Challenges and recommendations for the management of asthma in the Middle East and Africa

Mohamed Omar Zeitouni; Mohamed Saad Al-Moamary; Marie Louise Coussa; Moussa Riachy; Bassam Mahboub; Fatma AlHuraish; Mohamed Helmy Zidan; Mohamed Mostafa Metwally; Kurtuluş Aksu; Erdinç Yavuz; Ismail Sikander Kalla; Jeremiah Chakaya; Snouber Abdelmadjid; Habib Ghedira

doi:10.4103/atm.atm_469_21

Official publication of the Saudi Thoracic Society, affiliated to King Saud University

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Year : 2022 | Volume : 17 | Issue : 2 | Page : 71-80

Challenges and recommendations for the management of asthma in the Middle East and Africa

Mohamed Omar Zeitouni¹, Mohamed Saad Al-Moamary², Marie Louise Coussa³, Moussa Riachy⁴, Bassam Mahboub⁵, Fatma AlHuraish⁶, Mohamed Helmy Zidan⁷, Mohamed Mostafa Metwally⁸, Kurtuluş Aksu⁹, Erdinç Yavuz¹⁰, Ismail Sikander Kalla¹¹, Jeremiah Chakaya¹², Snouber Abdelmadjid¹³, Habib Ghedira¹⁴
¹ Pulmonary Medicine and Critical Care, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
² Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
³ Division of Pulmonary Diseases, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
⁴ Department of Pulmonary and Critical Care Medicine, Hotel Dieu De France Hospital, Beirut, Lebanon
⁵ Department of Pulmonary Medicine, Rashid Hospital, Dubai Academic City, United Arab Emirates
⁶ Respiratory Unit, Department of Internal Medicine, Al Sabah Hospital, Ministry of Health, Kuwait
⁷ Department of Chest Diseases, Faculty of Medicine, Alexandria University, Egypt
⁸ Department of Chest Diseases, Assuit University, Assuit, Egypt
⁹ Clinic of Chest Diseases, Immunology and Allergic Diseases, Ankara Atatürk Chest Diseases and Chest Surgery Hospital, Ankara, Turkey
¹⁰ Department of Family Medicine, Samsun University, Samsun, Turkey
¹¹ Pulmonologist, Suite D2 Ahmed Kathrada Private Hospital, K43 Highway, Lenasisa Ext 8, 1827, South Africa
¹² Physician, Fourth Floor Room 404 Fortis Suites, Hospital Road, 00100, Nairobi, Kenya
¹³ Chest Clinic, Faculty of Medicine,CHU ORAN University of Oran, Oran, Algeria
¹⁴ Department of Pathology, CHU Abderrahmen Mami, Ariana, Tunisia

Correspondence Address:
Dr. Mohamed Omar Zeitouni
Pulmonary Medicine and Critical Care, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/atm.atm_469_21

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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