The burden of severe asthma in sub-Saharan Africa: findings from the African Severe Asthma Project

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review



Severe asthma is associated with high morbidity, mortality and health care utilization but its burden in Africa is unknown.


To determine the burden (prevalence, mortality and activity and work impairment) of severe asthma in three Easter Africa countries (Uganda, Kenya and Ethiopia).


Using the American Thoracic Society/European Respiratory Society (ATS/ERS) case definition of severe asthma we analyzed for the prevalence of severe asthma (requiring GINA steps 4–5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4–5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA recommended medications. Asthma control was assessed using the asthma control questionnaire (ACQ).


Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% CI 23.1–28.3) and 4.6% (95% CI 3.5–6.0) respectively. Patients with severe asthma were (non- severe vs. severe vs. severe refractory) older (39, 42, 45 years, p=0.011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, p=0.004), had lower FEV1% (81%, 61%, 55.5%, p=<0.001), lower quality of life score (129, 127 vs 121, p=<0.001) and higher activity impairment (10%, 30%, 50%, p=<0.001).


The prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.

Original languageEnglish
Article number100209
Number of pages8
JournalJournal of Allergy and Clinical Immunology: Global
Issue number2
Early online date2 Feb 2024
Publication statusE-pub ahead of print - 2 Feb 2024


  • Severe asthma
  • Burden of severe asthma
  • Severe asthma determinants
  • Sub-Saharan Africa


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