5 kg/m2 (±6.0), and 11% were active smokers. Reliever medication was prescribed in 96% of patients with 65% having fixed-dose combined inhaled corticosteroid plus long-acting beta agonists. Good medication adherence was reported in 24% of patients. Among 7179 patients evaluable for GINA, asthma was controlled in 29.4% (95% CI, 28.4%-30.5%), partly controlled in 29.1% (95% CI, 28.1%-30.2%), and uncontrolled in 41.5% (95% CI, 40.3% to 42.6). The mean global ACT score was 17.8 (±5.0), with 16% of patients considering their asthma as controlled. Poor medication adherence, active smoking, absence of medical insurance, lower level of education, or diagnosis at least 5 years earlier were significantly associated with uncontrolled asthma in multivariate analyses (p < 0.001). CONCLUSIONS Asthma control in the Middle East and North Africa is unsatisfactory with less than one-third of asthma patients having controlled disease, highlighting the need to improve treatment access and medication adherence, along with better follow-up and education among healthcare providers and patients.
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Affiliation(s)
- Hesham Tarraf
- Cairo University, 22 Talaat Harb St, City Centre, Cairo, Egypt.
| | - Hamdan Al-Jahdali
- King Saud University for Health Sciences/McGill University/Sleep Disorders Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | | | - Anamarija Gjurovic
- AstraZeneca, Ibn Sina Building, Dubai Healthcare City, PO Box 505070, Dubai, United Arab Emirates.
| | - Houria Haouichat
- Service de Pneumologie, Hôpital Central de l'Armée, BP 244, Kouba, Algeria.
| | | | - Bassam Mahboub
- University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates.
| | - Roozbeh Naghshin
- Rasoul Akram Hospital/Tehran, Hazrat-e Rasool General Hospital, Niyayesh St, Satarkhan St, Tehran, Iran.
| | | | - Naser Behbehani
- Department of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
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Gonzalez-Barcala FJ, Calvo-Alvarez U, Salgado-Castro FJ, Facal D, Garcia-Sanz MT, Muñoz X, Garcia-Couceiro N, Paz-Neira O, San-Jose E, Valdes-Cuadrado L, Carreira JM. Asthma exacerbations: factors related to longer hospital stay. Acta Clin Belg 2017; 72:379-384. [PMID: 28245723 DOI: 10.1080/17843286.2017.1295524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hospital admissions account for a significant part of asthma cost, but with significant differences between geographic areas. AIMS The aim of our study is to analyse hospital admissions due to asthma, as well as the factors associated with longer hospital stays. METHODS A review was retrospectively carried out on all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. The personal characteristics of each patient, the asthma personal history, characteristics of every exacerbation, as well as the treatment before admission and after hospital discharge were recorded. RESULTS During the study period, there were 2163 hospital admissions in 1316 patients (mean age 62.6 years; mean hospital stay 11.6 days). The admissions mainly occur in winter, in the 56-75-year age group, and in patients with severe asthma. Female sex, higher comorbidity, a greater number of emergencies due to asthma in the previous year, and baseline treatment with theophylline were independently associated to longer hospital stay. CONCLUSIONS The management of asthma in our population seems improvable. There appears to be a need to optimise both the diagnosis and treatment of the disease, and to identify risk factors as important as tobacco habits. As regards exacerbations, the hospital stay and mortality must be significantly reduced.
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Affiliation(s)
- Francisco-Javier Gonzalez-Barcala
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Spanish Biomedical Research Networking Centre, CIBERES, Santiago de Compostela, Spain
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Uxio Calvo-Alvarez
- Department of Respiratory Medicine, Hospital of El Ferrol, El Ferrol, Spain
| | - Francisco-Javier Salgado-Castro
- Faculty of Biology/CIBUS, Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - David Facal
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Xavier Muñoz
- Spanish Biomedical Research Networking Centre, CIBERES, Santiago de Compostela, Spain
- Department of Medicine, University Autònoma of Barcelona, Barcelona, Spain
- Department of Respiratory Medicine, Hospital Vall d’Hebron, Barcelona, Spain
| | - Nuria Garcia-Couceiro
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Olalla Paz-Neira
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Esther San-Jose
- Central Laboratory, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Valdes-Cuadrado
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Jose-Martin Carreira
- Department of Radiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Taj-Aldeen SJ, Chandra P, Denning DW. Burden of fungal infections in Qatar. Mycoses 2016; 58 Suppl 5:51-7. [PMID: 26449507 DOI: 10.1111/myc.12386] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/15/2015] [Accepted: 05/20/2015] [Indexed: 12/31/2022]
Abstract
Few estimates of fungal disease frequency have been attempted in the Middle East. We have estimated the burden of fungal infections in Qatar. The aim of the study was to compute and determine the burden of serious fungal infections, in an attempt to estimate fungal disease frequency, which has not previously been attempted in this country. Disease statistics were collected from the Microbiology laboratory database and from 2011 WHO statistics. The data are expressed per 100,000 populations. The reported cases of candidaemia rose to 288 with an estimated rate of 15.4/100,000. A real increase in the burden of candidaemia was found over that previously reported (12.9/100,000) for the years 2004-2009. Candida peritonitis was estimated in 8.02 cases/100,000 population. Recurrent (≥4 year(-1) ) vaginal infections affect at least 32,782 women with a rate of 3506/100,000 inhabitants. Severe asthma with fungal sensitisation affected 1486 people, allergic bronchopulmonary aspergillosis 1126 people and chronic pulmonary aspergillosis 176 people. Rhinosinusitis, mucormycosis and Fusarium infection occurred at rates of 2.31, 1.23, 1.86 cases/100,000 respectively. The estimated rate of invasive aspergillosis was very low (0.6/100,000). Low rates of Cryptococcus meningitis and Pneumocystis pneumonia are attributable to low HIV infection rates. In conclusion, fungal infections are increasingly reported, especially candidaemia. Surveillance and guidelines are needed to optimise care and management of common fungal infections. In addition, a fungal registry system needs development for surveillance.
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Affiliation(s)
- Saad J Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Doha, Qatar
| | - Prem Chandra
- Medical Research Department, Hamad Medical Corporation, Doha, Qatar
| | - David W Denning
- Manchester Academic Health Science Centre, The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester, UK
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