Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project

Bruce Kirenga; Jeremiah Chakaya; Getnet Yimer; George Nyale; Tewodros Haile; Winters Muttamba; Levicatus Mugenyi; Winceslaus Katagira; William Worodria; Hellen Aanyu-Tukamuhebwa; Njira Lugogo; Moses Joloba; Amsalu Bekele; Fred Makumbi; Cindy Green; Corina de Jong; Moses Kamya; Thys van der Molen

doi:10.1136/bmjresp-2019-000484

Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project

Bruce Kirenga, Jeremiah Chakaya, Getnet Yimer, George Nyale, Tewodros Haile, Winters Muttamba, Levicatus Mugenyi, Winceslaus Katagira, William Worodria, Hellen Aanyu-Tukamuhebwa, Njira Lugogo, Moses Joloba, Amsalu Bekele, Fred Makumbi, Cindy Green, Corina de Jong, Moses Kamya, Thys van der Molen

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Abstract

Rationale: The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.

Methods: Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.

Results: A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.

Discussion: The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.

Original language	English
Article number	e000484
Number of pages	9
Journal	BMJ Open Respiratory Research
Volume	7
Issue number	1
DOIs	https://doi.org/10.1136/bmjresp-2019-000484
Publication status	Published - 12 Feb 2020

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Kirenga, B., Chakaya, J., Yimer, G., Nyale, G., Haile, T., Muttamba, W., Mugenyi, L., Katagira, W., Worodria, W., Aanyu-Tukamuhebwa, H., Lugogo, N., Joloba, M., Bekele, A., Makumbi, F., Green, C., de Jong, C., Kamya, M., & van der Molen, T. (2020). Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project. BMJ Open Respiratory Research, 7(1), Article e000484. https://doi.org/10.1136/bmjresp-2019-000484

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title = "Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project",

abstract = "Rationale: The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.Methods: Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.Results: A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.Discussion: The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.",

author = "Bruce Kirenga and Jeremiah Chakaya and Getnet Yimer and George Nyale and Tewodros Haile and Winters Muttamba and Levicatus Mugenyi and Winceslaus Katagira and William Worodria and Hellen Aanyu-Tukamuhebwa and Njira Lugogo and Moses Joloba and Amsalu Bekele and Fred Makumbi and Cindy Green and {de Jong}, Corina and Moses Kamya and {van der Molen}, Thys",

note = "Funding: The study was funded by a project grant from the GSK Africa Non-Communicable Disease Open Lab (Project number: 8019).",

year = "2020",

month = feb,

day = "12",

doi = "10.1136/bmjresp-2019-000484",

language = "English",

volume = "7",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

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Kirenga, B, Chakaya, J, Yimer, G, Nyale, G, Haile, T, Muttamba, W, Mugenyi, L, Katagira, W, Worodria, W, Aanyu-Tukamuhebwa, H, Lugogo, N, Joloba, M, Bekele, A, Makumbi, F, Green, C, de Jong, C, Kamya, M & van der Molen, T 2020, 'Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project', BMJ Open Respiratory Research, vol. 7, no. 1, e000484. https://doi.org/10.1136/bmjresp-2019-000484

TY - JOUR

T1 - Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma

T2 - findings from the African severe asthma project

AU - Kirenga, Bruce

AU - Chakaya, Jeremiah

AU - Yimer, Getnet

AU - Nyale, George

AU - Haile, Tewodros

AU - Muttamba, Winters

AU - Mugenyi, Levicatus

AU - Katagira, Winceslaus

AU - Worodria, William

AU - Aanyu-Tukamuhebwa, Hellen

AU - Lugogo, Njira

AU - Joloba, Moses

AU - Bekele, Amsalu

AU - Makumbi, Fred

AU - Green, Cindy

AU - de Jong, Corina

AU - Kamya, Moses

AU - van der Molen, Thys

N1 - Funding: The study was funded by a project grant from the GSK Africa Non-Communicable Disease Open Lab (Project number: 8019).

PY - 2020/2/12

Y1 - 2020/2/12

N2 - Rationale: The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.Methods: Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.Results: A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.Discussion: The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.

AB - Rationale: The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.Methods: Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.Results: A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.Discussion: The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.

U2 - 10.1136/bmjresp-2019-000484

DO - 10.1136/bmjresp-2019-000484

M3 - Article

C2 - 32054641

SN - 2052-4439

VL - 7

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

IS - 1

M1 - e000484

ER -

Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project

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