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Al-Moamary MS, Alhaider SA, Allehebi R, Idrees MM, Zeitouni MO, Al Ghobain MO, Alanazi AF, Al-Harbi AS, Yousef AA, Alorainy HS, Al-Hajjaj MS. The Saudi initiative for asthma - 2024 update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2024; 19:1-55. [PMID: 38444991 PMCID: PMC10911239 DOI: 10.4103/atm.atm_248_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 03/07/2024] Open
Abstract
The Saudi Initiative for Asthma 2024 (SINA-2024) is the sixth version of asthma guidelines for the diagnosis and management of asthma for adults and children that was developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up-to-date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA Panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5-12 years, and children aged <5 years. SINA guidelines have focused more on personalized approaches reflecting a better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.
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Affiliation(s)
- Mohamed Saad Al-Moamary
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami A. Alhaider
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riyad Allehebi
- Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majdy M. Idrees
- Department of Medicine, Respiratory Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed O. Al Ghobain
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah F. Alanazi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Adel S. Al-Harbi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah A. Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan S. Alorainy
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Paediatrics, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Al Zaabi A, Busaidi N, Al Mutairy S, Yorgancıoğlu A, Aksu K, Al-Jahdali H, Wali S, Elsayed M, Beekman MJ. Overprescription of short-acting β 2-agonists is associated with poor asthma symptom control: results from five Middle Eastern countries included in the SABINA International (III) study. Expert Rev Respir Med 2022; 16:833-847. [PMID: 35848074 DOI: 10.1080/17476348.2022.2099841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although short-acting β2-agonist (SABA) overuse is associated with poor treatment outcomes, data on SABA use in the Middle East are lacking. RESEARCH DESIGN AND METHODS In this cross-sectional study in patients (aged ≥12 years) with asthma, data on disease characteristics and asthma treatments were collected from the Middle Eastern cohort of the SABA use IN Asthma (SABINA) III study. Patients were classified by investigator-defined asthma severity and practice type. Multivariable regression models analyzed the association between SABA prescriptions and clinical outcomes. RESULTS Of 1389 patients (mean age, 46.7 years; female, 69.5%), 85.7% had moderate-to-severe asthma and 88.7% were treated by specialists. Overall, 51.3% of patients experienced ≥1 severe asthma exacerbation in the previous 12 months, with 58.2% having partly controlled or uncontrolled asthma. Notably, 47.1% of patients were prescribed ≥3 SABA canisters (considered overprescription). SABA canisters were purchased over the counter by 15.3% of patients. Higher SABA prescriptions (vs 1-2 canisters), except 3-5 canisters, were associated with increased odds of uncontrolled asthma (p<0.05). CONCLUSIONS SABA overprescription occurred in almost half of all patients in the Middle East, underscoring the need for healthcare providers and policymakers to adhere to the latest evidence-based recommendations to address this public health concern.
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Affiliation(s)
| | | | | | | | - Kurtuluş Aksu
- Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | | | - Siraj Wali
- King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
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Over-prescription of short-acting β 2-agonists and asthma management in the Gulf region: a multicountry observational study. Asthma Res Pract 2022; 8:3. [PMID: 35799290 PMCID: PMC9260980 DOI: 10.1186/s40733-022-00085-5] [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: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background The overuse of short-acting β2-agonists (SABA) is associated with poor asthma control. However, data on SABA use in the Gulf region are limited. Herein, we describe SABA prescription practices and clinical outcomes in patients with asthma from the Gulf cohort of the SABA use IN Asthma (SABINA) III study. Methods In this cross-sectional study conducted at 16 sites across Kuwait, Oman, and the United Arab Emirates, eligible patients (aged ≥ 12 years) with asthma were classified based on investigator-defined disease severity guided by the 2017 Global Initiative for Asthma report and by practice type, i.e., respiratory specialist or primary care physician. Data on demographics, disease characteristics, and prescribed asthma treatments, including SABA, in the 12 months prior to a single, prospective, study visit were transcribed onto electronic case report forms (eCRFs). All analyses were descriptive in nature. Continuous variables were summarized by the number of non-missing values, given as mean (standard deviation [SD]) and median (range). Categorical variables were summarized by frequency counts and percentages. Results This study analyzed data from 301 patients with asthma, 54.5% of whom were treated by respiratory specialists. Most patients were female (61.8%), with a mean age of 43.9 years, and 84.4% were classified with moderate-to-severe disease, with a mean (SD) asthma duration of 14.8 (10.8) years. Asthma was partly controlled or uncontrolled in 51.2% of patients, with 41.9% experiencing ≥ 1 severe exacerbation in the 12 months preceding their study visit. Overall, 58.5% of patients were prescribed ≥ 3 SABA canisters, 19.3% were prescribed ≥ 10 canisters, and 13.3% purchased SABA over-the-counter (OTC) in the 12 months before the study visit. Most patients who purchased OTC SABA (92.5%) also received SABA prescriptions. Inhaled corticosteroid/long-acting β2-agonist combinations and oral corticosteroid bursts were prescribed to 87.7% and 22.6% of patients, respectively. Conclusions SABA over-prescription was highly prevalent in the Gulf region, compounded by purchases of nonprescription SABA and suboptimal asthma-related outcomes. Increased awareness among policymakers and healthcare practitioners is needed to ensure implementation of current, evidence-based, treatment recommendations to optimize asthma management in this region. Trial registration NCT03857178 (ClinicalTrials.gov). Supplementary Information The online version contains supplementary material available at 10.1186/s40733-022-00085-5.
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Zeitouni MO, Al-Moamary MS, Coussa ML, Riachy M, Mahboub B, AlHuraish F, Zidan MH, Metwally MM, Aksu K, Yavuz E, Kalla IS, Chakaya J, Abdelmadjid S, Ghedira H. Challenges and recommendations for the management of asthma in the Middle East and Africa. Ann Thorac Med 2022; 17:71-80. [PMID: 35651897 PMCID: PMC9150662 DOI: 10.4103/atm.atm_469_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/18/2022] [Indexed: 11/04/2022] Open
Abstract
Clinical presentation of asthma is variable, and its diagnosis can be a major challenge in routine health-care practice, especially in low-and-middle-income countries. The aim of asthma management is to achieve optimal asthma control and to reduce the risk of asthma exacerbations and mortality. In the Middle East and in Africa (MEA), several patient- and physician-related factors lead to misdiagnosis and suboptimal management of asthma. A panel of experts comprising of specialists as well as general health-care professionals met to identify challenges and provide recommendations for the management of asthma in MEA. The major challenges identified for diagnosis of asthma were lack of adequate knowledge about the disease, lack of specialized diagnostic facilities, limited access to spirometry, and social stigma associated with asthma. The prime challenges for management of asthma in MEA were identified as overreliance on short-acting β-agonists (SABAs), underprescription of inhaled corticosteroids (ICS), nonadherence to prescribed medications, and inadequate insurance coverage for its treatment. The experts endorsed adapting the Global Initiative for Asthma guidelines at country and regional levels for effective management of asthma and to alleviate the overuse of SABAs as reliever medications. Stringent control over SABA use, discouraging over-the-counter availability of SABA, and using as-needed low-dose ICS and formoterol as rescue medications in mild cases were suggested to reduce the overreliance on SABAs. Encouraging SABA alone-free clinical practice in both outpatient and emergency department settings is also imperative. We present the recommendations for the management of asthma along with proposed regional adaptations of international guidelines for MEA.
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Affiliation(s)
- Mohamed Omar Zeitouni
- Pulmonary Medicine and Critical Care, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed Saad Al-Moamary
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Marie Louise Coussa
- Division of Pulmonary Diseases, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Moussa Riachy
- Department of Pulmonary and Critical Care Medicine, Hotel Dieu De France Hospital, Beirut, Lebanon
| | - Bassam Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai Academic City, United Arab Emirates
| | - Fatma AlHuraish
- Respiratory Unit, Department of Internal Medicine, Al Sabah Hospital, Ministry of Health, Kuwait
| | - Mohamed Helmy Zidan
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Egypt
| | | | - Kurtuluş Aksu
- Clinic of Chest Diseases, Immunology and Allergic Diseases, Ankara Atatürk Chest Diseases and Chest Surgery Hospital, Ankara, Turkey
| | - Erdinç Yavuz
- Department of Family Medicine, Samsun University, Samsun, Turkey
| | - Ismail Sikander Kalla
- Pulmonologist, Suite D2 Ahmed Kathrada Private Hospital, K43 Highway, Lenasisa Ext 8, 1827, South Africa
| | - Jeremiah Chakaya
- Physician, Fourth Floor Room 404 Fortis Suites, Hospital Road, 00100, Nairobi, Kenya
| | - Snouber Abdelmadjid
- Chest Clinic, Faculty of Medicine, CHU ORAN University of Oran, Oran, Algeria
| | - Habib Ghedira
- Department of Pathology, CHU Abderrahmen Mami, Ariana, Tunisia
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Ladner J, Alshurafa S, Madi F, Nofal A, Jayasundera R, Saba J, Audureau E. Factors impacting self-management ability in patients with chronic diseases in the United Arab Emirates, 2019. J Comp Eff Res 2021; 11:179-192. [PMID: 34806911 DOI: 10.2217/cer-2021-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Poor adherence to chronic disease therapy is a critical global problem that negatively effects the long-term therapy for chronic diseases, resulting in negative population health and economic effects. The WHO multidimensional model proposed a systems-based approach for improving adherence to chronic disease therapy. Patients & methods: In the current study, the WHO five-dimension framework was used to evaluate factors among, chronic-disease patients in the United Arab Emirates. Results: We show that patient's understanding of disease, involvement in treatment decision, age more than 40 years, time spent with physician and fear of how patients were perceived by others were the most predictive factors associated with a high ability to self-manage a chronic disease. Conclusion: Sociocultural factors have an indirect impact on disease self-management.
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Affiliation(s)
- Joel Ladner
- Department of Epidemiology & Health Promotion, Rouen University Hospital, Rouen, France
| | | | | | | | | | | | - Etienne Audureau
- Clinical Epidemiology and Ageing, Paris Est Université, Hôpital Henri Mondor Hôpital, Public Heath, Assistance Publique Hôpitaux de Paris, Créteil, France
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Sileem AE, Ali A, Elnahas H, Gouda AM. Comparing the Asthma Control and Anti-inflammatory Effects of Different Fixed Combinations of Inhaled Corticosteroids Plus Long-acting Beta 2 Agonist; A Randomized Clinical Trial. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Asthma is the most common chronic inflammatory disease of the pulmonary system. The prevalence of asthma is growing enormously worldwide posing a significant health and economic burden. Asthma treatment guidelines recommend a combination of inhaled corticosteroid (ICS) and long-acting beta 2 agonist (LABA). However, there is little guidance for clinicians on selecting a specific ICS/LABA combination.
Aim: To compare the effectiveness of three fixed dose ICS/LABA combination therapies i.e., fluticasone/salmeterol, fluticasone/formoterol and budesonide/formoterol for the management of moderate to severe asthma.
Design: This was a prospective interventional, three-armed, parallel group, open label, and randomized clinical trial
Methods: Adult asthmatic patients of both genders (n=135) were randomly allocated to the three ICS/LABA treatment groups: fluticasone/salmeterol-treated group (n=45) , fluticasone/formoterol-treated group (n=45) and budesonide/formoterol-treated group (n=45). All groups were treated for three months. The main outcome parameters included lung function (FEV1, FEV1%, FEV1/FVC), inflammatory state (hs-CRP, ECP) and asthma control (ACT).
Results: After 3 months of treatment, fluticasone/formoterol significantly increased FEV1 compared to fluticasone/salmeterol (p<0.01) and FEV1% compared to budesonide/formoterol (p<0.01). Both fluticasone-containing combinations significantly increased FEV1/FVC (p<0.001, p<0.001), decreased serum hs-CRP (p<0.01, p<0.001), and serum ECP (p<0.05, p<0.001) and improved ACT (p<0.05, p<0.01) compared to budesonide. Fluticasone/formoterol significantly reduced ECP in comparison to fluticasone/salmeterol (p<0.05).
Conclusion: Our study showed a superiority for fluticasone-containing combinations over budesonide for the treatment of moderate to severe asthma. Within the former combinations, fluticasone/formoterol was better than fluticasone/salmeterol.
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