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Cheng F, He L, Deng D, Zhang J, Liu C. Analysis of asthma incidence and mortality rates among children aged 0-14 in 204 countries from 1990 to 2019. J Asthma 2024:1-11. [PMID: 39074060 DOI: 10.1080/02770903.2024.2386442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/20/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Asthma is a common chronic respiratory disease in children. Understanding incidence and mortality trends is crucial for prevention and intervention strategies. METHODS Data from the Global Burden of Disease (GBD) study were used to analyze asthma incidence and mortality trends among children aged 0-14 in 204 countries from 1990 to 2019. The 30-year trends were calculated using the Estimated Annual Percentage Change (EAPC). RESULTS Globally, pediatric asthma cases increased from 18,857,697 in 1990 to 20,191,786 in 2019. Incidence rates for children <5, 5-9, and 10-14 years are 1509.36, 980.25, and 586.95 per 100,000, respectively. Over 30 years, pediatric asthma mortality rates significantly decreased from 1.59 to 0.51 per 100,000, with minimal gender differences. High-income North America, Tropical Latin America, and the Caribbean show the highest incidence rates at 3203.2, 2493.83, and 2314.8 per 100,000. The USA, Puerto Rico, and Haiti have the highest national rates at 3357.17, 2695.30, and 2605.38 per 100,000. Regions with higher Sociodemographic Index levels tend to have higher incidence rates. Pediatric asthma prevalence varies by region and age group. CONCLUSION Our study of asthma incidence and mortality rates among children aged 0-14 across 204 countries from 1990 to 2019 reveals significant global disparities. These findings underscore the influence of socioeconomic and environmental factors on asthma prevalence and outcomes.
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Affiliation(s)
- Fei Cheng
- Department of Critical Care Medicine, The Third People's Hospital of Chengdu, Chengdu, China
| | - Li He
- Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Dachuan Deng
- Department of Pediatrics, Dazhou Central Hospital, Dazhou, China
| | - Jinhui Zhang
- Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Cheng Liu
- Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
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Ozoh OB, Ndimande N, Amaral AFS, Lesosky M, Mbonigaba J, Stolbrink M, Zurba L, Ayo-Olagunju T, Kayembe-Kitenge T, Lakoh S, Mocumbi A, Mohammed J, Nantanda R, Nunes E, Ouédraogo AR, Owusu S, Sibomana JP, Masekela R, Mortimer K. Chronic respiratory disease observatory for Africa (CHEST-Africa): study protocol for the prevalence, determinants and economic impacts of asthma and COPD in Africa. BMJ Open Respir Res 2024; 11:e002416. [PMID: 39019625 PMCID: PMC11256067 DOI: 10.1136/bmjresp-2024-002416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/07/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Contemporary data on the burden of chronic respiratory diseases in sub-Saharan Africa is limited. More so, their economic burden is not well described. This study aims to establish a chronic respiratory disease observatory for Africa. Specific study aims are (1) to describe the prevalence and determinants of asthma with a target to screen up to 4000 children and adolescents across four African cities; (2) to determine the prevalence and determinants of chronic obstructive pulmonary disease (COPD) with a target to screen up to 3000 adults (≥18 years) across five African cities; (3) to describe the disease burden by assessing the frequency and severity of symptoms and exacerbations, medication use, emergency healthcare utilisation and hospitalisation; and (4) to assess the economic burden and affordability of the medicines for these diseases. METHODS AND ANALYSIS Surveys will be conducted in schools to identify children and adolescents with asthma using the Global Asthma Network screening questionnaire in Ghana, Nigeria, the Democratic Republic of Congo, and Uganda. Community surveys will be conducted among adults using an adapted version of the Burden of Obstructive Lung Disease Questionnaire to identify persons with COPD symptoms in Nigeria, Burkina Faso, Mozambique, Rwanda, and Sierra Leone. Fractional exhaled nitric oxide and pre-bronchodilator and post-bronchodilator spirometry will be done for children with asthma or asthma symptoms and for all adult participants. Children and adults with respiratory symptoms or diagnoses will complete the health economic questionnaires. Statistical analysis will involve descriptive and analytical statistics to determine outcomes. ETHICS AND DISSEMINATION Ethical approval has been obtained from participating institutions. This study's results will inform deliberations at the United Nations General Assembly high-level meeting on non-communicable diseases in 2025. The results will be shared through academic conferences and journals and communicated to the schools and the communities.
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Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, University of Lagos College of Medicine, Lagos, Nigeria
- Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Nqobile Ndimande
- Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | | | | | | | - Marie Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Tony Kayembe-Kitenge
- Higher Institute of Medical Techniques of Lubumbashi, Lubumbashi, Congo (the Democratic Republic of the)
- Lubumbashi University Hospital, Lubumbashi, Congo (the Democratic Republic of the)
| | | | - Ana Mocumbi
- Department of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Jibril Mohammed
- Department of Physiotherapy, Faculty of Allied Health Sciences Bayero University Kano, Kano, Nigeria
| | | | - Elizabete Nunes
- Department of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | | | - Sandra Owusu
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Refiloe Masekela
- Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Kevin Mortimer
- Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Shao M, Liu Z, Liu T. Effects of Family-Supported Healthcare on Children with Asthma. Ther Clin Risk Manag 2024; 20:427-436. [PMID: 39055744 PMCID: PMC11269404 DOI: 10.2147/tcrm.s464826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/30/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Healthcare is essential for asthma control, however, whether family-supported healthcare improves therapeutic effects in childhood asthma remains unclear. Methods The enrolled patients were randomly divided into control and intervention groups. The pulmonary function was evaluated by forced expiratory volume in 1 s as a percentage of forced vital capacity (FEV1/FVC) and fractional exhaled nitric oxide (FeNO). Asthma control and life quality were assessed via a childhood asthma control test and pediatric asthma quality of life questionnaire. Inflammatory cytokines interleukin-6 (IL-6) and interleukin-17 (IL-17) were determined by enzyme-linked immunosorbent assay. Results No significant differences existed in the basic characteristics of asthma children and their parents among two groups. The increase of FEV1/FVC was higher in the intervention group versus the control group (76.47 ± 10.76% vs 69.76 ± 8.88%, p = 0.001 at the time of post-intervention), and the decrease of FeNO was greater in the intervention group (30.43 ± 6.85 bbp vs 35.64 ± 6.62 bbp, p = 0.003 at the time of post-intervention). Family-supported healthcare highly improved asthma control and quality of life in childhood asthma post-treatment. Meanwhile, the inflammatory cytokines IL-17 (118.14 ± 25.79 pg/mL in intervention group vs 142.86 ± 28.68 pg/mL in control group, p = 0.004 at the time of post-intervention) and IL-6 (103.76 ± 23.11 pg/mL in intervention group vs 119.73 ± 22.68 pg/mL in control group, p = 0.009 at the time of post-intervention) significantly decreased by family-supported healthcare intervention. Importantly, acute exacerbation (80.8% in intervention group vs 95.7% in control group, p = 0.030) and rehospitalization cases (88.5% in intervention group vs 100% in control group, p = 0.028) also decreased by family-supported healthcare intervention. Discussion Family-supported healthcare improves pulmonary function and quality of life while alleviates inflammation, acute exacerbation, and rehospitalization in childhood asthma post-routine treatment.
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Affiliation(s)
- Mingyu Shao
- Department of Child Health Care, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
| | - Zhaohong Liu
- Department of Child Health Care, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
| | - Tongtong Liu
- Department of Pediatrics, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
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Kokori E, Olatunji G, Mustapha MJ, Fawehinmi P, Onyia A, Omoworare O, Akinmeji O, Solomon S, Olafimihan A, Ologbe D, Aderinto N. The potential of smart inhaler for asthma management in Sub-Saharan Africa. Ann Med Surg (Lond) 2024; 86:2408-2410. [PMID: 38694290 PMCID: PMC11060201 DOI: 10.1097/ms9.0000000000002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | | | | | | | - Adrian Onyia
- College of Medicine, University of Nigeria, Nsukka
| | - Oluwatobi Omoworare
- Department of Medicine and Surgery, Lagos State University College of Medicine, Lagos
| | - Olufemi Akinmeji
- Department of Medicine and Surgery, Olabisi Onabanjo University Teaching Hospital, Ogun
| | - Samuel Solomon
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | | | - Damilola Ologbe
- William Harvey Hospital, Kennington Rd, Willesborough, Ashford, Kent, UK
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
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Kirenga BJ, Chakaya J, Yimer G, Nyale G, Haile T, Muttamba W, Mugenyi L, Katagira W, Worodria W, Aanyu-Tukamuhebwa H, Lugogo N, Joloba M, Mersha TB, Bekele A, Makumbi F, Mekasha A, Green CL, de Jong C, Kamya M, van der Molen T. The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100209. [PMID: 38328803 PMCID: PMC10847773 DOI: 10.1016/j.jacig.2024.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/29/2023] [Accepted: 09/30/2023] [Indexed: 02/09/2024]
Abstract
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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Affiliation(s)
- Bruce J. Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Jeremiah Chakaya
- Kenya Association of Physicians Against TB and Lung Diseases, Nairobi, Kenya
| | - Getnet Yimer
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - George Nyale
- Kenya Association of Physicians Against TB and Lung Diseases, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Tewodros Haile
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Winters Muttamba
- Makerere University Lung Institute, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Levicatus Mugenyi
- Makerere University Lung Institute, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | | | | | | | - Njira Lugogo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Moses Joloba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Tesfaye B. Mersha
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amsalu Bekele
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Fred Makumbi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Amha Mekasha
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Corina de Jong
- Department of General Practice and Elderly Care, GRIAC-Primary Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Moses Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Thys van der Molen
- Department of General Practice and Elderly Care, GRIAC-Primary Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Zewdie S, Mekuria B, Alemu BK, Bayked EM, NurAhmed Toleha H, Ayenew W, Andargie A. Prevalence of medication adherence among adult asthmatic patients in four African countries: A systematic review and meta-analysis. World Allergy Organ J 2024; 17:100870. [PMID: 38304621 PMCID: PMC10831257 DOI: 10.1016/j.waojou.2024.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
Non-adherence to medications has many deleterious effects including poor treatment outcomes, increased economic burden, increased morbidity, hospitalization rate, health care utilization, productivity loss, and mortality. Therefore, this review aimed to estimate the pooled prevalence of medication adherence among asthmatic adults in 4 African countries. Primary studies were extensively searched from databases such as PubMed, HINARI, Cochrane Library, CINHALand, Google Scholar, and Google search engines. After screening and assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Chocran's Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of medication adherence among adult asthmatic patients in Africa. Sub-group analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test. A sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The review was performed among 16 studies of which 14 were cross-sectional with a total of 4019 participants. The pooled random effects prevalence of adherence to medications among adult patients with asthma in Africa was 39% (95% CI: 32, 47; p < 0.001) with a heterogeneity (I2 = 94.82, p < 0.001). The pooled prevalence of medication adherence among adult asthmatic patients in Africa is low. Researchers should conduct further multicenter longitudinal studies by using objective methods of adherence measurement.
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Affiliation(s)
- Segenet Zewdie
- Department of Pharmacy, Injibara University, Injibara, Ethiopia
| | | | | | | | | | - Wondim Ayenew
- Department of Pharmaceutics, University of Gondar, Gondar, Ethiopia
| | - Assefa Andargie
- Department of Public Health, Injibara University, Injibara, Ethiopia
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Tashiro H, Kurihara Y, Kuwahara Y, Takahashi K. Impact of obesity in asthma: Possible future therapies. Allergol Int 2024; 73:48-57. [PMID: 37659887 DOI: 10.1016/j.alit.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 09/04/2023] Open
Abstract
Obesity is one of the factors associated with the severity of asthma. Obesity is associated with aggravation of the pathophysiology of asthma, including exacerbations, airway inflammation, decreased pulmonary function, and airway hyperresponsiveness. The present review addresses the characteristics of asthma with obesity, focusing especially on the heterogeneity caused by the degree of type 2 inflammation, sex differences, the onset of asthma, and race differences. To understand the severity mechanisms in asthma and obesity, such as corticosteroid resistance, fatty acids, gut microbiome, and cytokines, several basic research studies are evaluated. Finally, possible future therapies, including weight reduction, microbiome-targeted therapies, and other molecular targeted therapies are addressed. We believe that the present review will contribute to better understanding of the severity mechanisms and the establishment of novel treatments for severe asthma patients with obesity.
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Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
| | - Yuki Kurihara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuki Kuwahara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Tashiro H, Takahashi K, Uchida M, Kurihara Y, Sadamatsu H, Takamori A, Kimura S, Sueoka-Aragane N. Effect of Azithromycin on Exacerbations in Asthma Patients with Obesity: Protocol for a Multi-Center, Prospective, Single-Arm Intervention Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1861. [PMID: 36767227 PMCID: PMC9915079 DOI: 10.3390/ijerph20031861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Obesity is associated with severe asthma, but no specific treatment has been established. The gut microbiome is increasingly recognized as a crucial factor, but specific treatments focused on the gut microbiome have not been established. Recently, azithromycin has been found to have the capacity to attenuate exacerbations, a characteristic of severe asthma. The effect of azithromycin on obesity-induced severe asthma is not understood. METHODS The purpose of the present study is to clarify the effect of azithromycin on exacerbations in asthmatic patients with obesity. To explore the mechanism, the gut microbiome, metabolites of microbes such as short-chain fatty acids, and blood inflammatory cytokines will be analyzed to evaluate the correlation with the effect of azithromycin on exacerbations in obesity-induced severe asthma. A multi-center, prospective, single-arm intervention study is planned. DISCUSSION The present study will allow us to evaluate the effect of azithromycin on exacerbations, particularly in asthma patients with obesity, and explore biomarkers, targeting molecules including the gut microbiome, which are correlated with decreased exacerbations. The present results could contribute to identifying new therapeutic prospects and targeted microbes or molecules associated with severe clinical characteristics in asthmatic patients with obesity. TRIAL REGISTRATION This study has been registered as a prospective study with the University Hospital Medical Information Network (UMIN0000484389) and the Japan Registry of Clinical Trials (jRCTs071220023).
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Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 8498501, Japan
- TARGET Investigator Group, Saga 8498501, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 8498501, Japan
- TARGET Investigator Group, Saga 8498501, Japan
| | - Masaru Uchida
- TARGET Investigator Group, Saga 8498501, Japan
- Division of Internal Medicine, Japan Community Health Care Organization Saga Central Hospital, Saga 8498522, Japan
| | - Yuki Kurihara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 8498501, Japan
- TARGET Investigator Group, Saga 8498501, Japan
| | - Hironori Sadamatsu
- TARGET Investigator Group, Saga 8498501, Japan
- Division of Respiratory Medicine, Saga Prefectural Medical Center Koseikan, Saga 8408571, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga 8498501, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 8498501, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 8498501, Japan
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Stepped treatment algorithm using budesonide-formoterol for chronic respiratory diseases: A single arm interventional study. PLoS One 2022; 17:e0271178. [PMID: 35816478 PMCID: PMC9273083 DOI: 10.1371/journal.pone.0271178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background While the safety and efficacy of inhaled budesonide-formoterol, used as-needed for symptoms, has been established for patients with asthma, it has not been trialed in undifferentiated patients with chronic respiratory diseases. We aimed to assess the feasibility of a pragmatic intervention that entails a stepped algorithm using inhaled budesonide-formoterol (dry powder inhaler, 160μg/4.5μg per dose) for patients presenting with chronic respiratory diseases to three rural district hospitals in Hanoi, Vietnam. Methods We recruited patients with evidence of airflow obstruction on spirometry and/or symptoms consistent with asthma. The algorithm consisted of three steps: 1. as-needed inhaled budesonide-formoterol for symptoms, 2. maintenance plus as-needed inhaled budesonide-formoterol, and 3. referral to a higher-level healthcare facility. All participants started at step 1, with escalation to the next step at review visits if there had been exacerbation(s) or inadequate symptom control. Patients were followed for 12 months. Results Among 313 participants who started the treatment algorithm, 47.2% had ≥ 1 episode of acute respiratory symptoms requiring a visit to hospital or clinic and 35.4% were diagnosed with an exacerbation. Twelve months after enrolment, 50.7% still adhered to inhaled budesonide-formoterol at the recommended treatment step. The mean and median number of doses per day was 1.5 (standard deviation 1.2) doses and 1.3 (interquartile range 0.7–2.3) doses, respectively. The proportion of patients taking more than 800μg budesonide per day was 3.8%. Conclusion This novel therapeutic algorithm is feasible for patients with chronic respiratory diseases in a rural setting in Vietnam. Further studies are required to establish the effectiveness, safety and cost-effectiveness of similar approaches in different settings. Trial registration ACTRN12619000554167.
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Trikamjee T, Comberiati P, Peter J. Pediatric asthma in developing countries: challenges and future directions. Curr Opin Allergy Clin Immunol 2022; 22:80-85. [PMID: 35197428 DOI: 10.1097/aci.0000000000000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Asthma continues to be a significant health problem worldwide, and epidemiological studies in the last few decades have consistently shown a marked increase in childhood asthma prevalence. The International Study of Asthma and Allergies in Childhood (ISAAC) showed significant geographic variability in prevalence, and larger associations with morbidity and mortality in low-middle income countries (LMICs). The Global Burden of Disease estimated that 420,000 deaths occurred globally from asthma in 2016, and although asthma prevalence is higher in high-income countries, most asthma-related mortality occurs in LMICs. The general health of a population is measured, in part, by the under-5 childhood death rate, and developing countries still account for more than 80 percentage of child deaths in the world, highlighting the need for efforts to reduce disease burden in these regions. RECENT FINDINGS The burden of asthma is higher in developing countries and underserved populations. Despite this, LMICs still face many barriers to appropriate allergy and asthma care, resulting in significant morbidity, potentially preventable asthma deaths, and economic consequences. A 2017 survey of 112 countries participating in the Global Asthma Network found that only 26 countries (23%) had a national asthma plan for children, with a lower proportion in LMICs. SUMMARY The rising asthma prevalence and high asthma-related death rates in LMICs suggest that global efforts in improving asthma diagnosis and care are not reaching the most vulnerable communities. Lack of appropriate diagnosis, availability of viable treatment options, and access to specialised care still remain a challenge in many parts of the world. Though barriers to achieving better outcomes differ in specific populations, many LMICs share similar barriers relating to accessibility.
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Affiliation(s)
- Thulja Trikamjee
- Allergy Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jonny Peter
- Allergy Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Division of Allergy and Clinical Immunology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Skevaki C, Ngocho JS, Amour C, Schmid-Grendelmeier P, Mmbaga BT, Renz H. Epidemiology and management of asthma and atopic dermatitis in Sub-Saharan Africa. J Allergy Clin Immunol 2021; 148:1378-1386. [PMID: 34715154 DOI: 10.1016/j.jaci.2021.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Sub-Saharan Africa (SSA) is currently undergoing a transformation process of unprecedented magnitude owing to economic development and urbanization. This process is paralleled by a dramatic increase in prevalence and incidence of noncommunicable diseases. In this article we analyze the current situation with regard to 1 group of the earliest noncommunicable diseases in a person's life, namely, allergies and asthma. This article provides an update on the epidemiology, availability, and access to management strategies by patients experiencing bronchial asthma or atopic dermatitis in SSA. Despite all of the progress, there is still a tremendous need to support education and training, transfer of resources, and cooperation with pharmaceutical and diagnostic companies to achieve adequate treatment and sustainability in SSA with regard to allergy, asthma, and eczema management.
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Affiliation(s)
- Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps Universität Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | - James S Ngocho
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Caroline Amour
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Blandina T Mmbaga
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Harald Renz
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps Universität Marburg, Member of the German Center for Lung Research, Marburg, Germany; Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia.
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12
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Rocha CBD, Nascimento APC, Silva AMCD, Botelho C. [Uncontrolled asthma in children and adolescents exposed to pesticides in an area of intense agribusiness activity]. CAD SAUDE PUBLICA 2021; 37:e00072220. [PMID: 34133636 DOI: 10.1590/0102-311x00072220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze factors associated with uncontrolled asthma in schoolchildren exposed to pesticides in a medium-sized municipality in the state of Mato Grosso, Brazil. This was a case-control study of children 6 to 7 and 13 to 14 years old in Primavera do Leste, in 2016. Cases were defined as schoolchildren that met the criteria for uncontrolled asthma based on International Study of Asthma and Allergies in Childhood (ISAAC) questions, and controls were selected from the same schools as the cases, after randomization, at a 1:1 ratio. Data collection used the questionnaires from Phases I and II of ISAAC and an additional questionnaire on pesticide exposure. Descriptive, bivariate, and logistic da e regression analyses were performed with the individual and environmental sociodemographic, and economic variables. 319 cases and 319 controls were selected, totaling 638 participants in the study. In the final da logistic model, the variables family income greater than 4 minimum wages (OR = 14.36; 95%CI: 8.89-23.20), maternal schooling up to incomplete secondary (OR = 16.32; 95%CI: 8.96-29.75), prematurity (OR = 13.25; 95%CI: 4.83-36.41), and low birthweight (OR = 17.08; 95%CI: 5.52-52.90) remained associated with uncontrolled asthma. Of the pesticide exposure variables, presence of household member working in agriculture (OR = 5.91; 95%CI: 2.11-16.53), living near farming activities (OR = 3.98; 95%CI: 1.47-11.76), and spraying areas near the household (OR = 4.20; 95%CI: 1.49-11.87) were related to the outcome. In this study, pesticides and sociodemographic, neonatal, and childhood conditions proved related to uncontrolled asthma in schoolchildren.
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13
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Rylance S, Chinoko B, Mnesa B, Jewell C, Grigg J, Mortimer K. An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial. Thorax 2021; 76:434-440. [PMID: 33479040 PMCID: PMC8070641 DOI: 10.1136/thoraxjnl-2020-216065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Shortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles. METHODS We conducted a non-blinded individually randomised controlled trial at a tertiary-level government hospital in Blantyre, Malawi. Children aged 6-15 years diagnosed with asthma were recruited from outpatient clinic, stratified by Childhood Asthma Control Test (cACT) score and allocated 1:1 from a concealed file, accessed during electronic questionnaire completion. The intervention, delivered by non-physicians, comprised clinical assessment, optimisation of inhaled treatment, individualised asthma education. The control group received standard care from outpatient physicians. Primary outcome for intention-to-treat analysis was change in cACT score at 3 months. Secondary outcomes included asthma exacerbations requiring emergency healthcare and school absence. FINDINGS Between September 2018 and December 2019, 120 children (59 intervention; 61 control) were recruited; 65.8% males, with mean (SD) age 9.8 (2.8) years, mean (SD) baseline cACT 20.3 (2.6). At 3 months, intervention children (n=56) had a greater mean (SD) change in cACT score from baseline (2.7 (2.8) vs 0.6 (2.8)) compared with standard care participants (n=59); a difference of 2.1 points (95% CI: 1.1 to 3.1, p<0.001). Fewer intervention children attended emergency healthcare (7.3% vs 25.4%, p=0.02) and missed school (20.0% vs 62.7%, p<0.001) compared with standard care children. INTERPRETATION The intervention resulted in decreased asthma symptoms and exacerbations. Wider scale-up could present substantial benefits for asthmatic patients in resource-limited settings. TRIAL REGISTRATION NUMBER PACTR201807211617031.
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Affiliation(s)
- Sarah Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Beatrice Chinoko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Bright Mnesa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Jonathan Grigg
- Centre for Child Health, Queen Mary University London, London, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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14
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Fletcher MJ, Tsiligianni I, Kocks JWH, Cave A, Chunhua C, Sousa JCD, Román-Rodríguez M, Thomas M, Kardos P, Stonham C, Khoo EM, Leather D, van der Molen T. Improving primary care management of asthma: do we know what really works? NPJ Prim Care Respir Med 2020; 30:29. [PMID: 32555169 PMCID: PMC7300034 DOI: 10.1038/s41533-020-0184-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.
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Affiliation(s)
- Monica J Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janwillem W H Kocks
- General Practitioners Research Institute, 59713 GH, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Andrew Cave
- Department of Family Medicine, 6-10 University Terrace, University of Alberta, Edmonton, AB, T6G 2T4, Canada
| | - Chi Chunhua
- Peking University First Hospital, Beijing, China
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- 33ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Miguel Román-Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Mike Thomas
- Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, SO16 5ST, UK
| | - Peter Kardos
- Respiratory, Allergy and Sleep Unit at Red Cross Maingau Hospital, Friedberger Anlage 31-32, 60316, Frankfurt, Germany
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - David Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Nantanda R, Kayingo G, Jones R, van Gemert F, Kirenga BJ. Training needs for Ugandan primary care health workers in management of respiratory diseases: a cross sectional survey. BMC Health Serv Res 2020; 20:402. [PMID: 32393227 PMCID: PMC7212561 DOI: 10.1186/s12913-020-05135-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 03/20/2020] [Indexed: 11/12/2022] Open
Abstract
Background Respiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention and capacity for management of chronic respiratory diseases in the health programmes. This survey assessed gaps in knowledge and skills among healthcare workers in managing respiratory illnesses. Methods A cross sectional study was conducted among primary care health workers, specialist physicians and healthcare planners to assess gaps in knowledge and skills and, training needs in managing respiratory illnesses. The perspectives of patients with respiratory diseases were also sought. Data were collected using questionnaires, patient panel discussions and review of pre-service training curricula for clinicians and nurses. Survey Monkey was used to collect data and descriptive statistical analysis was undertaken for quantitative data, while thematic content analysis techniques were utilized to analyze qualitative data. Results A total of 104 respondents participated in the survey and of these, 76.9% (80/104) were primary care health workers, 16.3% (17/104) specialist clinicians and 6.7% (7/104) healthcare planners. Over 90% of the respondents indicated that more than half of the patients in their clinics presented with respiratory symptoms. More than half (52%) of the primary care health workers were not comfortable in managing chronic respiratory diseases like asthma and COPD. Only 4% of them were comfortable performing procedures like pulse oximetry, nebulization, and interpreting x-rays. Majority (75%) of the primary care health workers had received in-service training but only 4% of the sessions focused on respiratory diseases. The pre-service training curricula included a wide scope of respiratory diseases, but the actual training had not sufficiently prepared health workers to manage respiratory diseases. The patients were unsatisfied with the care in primary care and reported that they were often treated for the wrong illnesses. Conclusions Respiratory illnesses contribute significantly to the burden of diseases in primary care facilities in Uganda. Management of patients with respiratory diseases remains a challenge partially because of inadequate knowledge and skills of the primary care health workers. A training programme to improve the competences of health workers in respiratory medicine is highly recommended.
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Affiliation(s)
- Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | | | - Rupert Jones
- Peninsula Medical School, Plymouth University, Plymouth, UK
| | - Frederik van Gemert
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Bruce J Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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16
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Mpairwe H, Tumwesige P, Namutebi M, Nnaluwooza M, Katongole T, Tumusiime J, Apule B, Onen C, Mukasa M, Kahwa J, Webb EL, Pearce N, Elliott AM. Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study. Wellcome Open Res 2019; 4:168. [PMID: 32656365 PMCID: PMC7327727 DOI: 10.12688/wellcomeopenres.15460.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.
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Affiliation(s)
- Harriet Mpairwe
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Pius Tumwesige
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Milly Namutebi
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Marble Nnaluwooza
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Tonny Katongole
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Josephine Tumusiime
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Barbara Apule
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Caroline Onen
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Mike Mukasa
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Joseph Kahwa
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Neil Pearce
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Alison M Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Box 49, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
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17
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McDonald VM, Gibson PG. Treatable traits and their application in high-, middle- and low-income countries. Respirology 2019; 24:942-943. [PMID: 31222869 DOI: 10.1111/resp.13626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Vanessa M McDonald
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.,Viruses, Immunology, Vaccines, Asthma (VIVA) programme, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.,Viruses, Immunology, Vaccines, Asthma (VIVA) programme, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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18
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FitzGerald JM, Al Efraij K. Asthma in low-income and middle-income countries: an urgent call to action. Thorax 2018; 73:898-899. [PMID: 29777061 DOI: 10.1136/thoraxjnl-2018-211718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 11/04/2022]
Affiliation(s)
- J Mark FitzGerald
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Khalid Al Efraij
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
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