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

doi:10.1016/j.jacig.2024.100209

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 journal › Article › peer-review

Abstract

Background

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

Objective

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

Methods

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).

Results

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).

Conclusion

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

Original language	English
Article number	100209
Number of pages	8
Journal	Journal of Allergy and Clinical Immunology: Global
Volume	3
Issue number	2
Early online date	2 Feb 2024
DOIs	https://doi.org/10.1016/j.jacig.2024.100209
Publication status	Published - 1 May 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

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

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Kirenga_2024_JAllCliImm_Burden-severe-asthma_CC
Copyright 2024 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NC- ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Final published version, 590 KBLicence: CC BY-NC-ND

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Kirenga, B. J., Chakaya, J., Yimer, G., Nyale, G., Haile, T., Muttamba, W., Mugenyi, L., Katagira, W., Worodria, W., Aanyu-Tukamuhebwa, H., Lugogo, N., Joloba, M., Mersha, T., Bekele, A., Makumbi, F., Mekasha, A., Green, C. L., de Jong, C., Kamya, M., & van der Molen, T. (2024). The burden of severe asthma in sub-Saharan Africa: findings from the African Severe Asthma Project. Journal of Allergy and Clinical Immunology: Global, 3(2), Article 100209. https://doi.org/10.1016/j.jacig.2024.100209

@article{917742861aba4463b2485201c56fd7c5,

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

abstract = "BackgroundSevere asthma is associated with high morbidity, mortality and health care utilization but its burden in Africa is unknown.ObjectiveTo determine the burden (prevalence, mortality and activity and work impairment) of severe asthma in three Easter Africa countries (Uganda, Kenya and Ethiopia).MethodsUsing 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).ResultsOverall, 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).ConclusionThe prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.",

keywords = "Severe asthma, Burden of severe asthma, Severe asthma determinants, Sub-Saharan Africa",

author = "Kirenga, \{Bruce J.\} 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 Tesfaye Mersha and Amsalu Bekele and Fred Makumbi and Amha Mekasha and Green, \{Cynthia L.\} and \{de Jong\}, Corina and Moses Kamya and \{van der Molen\}, Thys",

note = "Funding: Funded by a project grant from the GSK Africa Non-communicable Disease Open Lab (project 8019).",

year = "2024",

month = may,

day = "1",

doi = "10.1016/j.jacig.2024.100209",

language = "English",

volume = "3",

journal = "Journal of Allergy and Clinical Immunology: Global",

issn = "2772-8293",

publisher = "Elsevier",

number = "2",

}

Kirenga, BJ, Chakaya, J, Yimer, G, Nyale, G, Haile, T, Muttamba, W, Mugenyi, L, Katagira, W, Worodria, W, Aanyu-Tukamuhebwa, H, Lugogo, N, Joloba, M, Mersha, T, Bekele, A, Makumbi, F, Mekasha, A, Green, CL, de Jong, C, Kamya, M & van der Molen, T 2024, 'The burden of severe asthma in sub-Saharan Africa: findings from the African Severe Asthma Project', Journal of Allergy and Clinical Immunology: Global, vol. 3, no. 2, 100209. https://doi.org/10.1016/j.jacig.2024.100209

TY - JOUR

T1 - The burden of severe asthma in sub-Saharan Africa

T2 - findings from the African Severe Asthma Project

AU - Kirenga, Bruce J.

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 - Mersha, Tesfaye

AU - Bekele, Amsalu

AU - Makumbi, Fred

AU - Mekasha, Amha

AU - Green, Cynthia L.

AU - de Jong, Corina

AU - Kamya, Moses

AU - van der Molen, Thys

N1 - Funding: Funded by a project grant from the GSK Africa Non-communicable Disease Open Lab (project 8019).

PY - 2024/5/1

Y1 - 2024/5/1

N2 - BackgroundSevere asthma is associated with high morbidity, mortality and health care utilization but its burden in Africa is unknown.ObjectiveTo determine the burden (prevalence, mortality and activity and work impairment) of severe asthma in three Easter Africa countries (Uganda, Kenya and Ethiopia).MethodsUsing 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).ResultsOverall, 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).ConclusionThe prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.

AB - BackgroundSevere asthma is associated with high morbidity, mortality and health care utilization but its burden in Africa is unknown.ObjectiveTo determine the burden (prevalence, mortality and activity and work impairment) of severe asthma in three Easter Africa countries (Uganda, Kenya and Ethiopia).MethodsUsing 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).ResultsOverall, 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).ConclusionThe prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.

KW - Severe asthma

KW - Burden of severe asthma

KW - Severe asthma determinants

KW - Sub-Saharan Africa

UR - https://www.scopus.com/pages/publications/85184056678

U2 - 10.1016/j.jacig.2024.100209

DO - 10.1016/j.jacig.2024.100209

M3 - Article

SN - 2772-8293

VL - 3

JO - Journal of Allergy and Clinical Immunology: Global

JF - Journal of Allergy and Clinical Immunology: Global

IS - 2

M1 - 100209

ER -

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

Abstract

UN SDGs

Keywords

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