Asthma prevalence among adults in Saudi Arabia

Breastfeeding Versus Bottle Feeding and Risk of Bronchial Asthma in Children in Tabuk Area, Saudi Arabia: A Cross-Sectional Study

Introduction Asthma is a common chronic airway disorder, particularly among children in Saudi Arabia, with an increasing global prevalence. Limited epidemiological studies in the region indicate variable asthma rates, potentially influenced by factors such as modernization and environmental changes. Given the potential health benefits of breastfeeding, it is critical to investigate the relationship between type of feeding, and asthma risk. This study aims to assess the relationship between breastfeeding and bottle-feeding practices and the risk of developing asthma, as well as to evaluate how breastfeeding practices influence the severity of asthma among children in Tabuk, Saudi Arabia.  Methods A cross-sectional study was conducted among children with bronchial asthma at King Salman Armed Forces Hospital in Tabuk City, Saudi Arabia. The study took place from June to August 2023 using convenient sampling. Data were collected through a validated, structured web-based questionnaire distributed to the parents of children with bronchial asthma. The analysis was performed using SPSS (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Results The study comprised 103 participants, of whom 66 (64.1%) were breastfed. There was no significant association between the severity of asthma and breastfeeding practices, including the initiation time, duration, or the age at which formula milk was introduced, as well as the combination of breastfeeding with bottle feeding. However, paternal smoking was significantly associated with asthma (p = 0.003), with 78.5% of children with smoking fathers affected compared to 50% of those without smoking fathers. In the multivariate analysis, having a father employed in the health sector (p = 0.040) and a maternal age over 35 years (p = 0.026) were significantly associated with an increased risk of asthma. Other factors, such as the child's age, gender, birth order, monthly income, parental education, family size, type of accommodation, and maternal diet during pregnancy, did not demonstrate significant associations with asthma. Conclusion Our study underscores the significant role of paternal smoking and specific parental sociodemographic factors, such as having a father employed in the health sector and maternal age over 35 years, in influencing the risk of childhood asthma. While breastfeeding practices, including duration and method, were not significantly associated with asthma severity, understanding these key risk factors can aid in developing targeted interventions for asthma prevention and management.

The effect of salbutamol sulphate inhalation (an anti-asthmatic medication) on the surfaces of orthodontic Archwires

OBJECTIVES

This study aimed to compare the surface roughness and friction of different orthodontic archwires after exposure to salbutamol sulphate inhalation, an anti-asthmatic medication.

METHODS

Orthodontic archwires (stainless-steel [StSt], nickel-titanium [NiTi], beta-titanium [β-Ti], and copper-NiTi [Cu-NiTi]) were equally divided into two groups. The exposed groups were subjected to 20 mg salbutamol sulphate for 21 days and kept in artificial saliva. The control groups were only kept in artificial saliva. Surface changes were visualized using scanning electron microscopy (SEM). The average surface roughness (Ra) was evaluated using atomic force microscopy (AFM), and friction resistance forces were assessed using a universal testing machine. Statistical analyses were performed using t-tests and ANOVA followed by post hoc tests.

RESULTS

Salbutamol sulphate did not change the surface roughness of StSt and NiTi archwires (p > .05). However, the change in the surfaces of β-Ti and Cu-NiTi archwires was significant (p < .001). The frictional forces of exposed StSt, NiTi, and Cu-NiTi archwires did not change (p > .05). However, the frictional forces of β-Ti archwires increased significantly after exposure to salbutamol sulphate (p = .021). Brushing with fluoride after exposure to salbutamol sulphate increased the frictional forces of β-Ti only (p = .002).

CONCLUSIONS

Salbutamol sulphate inhalation significantly affected the surface texture of β-Ti and Cu-NiTi orthodontic archwires and increased the friction of β-Ti archwires. These deteriorating effects were not detected on the surface of StSt and NiTi archwires. Therefore, we suggest that β-Ti and copper titanium archwires should be used cautiously in individuals under salbutamol sulphate inhalation treatment.

Asthma medication adherence, control, and psychological symptoms: a cross-sectional study

BACKGROUND

Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control.

METHODS

We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control.

RESULTS

A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted β: -0.25; 95% CI: -0.36 to -0.14; p < 0.001 and adjusted β: -0.29; 95% CI: -0.40 to -0.18; p < 0.001, respectively). A negative relationship was also observed between adherence to inhalers and anxiety and depressive symptoms (adjusted β: -0.34; 95% CI: -0.46 to -0.22; p < 0.001 and adjusted β: -0.36; 95% CI: - 0.48 to - 0.24; p < 0.001, respectively).

CONCLUSIONS

The high prevalence of uncontrolled asthma symptoms and poor adherence to inhalers and their impact on anxiety and depression levels among patients with asthma point to the need for early screening for psychological symptoms and recognition of nonadherence as part of asthma assessment and management plan in primary care in Saudi Arabia to avoid further worsening of asthma symptoms. Further studies are needed to explore the effectiveness of specific psychoeducational interventions and investigate the long-term impact of early psychological symptom detection on asthma outcomes.

The Saudi initiative for asthma - 2024 update: Guidelines for the diagnosis and management of asthma in adults and children

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.

Asthma Prevalence Among Adults in Qassim Region, Saudi Arabia

BACKGROUND

Asthma is a major non-communicable disease affecting both children and adults and is the most common chronic disease among children. It has a significant effect on patient's daily lives, as well as a big economic impact on society, as it affects 262 million people of the population globally. According to the previous research conducted in the Aseer region in southwestern Saudi Arabia, the prevalence rate of bronchial asthma was found to be 19.2%. Also, a number of studies revealed a significant prevalence of asthma in Saudi Arabia. Therefore, it is simple and effective to measure specific asthma symptoms among the adult population by utilizing the European Community Respiratory Health Survey (ECRHS) criteria.

OBJECTIVES

To investigate asthma prevalence and measure asthma symptoms among Saudi adults in Qassim, Saudi Arabia using the ECRHS.

METHODS

This cross-sectional study targets the males and females living in the Qassim region of Saudi Arabia. The study was conducted by handing out a validated, self-administered questionnaire among adult male and female patients in the Qassim region of Saudi Arabia. Both descriptive and inferential statistics analyses were conducted. To test the association, both chi-square and Fisher's exact tests were carried out. For the test, a p-value less than 0.05 was considered statistically significant.

RESULTS

The study involved 461 participants who met the inclusion criteria. The study found that 137 (29.9%) participants reported having tightness in their chests when they woke up. Among the respondents who reported these symptoms were 83 (60.1%) female and 55 (39.9%) male respondents. This shows a statistically significant difference between the gender and severity of chest tightness upon waking up (p = 0.008) with more females experiencing it than the male gender. More so, there was a statistically significant difference between the gender and severity of shortness of breath (p = 0.008), with more females (81, 60.4%) having the symptoms than the male gender (53, 39.6%). In addition, the study results reveal statistically significant gender differences among the patients who were diagnosed with asthma by the physician (p = 0.003), with more males (51, 65.4%) having been diagnosed than the female gender (27, 34.6%). Asthma attacks in the 12 months (p = 0.047) and the use of tobacco products (p = 0.001) were also found to have a statistically significant difference across the genders. This was shown by most males (26, 65.0%) who had asthma attacks in the 12 months and 70 (98.6%) who smoked any tobacco products than the few females (14, 35.0%) who reported to have had asthma attacks in the 12 months and one (1.4%) who reported smoking any tobacco products.

CONCLUSION

This study noted that the prevalence of asthma symptoms varied based on the gender of the participants. Therefore, the study suggests that gender should be taken as an important factor while evaluating the severity and how asthma-related symptoms manifest.

The Association of Asthma with Anxiety, Depression, and Mild Cognitive Impairment among Middle-Aged and Elderly Individuals in Saudi Arabia

Asthma is a common chronic inflammatory condition with increasing global prevalence. There is some evidence highlighting the effect of asthma on brain functioning. In Saudi Arabia, limited studies have examined the relationship between asthma and mental health, including cognition and mood disorders in older adults in particular. In this study, we examine the association between asthma and mental health outcomes in middle-aged and elderly individuals in Riyadh, Saudi Arabia. In a cross-sectional study, 243 subjects were recruited from outpatient clinics between 2020-2021 (non-asthmatic: n = 159, asthmatic: n = 84). The Montreal Cognitive Assessment test, the Hospital Anxiety and Depression Scale, and the Asthma Control Test were used to assess cognition, anxiety and depression, and asthma control, respectively. Logistic regression analysis while controlling for covariates revealed an association between asthma and symptoms of anxiety and depression (OR = 2.40 [95% CI: 1.07-5.35]) and mild cognitive impairment (MCI) (OR = 1.80 [95% CI: 1.00-3.24]). Poorly controlled asthma increased the odds of anxiety cases (OR = 4.88 [95% CI: 1.09-17.2]). Stratifying analysis by age intervals revealed that asthma was associated with symptoms of anxiety and depression (OR = 2.5 [95% CI: 1.00-6.08]) in middle-aged patients only, while elderly asthmatics had increased odds of having MCI (OR = 7.4 [95% CI: 2.34-23.31]). These findings highlight the possible effects of asthma and its control on mental health among middle-aged and elderly individuals in Saudi Arabia.

Validation of the Arabic Version of the European Community Respiratory Health Survey Screening Questionnaire

Purpose

The European Community Respiratory Health Survey (ECRHS) questionnaire has been widely used in epidemiological studies to quantify respiratory symptoms and screen for asthma, but there is no formally validated Arabic version. This study developed an Arabic ECRHS screening questionnaire, comprehensively evaluated its reliability and validity, and used it to estimate the population prevalence of respiratory symptoms and asthma in Saudi Arabia.

Methods

The ECRHS screening questionnaire was adapted to Arabic through translation and back-translation by bilinguals with consultation to a professional committee and lay panel. Reliability and validity were evaluated in a prospective, cross-sectional convenience sample of adults (>18 years) between January and July 2022 in Riyadh, Saudi Arabia. A subgroup completed the questionnaire again three weeks later to assess test-retest reliability. All respiratory symptom-positive participants were invited for spirometry to diagnose asthma according to GINA criteria. Internal consistency was assessed using Cronbach's α coefficient, test-retest reliability with Cohen κ coefficients, and reliability by calculating the sensitivity and specificity for diagnosing asthma.

Results

Of 2500 invited individuals, 1881 participated (75.2%). A total of 668 (35.5%) participants reported respiratory symptoms according to the ECRHS questionnaire, and 157/1881 (8.3%) had a current diagnosis of asthma on ECRHS questions. Cronbach's α coefficient for internal consistency was 0.831, "good" internal consistency. The test-retest reliability (n = 303) was "excellent" for all questions (Cohen's κ≥0.75). A total of 543 (81.3%) screening-positive participants underwent spirometry, of whom 278 (52%) were diagnosed with asthma according to GINA guidelines, an overall estimated prevalence of 14.8%. Most questions showed good-to-fair specificity and variable sensitivity for physician-diagnosed asthma.

Conclusion

This Arabic version of the ECRHS screening questionnaire is conceptually similar to the English version, comprehensible, and reliable. Many asthma cases remain hidden and undiagnosed. In addition to utility in epidemiological studies, the ECRHS screening questionnaire might be a simple, quick, and useful tool for asthma case finding.

Immune cell ratio and coagulation markers in assessing prognosis of asthma: a cross-sectional study from Saudi Arabia

Asthma affects a significant number of individuals in Saudi Arabia, with increasing prevalence worldwide, leading to a considerable impact on their quality of life and frequent hospitalizations. In this study, we aimed to explore the relationship between the immune cell ratio and coagulation markers, specifically to identify the occurrence of coagulation abnormalities associated with asthma. To achieve this, we assessed asthma history and severity using a questionnaire while analyzing coagulation biomarkers through venous blood samples. The biomarkers examined included d-dimer, prothrombin time (PT), partial thromboplastin time (PTT), and the international normalized ratio (INR). In addition, we evaluated various hematological parameters such as blood cell counts and hemoglobin (HGB) levels. Our findings revealed compelling evidence, showing significantly elevated levels of d-dimer and the eosinophil-to-neutrophil (ENR) ratio in asthma cases compared to the controls. Moreover, we observed a positive correlation between d-dimer levels and the ENR, with each unit increase in d-dimer associated with a 0.0006 increase in the ENR among asthma cases. These results highlight the potential of assessing ENR and d-dimer levels as predictive indicators for disease prognosis and the development of coagulation abnormalities in individuals with asthma. By shedding light on the relationship between immune cell ratios and coagulation markers in the context of asthma, our study contributes to a better understanding of disease progression and the associated complications. These insights can potentially lead to improved management strategies and better outcomes for asthma patients.

The impact of unsupervised and unconsented switch of inhalers in patients with controlled asthma - A targeted literature review

Inhaler combination formulations consisting of an inhaled corticosteroid (ICS) (fluticasone propionate) and a long-acting β2 agonist (salmeterol xinafoate) are indicated as maintenance treatments for patients with asthma and/or for selected patients with chronic obstructive pulmonary disease. The emergence of generic equivalents to branded inhalers is expected to offer economic edge/savings; however, some may argue that cost advantages offered by generic inhalers may be offset by worsening outcomes due to improper inhaler use, reduced adherence, and consequently worse disease control. To understand how unsupervised and unconsented switch of dry-powder inhalers and/or metered-dose inhalers affects clinical and humanistic outcomes in asthma, comprehensive searches of Embase and MEDLINE were conducted to identify research articles published in the English language since 2011. Patients with asthma of any age who underwent an unsupervised and unconsented switch from an ICS/long-acting β2 agonist to another (brand-to-generic or brand-to-brand) for non-medical reasons were the target of this research. Relevant outcomes included asthma control, medication adherence, and healthcare resource utilization. In total, 11 studies were identified for review (ten non-interventional and one post hoc); cohorts ranged from 19 to 42,553 patients. Six studies indicated that unsupervised and unconsented inhaler switch had a negative impact on asthma control; six studies indicated reduced medication adherence post-switching; and five studies reporting healthcare resource utilization showed it was unchanged or increased post-switching. Findings from this targeted review support concerns that unsupervised and unconsented inhaler switch has a largely negative impact on asthma-associated outcomes. Additional studies are warranted to further explore unsupervised and unconsented switch in asthma.

Relationship Between Asthma and Headache Attacks in the Qassim Region, Saudi Arabia

BACKGROUND

Headaches are a common complaint among asthma patients. However, there is no study to assess the relationship between asthma and headaches or to assess the prevalence of headaches among asthma patients in Saudi Arabia. We aim to study the relationship between asthma and headaches and also to assess the prevalence of headaches among asthma patients.

RESEARCH METHODOLOGY

We conducted a cross-sectional study among 528 asthmatic patients. Participants were selected through non-probability sampling from the system of four hospitals (King Fahad Specialist Hospital, King Saud Hospital, Buraidah Central Hospital, and Qassim University Hospital). The duration of our study was one year from 11 September 2022 to 14 May 2023. Data collection was performed by using a pre-tested and self-administered questionnaire. Data were analyzed through IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York, United States) by using the chi-square test to assess the relationship between the qualitative variables and independent t-test and ANOVA for comparing the quantitative variables with a significant level set at p-value < 0.05.

RESULTS

Five hundred and twenty-eight asthmatics were studied for demographics, asthma management, and headaches. Most of the patients were male, married, and university-educated. Sixty-one percent had uncontrolled asthma, and 47.3 percent of individuals had headaches, mostly migraines. Uncontrolled asthma was linked to greater headache prevalence. Gender, educational level, and headache type did not affect headache prevalence in demographic and asthma control subgroups. Co-occurring asthma and migraines may benefit from asthma control and treatment.

CONCLUSION

 The research emphasizes the significant frequency of uncontrolled asthma and headaches among asthmatic patients. The association between asthma control and headache prevalence was statistically significant, highlighting the necessity for appropriate management and treatment techniques for both disorders. These findings have significant implications for health care providers and politicians seeking to improve the quality of life for those with asthma and co-occurring headaches.

The Impact of Allergic Rhinitis on Asthma and Its Effect on the Quality of Life of Asthmatic Patients

Background Allergic rhinitis (AR) and asthma are one of the most common diseases in the Kingdom of Saudi Arabia. Asthma and AR patients report significant reductions in their daily activities due to this condition. Therefore, measuring health-related quality of life (HRQOL) in adult asthmatic and AR patients and evaluating the use of allergic rhinitis treatment modalities to improve asthma control may help prevent future respiratory complications, improve patient quality of life, and reduce morbidity. Methods This cross-sectional observational study was conducted through an online self-administrated questionnaire distributed electronically on social media through "Survey Monkey" (http://www.surveymonkey.com) from April 2 to September 18, 2021. The study targeted adult patients with asthma and/or allergic rhinitis residing in the Riyadh region of Saudi Arabia. The study compared and evaluated HRQOL between three groups: asthmatic patients with concomitant AR, patients with asthma only, and patients with AR only. Results A total of 811 questionnaires were analyzed. Of those, 23.1% were diagnosed with asthma and 64% were diagnosed with allergic rhinitis; from those who were diagnosed with AR, 27.2% were asthmatics. A statistically significant association was observed between receiving AR medications and asthma control in respondents with intermittent AR (P < 0.001). However, no association was observed between asthma control and receiving medications for AR in respondents with persistent AR (P = 0.589). The average scores for all eight-item short-form (SF-8) QOL dimensions were lower in patients with combined asthma and AR than in patients with AR only and asthma only (P < 0.001). Conclusions This study suggested that AR was associated with more severe asthma and quality of life impairment.

Association of Asthma Control With Caregivers' Knowledge and Practices for Children With Asthma in the Tabuk Region of Saudi Arabia: A Cross-Sectional Study

Introduction Asthma is a chronic heterogeneous inflammatory disease that affects millions of individuals around the globe. Standardized asthma management is crucial to maintain and control the disease. Caregivers are the leading players in managing asthma during childhood. Studies are lacking in the Tabuk region. The aim of this study was to elucidate knowledge levels and common practices of caregivers of pediatric patients with asthma in the Tabuk region of Saudi Arabia and its impact on asthma control. Methodology A validated cross-sectional survey of the population of the Tabuk region was conducted from July 1, 2022, to September 30, 2022. Convenience sampling via an internet-based questionnaire within the study area was deployed, followed by phone interviews. Results  A total of 393 caregivers completed the questionnaire, and the data were analyzed. The median age of asthmatic children was nine years, and most of them were males (60.8%). Most caregivers had a higher education (62.1%). The symptoms of allergic rhinitis were found in almost 80% of children. Pulmonary function tests were performed in 42.5% of children, and only one-third underwent radioallergosorbent (RAST) skin testing. About half the children had an asthmatic attack and an emergency department visit once during the previous 12 months, and most were hospitalized during that period. Most caregivers showed good knowledge (score=7) about symptoms of asthma and factors that could worsen the child's asthma, as well as good asthma control practices (score ≥7). Children with poorly controlled asthma were younger, had significant allergic rhinitis symptoms (30%), and underwent pulmonary function tests (60%). Conclusion  In the Tabuk region, the extent of asthma control was significantly associated with caregivers' knowledge and practices for children with asthma. Future public education campaigns should focus on closing the observed knowledge and practice gaps to reduce the impact of childhood asthma.

The Prevalence and Impact of Allergic Rhinitis on Asthma Exacerbations in Asthmatic Adult Patients in the Riyadh Region of Saudi Arabia: A Cross-Sectional Study

OBJECTIVES

Allergic rhinitis (AR) and asthma are highly prevalent conditions known to occur concomitantly. However, observational, cross-sectional studies in Saudi Arabia assessing the frequency and severity of rhinitis in asthmatics adults using questionnaires based on guidelines are unavailable. Therefore, this study attempted to investigate this side and evaluate the role of triggers, symptoms, and family history or history of AR on asthma control levels.

METHODS

From April 2nd to September 18th, 2021, this observational cross-sectional study was conducted through an online self-administrated questionnaire that was distributed electronically on social media through the SurveyMonkey website (Momentive Inc., Waterford, NY). The study targeted asthmatic adult patients residing in Riyadh city in Saudi Arabia.

RESULTS

Overall, 187 questionnaires were analyzed. In this study, the frequency of AR in asthmatic patients was 75.5% (95% CI: 74.87-75.4%). Of those, AR was intermittent mild for 15.0%, intermittent moderate to severe for 43.9%, mild persistent for 2.14%, persistent moderate to severe for 14.4%, and 24.6% of patients were without AR. A significant association was observed between asthma control level and the severity of AR (P < 0.001). Moderate to severe persistent AR was more prevalent in patients with uncontrolled asthma (40.6%) than patients with partially controlled (25%) or controlled asthma (2.7%).

CONCLUSIONS

This study suggested that AR was related to more severe asthma and more difficulty in controlling asthma. The frequency significantly increased with the severity of asthma.

Overprescription of short‐acting β 2 ‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Despite near-universal health care and timely updates to treatment guidelines in Saudi Arabia, asthma control remains suboptimal, warranting deeper exploration of its management practices. This study describes asthma characteristics and prescription patterns of short-acting β₂ -agonists (SABAs) in the Saudi Arabia cohort of the SABA use IN Asthma (SABINA) III study. Patients with asthma (aged ≥12 years) from seven sites across Saudi Arabia participated in this cross-sectional study. Asthma severity was classified by study investigators, guided by the 2017 Global Initiative for Asthma (GINA) recommendations. Of 511 patients enrolled, 502 patients, treated by respiratory medicine specialists, were analyzed (mean [standard deviation] age, 47.5 [14.8] years; female, 68.5%). Most patients had moderate-to-severe asthma (89.6%, GINA treatment steps 3-5), were overweight/obese (78.9%), and received full health care reimbursement (83.4%). Asthma was partially controlled/uncontrolled among 64.3% of patients; 62.3% experienced ≥1 severe asthma exacerbation(s), and 60.6% and 41.2% were prescribed ≥3 (overprescription) and ≥10 SABA canisters, respectively, in the 12 months preceding study initiation. Additionally, 21.9% of patients purchased SABA over the counter (OTC), of whom 66.4% purchased ≥3 SABA canisters. Ninety-seven (88.2%) patients who purchased SABA OTC also received SABA prescriptions, and 80.4% and 56.7% of these were prescribed ≥3 and ≥10 SABA canisters, respectively. Overall, compared with SABINA III, a higher percentage of patients from Saudi Arabia were overprescribed SABA (60.6% vs. 38.0%, respectively) and purchased SABA OTC (21.9% vs. 18.0%, respectively), underscoring the need to align asthma treatment practices with current evidence-based recommendations and regulate SABA OTC sales in Saudi Arabia.

Caregiving burden, psychological distress, and individual characteristics among family members providing daily care to patients with chronic conditions

PURPOSE

This study determined the relationship between care burden and psychological distress among 163 family caregivers of patients with chronic conditions.

DESIGN AND METHODS

This was a cross-sectional study. The Zarit Caregiver Burden for Family Caregiver's Support and Kessler Psychological Distress scales were used for data collection. Multivariate analysis was run using SPSS.

FINDINGS

Most participants reported low levels of care burden and psychological distress. A significant association existed between care burden and psychological distress (β = 0.611, p < 0.05).

PRACTICE COMPLICATIONS

It is critical to implement programs to help promote caregivers' understanding of caring and involvement in treatment.

Physicians' Knowledge and Practices Regarding Asthma: A Cross-Sectional Study in Saudi Arabia

Objective

This study aimed to explore the characteristics of knowledge and practice of physicians towards asthma in Saudi Arabia.

Methods

An online cross-sectional study was conducted in Saudi Arabia between 28 August and 10 November 2021. Convenience sampling technique was applied in this study through social media websites. Previously developed 10-items questionnaire was used to assess the knowledge about asthma among the participating physicians. Descriptive statistics were used to describe the participants’ demographic characteristics. Binary logistic regression analysis was conducted to identify factors associated with being adherent to asthma practices guidelines.

Results

Overall, participants’ knowledge was moderate. The average percentage of physicians who reported practicing asthma management based on recommended guidelines 63.7%. Younger age (30–34 years) and having a work experience of (6–10 years) were significant predictors of being adherent to asthma practices guidelines (OR: 1.96 (95% CI: 1.21–3.17) (p=0.006) and OR: 1.67 (95% CI 1.05–2.67) (p=0.031), receptively).

Conclusion

This study showed that the percentage of physicians who reported practicing asthma management based on recommended guidelines in Saudi Arabia are moderate. Future studies to investigate factors associated with improvement in knowledge about asthma and adherence to guidelines are needed.

Blockade of Tyrosine Kinase, LCK Leads to Reduction in Airway Inflammation through Regulation of Pulmonary Th2/Treg Balance and Oxidative Stress in Cockroach Extract-Induced Mouse Model of Allergic Asthma

Asthma is one of the most common inflammatory diseases affecting the airways. Approximately 300 million individuals suffer from asthma around the world. Allergic immune responses in the asthmatic airways are predominantly driven by Th2 cells and eosinophils. Lymphocyte-specific protein tyrosine kinase (LCK) is a non-receptor tyrosine kinase which regulates several key intracellular events through phosphorylation of its substrates. Some of the intracellular signaling pathways activated by LCK phosphorylation help in differentiation of Th2 cells which secrete allergic cytokines that amplify airway inflammation. Therefore, this investigative study was designed to determine the role of LCK in a cockroach extract (CE)-induced airway inflammation murine model of allergic asthma. Further, the effect of a pharmacological LCK inhibitor, A-770041, on allergic airway inflammation and key intracellular pathways in CD4+ T cells was assessed. Our data exhibit that there is an activation of LCK during allergic airway inflammation as depicted by increased p-LCK levels in CD4+ T cells. Activated LCK is involved in the activation of ITK, PLC-γ, GATA3, NFkB, and NFATc1. Activated LCK is also involved in the upregulation of Th2 related cytokines, such as IL-4/IL-5/IL-13 and oxidative stress, and the downregulation of Treg cells. Furthermore, utilization of LCK inhibitor causes the reduction in p-LCK, PLC-γ, GATA3, and NFATc1 as well as Th2 cytokines and oxidative stress. LCK inhibitor causes upregulation of Treg cells in allergic mice. LCK inhibitor also caused a reduction in CE-induced airway inflammation and mucus secretion. Therefore, the inhibition of LCK signaling could be a fruitful approach to adjust allergic airway inflammation through the attuning of Th2/Treg immune responses. This study could lead to the design of newer treatment options for better management of allergic inflammation in asthma.

Gulf Asthma Diagnosis and Management in Adults: Expert Review and Recommendations

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.

Association Between Asthmatic Patients' Asthma Control Test Score and the Number of Exacerbations per Year in King Abdulaziz Medical City, Riyadh

Background Asthma is a reactive airway disease that has a high prevalence across the globe. Asthma exacerbations can occur due to various bacterial and viral infections that irritate nerve endings in the airways. With time, airway obstruction follows, and patients with asthma have various symptoms that occur intermittently. Asthma symptoms primarily include breathlessness, wheezing, coughing, and chest tightness. This research focused on the association between the Asthma Control Test (ACT) score and number of exacerbations per year. Methods  A questionnaire-based, cross-sectional study was conducted at the outpatient pulmonary clinic, King Abdulaziz Medical City, a tertiary hospital in Riyadh. The study included 227 adult patients who were diagnosed with asthma and had no other pulmonary diseases or other medical diseases that could mimic asthma exacerbation. Data was collected by direct interview with the patients and through the BESTCare system in King Abdulaziz Medical City. All the data were collected through Microsoft Excel 2010 (Microsoft, Redmond, WA, USA) and analyzed using Statistical Package for Social Sciences (SPSS) Statistics version 23 (IBM Corp., Armonk, NY, US). The categorical data we used were presented by percentages and frequencies such as gender, whereas the numerical data were prescribed as mean and standard deviation such as age and number of exacerbations. For inferential statistics, Chi square was used to find the association between the categorical variable while T-test and ANOVA test were used to find the relationship between asthma control test score of asthmatic patients, which was divided into three different groups based on their scores that include: well-controlled, partially controlled, or uncontrolled, and the number of exacerbations per year.  Results A total of 227 adult asthma patients were enrolled in this study, most of them were females (72.7%). Average age of the participants was 47.3 ± 13.8 years. The average ACT score was found to be 18.5 ± 4.9 out of 25. Uncontrolled asthma was present in 26% of the patients, 22.9% were partially controlled and 51.1% had well-controlled asthma; to relieve the exacerbation most of the patients used salbutamol (51.5%), 35.2% used oxygen and 30.4% did not use any medication. Gender and age were not associated with ACT score (P = 0.787 and 0.797, respectively), whereas number of exacerbations was significantly associated with ACT score (P = 0.000), as fewer exacerbations were reported with higher ACT scores. Conclusion About one-quarter of the patients had uncontrolled asthma, slightly less than one-quarter of the patients had partially controlled asthma while more than half of the patients had well-controlled asthma. Number of exacerbations was found to be significantly associated with asthma control test score as fewer exacerbations were reported in well-controlled asthmatic patients.

Evaluating the knowledge on microbiome and dysbiosis in allergic diseases among medical sciences students in Saudi Arabia

BACKGROUND

Microbiome science deals with the development of diseases that are derived from the interaction between the host immune system and microbes. Microbiome disturbance or dysbiosis has been increasingly recognized as an important contributor to the pathogenesis of allergic diseases. Thus, this field is pivotal in the management of allergic disorders. Despite the increasing prevalence of allergic disorders in Saudi Arabia, medical students lack knowledge of microbiome science. Therefore, this study aimed to assess the level of knowledge of medical sciences students on the human microbiome, dysbiosis, and management of the impaired microbiome with a focus on allergic diseases and asthma.

METHODS

An online survey was designed, validated, and distributed to 100 final-year students and interns majoring in clinical nutrition, public health, and clinical laboratory sciences at a single university in Saudi Arabia. The study period was from November 2020 to January 2021.

RESULTS

The overall knowledge of the human microbiome was adequate among the participants, but their understanding of dysbiosis and management of the impaired microbiome was low to moderate. Knowledge of dysbiosis management was significantly higher in students majoring in clinical nutrition than in those majoring in public health and clinical laboratory sciences.

CONCLUSIONS

Collectively, this study provides the first evidence that knowledge of specific domains of microbiome science among a cohort of medical sciences students in Saudi Arabia is insufficient. Large-scale studies are warranted to confirm these observations at a national level, and specific curriculum modifications are necessary to improve the knowledge of future healthcare professionals about clinical applications of microbiome science.

Elevated Plasma Levels of CXCL13 Chemokine in Saudi Patients With Asthma Exacerbation

Background: Bronchial asthma is a lung disorder characterized by chronic allergic inflammation of the airways, and several of the immune and non-immune cells contribute to asthma's pathogenicity. B-cell activation plays an essential role in developing allergic inflammation in the lungs. CXCL13 is a potent B-cell chemoattractant chemokine, which has a crucial role in the recruitment and trafficking of B cells after interaction with its receptor CXCR5. This study is aimed to evaluate plasma levels of CXCL13 and its receptor CXCR5 in Saudi patients with asthma exacerbation relative to healthy controls.

Methods: A total of 23 patients with asthma exacerbation and 20 healthy controls participated in this study. Total immunoglobulin E (IgE) and CXCL13 protein levels were measured in the plasma of patients with asthma exacerbations and healthy controls by specific enzyme-linked immunosorbent assay (ELISA). Gene expression mRNA for CXCR5 was measured using real-time polymerase chain reaction (RT-PCR).

Results: Total IgE protein concentrations were elevated significantly in asthma exacerbation patients than that in healthy controls. CXCL13 protein levels were increased significantly in the asthma group relative to healthy controls. In addition, CXCR5 mRNA levels were elevated significantly in the asthma group than in the healthy controls.

Conclusions: Measurement of CXCL13 and CXCR5 may be used as an additional biomarker of asthma exacerbation, and targeting CXCL13 or its receptor may be used as new treatment options in asthma.

Prevalence of asthma symptoms and associated risk factors among adults in Saudi Arabia: A national survey from Global Asthma Network Phase Ⅰ

Purpose

Estimating the prevalence and severity of asthma symptoms with standardized methods of population-based surveys is a critical step in reducing asthma burden. However, no sufficient surveys have been conducted in most countries of the Middle East especially at the national level. In this survey, we applied sound measures to estimate the prevalence and severity of asthma symptoms and related risk factors in adults in Saudi Arabia.

Patients and methods

In this national cross-sectional study, the prevalence and severity of asthma symptoms were estimated throughout the country. Overall, 7955 adult individuals were selected from 20 regions across Saudi Arabia through their children at schools using a multistage, stratified cluster-sampling technique. A validated questionnaire, including the core and environmental questions of the Global Asthma Network questionnaires, was applied from March 4 to April 25, 2019. In addition, multivariate logistic regression analysis was performed to investigate the independent relationships between current wheeze and related risk factors.

Results

The overall prevalence of current wheeze (wheeze during the past 12 months) was 14.2%. Among persons with current wheeze, 38.1% were affected by severe asthma symptoms. Although a high percentage of those who had experienced asthma-ever reported that their asthma was diagnosed by doctors (83.3%), only 38.4% had a written plan for controlling their asthma. Women were more likely to develop current wheeze (adjusted odds ratio (aOR) 1.4; 95% CI: 1.1–1.7), while other statistically significant factors associated with current wheeze were jobs (aOR 11.8; 95% CI: 7.3–18.9), current exposure to moisture or damp spots (aOR 2.2; 95% CI: 1.5–3.4), heating the house when it is cold (aOR 1.7; 95% CI: 1.3–2.1), and ever using tobacco daily (aOR 2.7; 95% CI: 2.0–3.5).

Conclusions

These findings provide enough evidence for health authorities in Saudi Arabia about the prevalence and severity of asthma symptoms, asthma control, and associated risk factors to scale up monitoring projects, control plans, and high-impact interventions.

The effects of the antecedent use of inhaled steroid on the clinical course of COVID-19: A retrospective study of asthmatic patients

BACKGROUND

There is conflicting evidence regarding the effect of asthma and its different therapeutic options on COVID-19 severity and the clinical outcomes.

AIM

This study aimed to investigate the relationship between using inhaled corticosteroids (ICS) by asthmatic patients and the severity of COVID-19.

MATERIALS AND METHODS

This retrospective observational study was conducted from March 15 to October 23, 2020 and included data of all COVID-19 asthmatic patients (n = 287) at King Abdulaziz Medical City. Twelve patients were excluded due to poor medication history documentation or using ICS for non-asthma indication. Ordinal logistic regression was used to determine the clinical variables that affect COVID-19 severity. The clinical outcomes of ICS and non-ICS users were compared.

RESULTS

Of the sample (n = 275), 198 (72%) were using ICS therapy. No significant difference was found between ICS and non-ICS users in disease severity (P = 0.12), mortality (P = 0.45), ICU admission (P = 0.78), and the occurrence of complications. However, the number of days on ventilation were significantly increased in ICS users (P = 0.006). Being prescribed the ICS/LABA combination (adj OR: 0.72 [0.15,1.2]; P = 0.021), being hypertensive (adj OR: 0.98 [0.28,1.6]; P = 0.006), having cancer (adj OR: 1.49 [0.12, 2.8]; P = 0.033), or having diabetes (adj OR: 0.75 [0.09, 1.4]; P = 0.024) could not increase the risk for more severe disease.

CONCLUSION

Overall, ICS therapy did not alter the COVID-19 severity or mortality in asthmatic patients. The continued use of ICS during the pandemic should be encouraged to prevent asthma exacerbations.

Investigating the Outcomes of an Asthma Educational Program and Useful Influence in Public Policy

The study was conducted to evaluate the effectiveness of an asthma educational program for asthma control, asthma self-management, asthma knowledge, and patient activation. The study analyzes different demographic variables with the purpose of investigating which asthma patients performed better than others. Based on these demographic characteristics, the study provides several recommendations for various stakeholders. The study is based on a positivist approach since its purpose is to investigate the consequences of an asthma educational program with a view to generalizing the results to a larger population. The study targets public and private hospitals which have applied the asthma educational program in collaboration with the Saudi Initiative for Asthma (SINA). Multiple questionnaires were deployed 263 valid responses were received from patients of public and private hospitals using online and offline data collection method. Several parametric and non-parametric tests were carried out in terms of data analysis. The results reveal that patients in the intervention group obtained high scores and were therefore more knowledgeable and able to control their asthma compared to the control group. Overall, patients in the intervention group performed better in terms of asthma control, asthma self-management and knowledge and awareness. There was a high level of patient activation in this group. In the context of demographic features, it was found that patients who are married and are undergraduate degree holders in employment scored high compared to patients who were young, single, post-graduate degree holders that were mainly self-employed. The results of this study can guide policy makers, SINA authorities, and hospitals as to which demographic category of asthma patients require immediate attention. The significance of asthma educational programmes has increased especially through social media platforms as the number of adult patients continues to increase day by day.

Perceived quarantine competence, attitudes and practices among the public during the coronavirus pandemic: A Saudi descriptive study

BACKGROUND

The unavailability of data on the long-term efficacy of COVID-19 vaccines and of effective specific treatment, in addition to the emergence of new COVID-19 variants, makes nonpharmaceutical measures a mainstay for preventing the spread of infection. The policy responses of governments to the pandemic should be integrated with public behavioral changes. This study examines public attitudes, practices and perceived quarantine competency in Saudi Arabia during the COVID-19 pandemic.

METHODS

A cross-sectional descriptive design using an online survey was employed. Convenience and snowball sampling were adopted, and 1022 valid responses were received.

FINDINGS

Most respondents demonstrated satisfactory practices, including wearing face masks (76.5%), keeping a safe distance (97.8%) and appropriate hand hygiene (99.2%). Fear of stigma (8.9%) and of financial consequences (0%) were minimal drivers of underreporting of symptoms among the respondents, whereas uncertainty of the relevance of symptoms (30.3%) was a main cause of not reporting to health authorities. Most participants (73.4%) abided by government instructions due to fear of infection rather than of legal penalties. Participants, especially females and Saudi citizens, reported a high level of perceived quarantine competence (12.9 ± 2.59). Spearman's rho correlation showed a significant positive association between wearing face masks and other precautionary practices, including keeping a safe distance (0.25, P < .01) and frequent handwashing (0.224, P < .01), which rules out the concern that wearing face masks would result in less adherence of the participants to other protective measures.

CONCLUSION

Our findings suggest that COVID-19 awareness programs should focus more on males and non-Saudi populations. We also recommend the development of screening protocols and education programs for asthmatic patients in Saudi Arabia to avoid the consequences of confusing COVID-19 symptoms with those of asthma.

Asthma prevalence and associated factors among lebanese adults: the first national survey

BACKGROUND

No national research has yet explored the prevalence of asthma among adults in Lebanon. This study aims to evaluate the prevalence of physician-diagnosed asthma and current asthma, and their determinants among Lebanese adults 16 years old or above.

METHODS

A cross-sectional study was carried out using a multistage cluster sampling. The questionnaire used collected information on asthma, respiratory symptoms, and risk factors.

RESULTS

The prevalence of physician-diagnosed asthma was 6.7% (95% CI 5-8.7%), and that of current asthma was 5% (95% CI 3.6-6.9%). Chronic symptoms such as cough, wheezing, and shortness of breath were worst at night. Factors positively associated with physician-diagnosed asthma were a secondary educational level (adjusted OR, aOR = 4.45), a family history of chronic respiratory diseases (aOR = 2.78), lung problems during childhood (15.9), and allergic rhinitis (4.19). Additionally, consuming fruits and vegetables less than once per week (3.36), a family history of chronic respiratory diseases (3.92), lung problems during childhood (9.43), and allergic rhinitis (8.12) were positively associated with current asthma.

CONCLUSIONS

The prevalence of asthma was within the range reported from surrounding countries. However, repeated cross-sectional studies are necessary to evaluate trends in asthma prevalence in the Lebanese population.

Asthma control and its association with knowledge of caregivers among children with asthma. A cross-sectional study

OBJECTIVES

To investigate the level of asthma control among children and to investigate the association between asthma control and the knowledge of caregivers.

METHODS

A cross-sectional study was conducted from January 2018 to July 2018 among 278 children with asthma aged 1-12 with their caregivers attending the primary health care centers in Al Madinah Al Munawarah, Saudi Arabia. An asthma knowledge questionnaire was used to measure the parents' knowledge. The Test for Respiratory and Asthma Control in Kids (TRACK) and the Childhood Asthma Control Test (C-ACT) were used to evaluate asthma control among the children. Univariate and multivariate analyses were used to compare the knowledge level between the controlled and uncontrolled asthma groups.

RESULTS

Approximately 62.6% of children had uncontrolled asthma and 37.4% were controlled. The knowledge scores of the caregivers ranged from 43 to 64, with a mean score of 52.55. The mean knowledge score was higher in the controlled group (55.57) than in the uncontrolled group (50.76). There was a statistically significant difference in the knowledge scores between the participant groups (t=9.892, p less than 0.001).

CONCLUSION

There is a high percentage of children with uncontrolled asthma and 3 is a high knowledge deficit among the caregivers of children with asthma. An educational program targeting the general population and the caregivers should be implemented to correct any false beliefs regarding asthma and asthma medications.

The Impact of a School-based, Nurse-delivered Asthma Health Education Program on Quality of Life, Knowledge, and Attitudes of Saudi Children with Asthma

More than two million people have asthma in Saudi Arabia: 13% aged 6-10 years. Asthma is one of the most common childhood illnesses. Little has been explored about children's ability to learn more about their own asthma in Saudi Arabia. The study was designed to assess the impact of a school-based, nurse-delivered asthma health education program on asthmatic children's knowledge and attitude toward asthma, quality of life, anxiety level, and school absenteeism. A quasi-experimental, non-equivalent group, pretest-posttest design was used. The education program was developed from existing evidence. The Pediatric Asthma Quality of Life Questionnaire, Spence Anxiety Tool, Asthma Knowledge Questionnaire, and Asthma Attitude Questionnaire were employed for data collection. Intervention (n = 130) and control (n = 98) groups were drawn from 10 schools in Ha'il region, Saudi Arabia. Descriptive and inferential statistics were used to examine differences within and between groups. Knowledge of asthma increased significantly more in the intervention group than in the control group. Attitude toward asthma was not changed by the intervention. Anxiety scores reverted to pretest level by posttest II. The intervention group had significantly better total quality of life scores than the control group, and school absenteeism reduced significantly after the delivery of the program. It was concluded that the asthma education program impacted positively on students' knowledge, quality of life, and school attendance. However, asthma education did not change attitudes toward the condition, and the impact on anxiety was not persistent. The results emphasize the benefits of the provision of health education directly to children. Asthma education should be integrated into the Saudi national child health program.

The Prevalence of Asthma and Asthma-Like Symptoms among Seasonal Agricultural Workers

AIM

The aim of the study was to determine the prevalence and risk factors of asthma and asthma-like symptoms in seasonal agricultural workers living in fields with toxic chemical exposure.

METHODS

European Community Respiratory Health Survey (ECRHS) questionnaire was used to assess the prevalence of asthma and asthma-like symptoms in the study.

RESULTS

Of the study group, 51.1% (267) were male and the age of the study group ranged from 18 to 88 years and the mean (SD) was 45.68 (13.39) years. The prevalence of asthma attacks in seasonal agricultural workers in the last one year (current prevalence) was 11.2%; the prevalence of asthma (cumulative prevalence) was 15.1%. In the study, smoking was found to be an important risk factor for current asthma. The prevalence of cumulative asthma was higher in seasonal agricultural workers with allergic rhinitis (p < 0.05 for each).

CONCLUSIONS

Seasonal agricultural workers are exposed to the worst conditions of working groups. These difficult conditions also cause many health problems. Asthma has also been identified as an important health problem among seasonal agricultural workers.

Evaluation of C-C Chemokine Ligand 5 (CCL5) Chemokine, Interleukin 5 (IL-5) Cytokine, and Eosinophil Counts as Potential Biomarkers in Saudi Patients with Chronic Asthma During Sandstorms

Background and objectives

Asthma is a common chronic inflammatory disorder of the lung that can be exacerbated by environmental triggers during sandstorms. This study aimed to evaluate the usefulness of C-C chemokine ligand 5 (CCL5) chemokine and interleukin 5 (IL-5) cytokine and determine the total eosinophil count in blood and sputum for use as biomarkers in Saudi patients with chronic asthma who visited emergency departments during sandstorms.

Methods

The study included 42 Saudi patients with chronic asthma and 20 healthy controls. Plasma levels of CCL5, IL-5, and total immunoglobulin E (IgE) were measured using a specific enzyme-linked immunosorbent assay (ELISA). Total eosinophils in peripheral blood were counted using a hematology analyzer (CELL-DYN Ruby System; Abbott Diagnostics, Chicago, Illinois); in sputum, eosinophils stained with Giemsa were examined under a microscope, counted, and expressed as a percentage of the total cells.

Results

Total IgE levels were significantly higher in patients with asthma (mean 433 IU/ml, P = 0.0001) as compared to normal controls (139 IU/ml). There was no significant difference in the levels of CCL5 in patients with asthma (625 pg/ml) as compared to normal controls (663 pg/ml, P = 0. 57). No correlation was found between total IgE and CCL5 levels. IL-5 was not detected in patients with asthma or in controls. Moreover, the total counts of eosinophils in the blood did not increase in patients with asthma as compared to controls while eosinophils in sputum samples were increased in the former (mean =3.128%).

Conclusion

Plasma levels of CCL5 and IL-5 or eosinophil counts in the peripheral blood may not be useful diagnostic biomarkers to evaluate airway inflammation and monitor asthma severity. Conversely, the sputum eosinophil count may represent a useful diagnostic marker for assessing the magnitude of asthma exacerbation during sandstorms.

Opinions of healthcare providers on the design of a smartphone application for asthma treatment in the Kingdom of Saudi Arabia

Introduction

In several countries of the world, smartphone applications have been designed to contribute to the treatment of asthma. However, none of these applications has been developed in Saudi Arabia. Therefore, the objective of this article is to design a smartphone application for the treatment of asthma based on the opinions of healthcare providers from the Kingdom of Saudi Arabia.

Methods

In order to know the opinion of the healthcare providers from Saudi Arabia about the design of an asthma App, we used a purposive sampling method and conducted a cross sectional survey employing a questionnaire which was distributed through the QuestionPro.com website to all healthcare providers working in this country. The questionnaire was sent to 376 healthcare providers and the response rate was 25%.

Results

The data indicated that the majority of the respondents opined that the following features were important or very important in the design of a smartphone application for asthma treatment in Saudi Arabia: information about patient diagnosis (98%), primary physician access information(83%), patient satisfaction with the therapeutic process (91%), push notifications about reminder for drugs (95%), push notification for treatment of inhaler and other drugs (92%), push notifications about reminders of clinic visits and therapy sections (81%), push notifications to ask for help sending SMS to primary physician about patients’ attacks (89%), pathophysiology of asthma (82%), asthma triggers (98%), drug guidelines (94%), drug side effects (93%), number of asthma attacks (98%), medication statistics (88%), visual inputs such as peak flow (91%), data to link patients to healthcare providers and to healthcare centers (82%), and Global Initiative for Asthma (GINA) references (72%).

Conclusions

According to the opinion of the majority of healthcare providers (92%), the proposed smartphone application designed based on medical guidelines will contribute to improve the treatment of patients with asthma in the Kingdom of Saudi Arabia, and will help to reduce the number of asthma cases that need hospitalization, and the number of asthma cases in the emergency departments of the hospitals of the Kingdom.

Immunological Factors Associated with Adult Asthma in the Aseer Region, Southwestern Saudi Arabia

Background: The prevalence of asthma is on the rise in Saudi Arabia. Data regarding the immunological profile of asthma in adults in the Aseer region, in southwestern Saudi Arabia, have not been well studied. Objectives: Our aim was to study the immunological factors associated with sensitization to asthma among adults in the Aseer region. Methods: A cross-sectional study with a nested case control design in a 1:1 ratio was conducted on a sample of adults attending primary health care centers in the Aseer region. The study used a validated Arabic version of the International study of asthma and allergies in childhood (ISAAC) questionnaire. The presence of wheezing in the past 12 months was used as a proxy for bronchial asthma. Matched age and sex controls were selected. Both groups were tested for complete blood count (CBC), total and differential white blood cell (WBC) count including eosinophils, total immunoglobulin E (IgE) measurement, allergen-specific immunoglobulin E (IgE), and cytokine levels. Results: The present study included 110 cases and 157 age- and sex-matched controls. Rye wheat was found to be a significant outdoor sensitizing agent ((odds ratio) OR = 5.23, 95% CI: 1.06–25.69). Indoors, house dust mites Dermatophagoides petronyssinus (OR = 2.04, 95% CI: 1.04–3.99) and Dermatophagoides farinae (OR = 2.50, 95% CI: 1.09–5.75) were significant. Higher total IgE (OR = 1.84, 95% CI: 1.10–3.06) and eosinophil levels (OR = 2.85, 95% CI: 1.14–7.15) were significantly associated with adult bronchial asthma in Aseer. On the other hand, the role of cytokines was not significant. Conclusions: In the present study, certain environmental agents were found to be important with regards to sensitization to bronchial asthma in adults. Knowledge about these sensitization agents should be disseminated to health providers and treating physicians in order to enhance preventive environmental control measures and asthma management. Asthma-treating physicians in the region should be alerted to the use of targeted biological therapies in selected asthmatics with difficult-to-control courses.

Prevalence of asthma and other allergic conditions in adults in Khuzestan, southwest Iran, 2018

BACKGROUND

Health information on the dimensions of asthma and allergic conditions in Khuzestan Province, as a major industrial and polluted area in Iran as and the Middle East, is inadequate. This study was performed to measure the prevalence of asthma and other allergic conditions in adults in Khuzestan Province.

METHODS

This population-based cross-sectional study was carried out in 17 villages and 27 cities of Khuzestan Province during the years 2017-2018 on 20 to 65 year old respondents. Two-stage cluster sampling was used. The ECRHS (European Community Respiratory Health Survey) questionnaire was completed for individuals with additional questions regarding other allergic conditions.

RESULTS

In the study, 5720 questionnaires were distributed of which 5708 were returned. The prevalence of current asthma was 8.5% and that of asthma-like symptoms was 19.0%. The most common symptoms of asthma were nocturnal cough (13.6%), chest tightness (12.3%) and wheezing (13.1%). The prevalence of allergic rhinitis (AR), eczema and airway hyperresponsiveness were 27.2, 10.7, and 38.7%, respectively. The prevalence of current asthma was strongly correlated with age, current location (city, village), and the smoking status of respondents (p < 0.05).

CONCLUSION

The prevalence of current asthma and asthma-like symptoms in Khuzestan Province is almost twice as high as in Iran. Given the high prevalence of symptoms of airway hyperresponsiveness in the entire province, it is necessary to take environmental measures to mitigate the emergence of new cases of asthma among the residents. In addition, surveillance studies are necessary to monitor the trends in the prevalence of asthma in this province.

Asthma prevalence among adults in Saudi Arabia

[No Abstract Available].

Prevalence and factors associated with adult bronchial asthma in Aseer region, Southwestern Saudi Arabia

BACKGROUND:

Bronchial asthma (BA) is one of the most common chronic respiratory diseases in Saudi Arabia (SA). Most of the studies investigating the prevalence of BA in SA have focused on children and its exact prevalence in adults is unknown.

OBJECTIVES:

The objective of this study is tto investigate the prevalence and factors associated with adult BA in Aseer region, southwestern SA.

METHODS:

A cross-sectional study was conducted on a representative sample of adults who attended primary health care centers. A validated Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire was used. The presence of wheeze in the past 12 months was used as a proxy for BA.

RESULTS:

The study included 960 adults. The prevalence rate of BA was 19.2% (95% confidence interval [CI]: 16.72–21.80). In a multivariable analysis, the following factors were significantly associated with BA in adults; living in low-altitude areas (adjusted odds ratio [aOR] = 1.51, 95% CI: 1.04–2.21), being in rural areas (aOR = 1.58, 95% CI: 1.12–2.23), using analgesics (aOR = 1.52, 95% CI: 1.06–2.20), residing near heavy trucks traffics (aOR = 1.67, 95% CI: 1.13–2.46), having cats in the house (aOR = 2.27, 95% CI: 1.30–5.94), and being aged 55–64-year-old (aOR = 1.94, 95% CI: 1.02–3.69).

CONCLUSION:

The prevalence of BA was high, affecting one-fifth of adults in Aseer region. The study revealed some modifiable factors significantly associated with BA in adults. There is a need to improve asthma control programs at the primary health-care level, particularly at rural and at low-altitude areas, and more focus should address the elders. In addition, enhancing community-based health promotion programs tackling the identified modifiable factors of BA are required.

The Saudi Initiative for Asthma - 2019 Update: Guidelines for the diagnosis and management of asthma in adults and children

This is the fourth version of the updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (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 now more aligned for different age groups. The guidelines have focused more on personalized approaches reflecting better understanding of disease heterogeneity with integration of recommendations related to biologic agents, evidence-based updates on treatment, and 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 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.