Factors associated with uncontrolled asthma in adult asthmatics in Kinshasa, Democratic Republic of Congo

Abstract

Background The ultimate goal of asthma treatment is long-term control. Uncontrolled asthma is a major public health problem worldwide, but there is a lack of data on asthma control and its causes in the Democratic Republic of Congo (DRC). Objective To determine the socio-demographic, environmental, clinical, and biological factors and comorbidities associated with uncontrolled adult asthma in Kinshasa, DRC. Methods We performed a cross-sectional study of 216 male and female asthmatics aged 18 and over consecutively recruited from tertiary clinics and the community in Kinshasa between June 2017 and February 2018. For each subject, socio-demographic, clinical, para clinical and environmental data were recorded. Forced Expiratory Volume in one second (FEV 1 ) values were obtained by Spirometry, allergen testing performed using the skin prick test, serum vitamin D levels measured by radioimmunoassay, and asthma control assessed using the asthma control test (ACT) score. Multiple logistic regression identified factors associated with uncontrolled asthma. Results The average age of participants was 45.2 (SD 17.6) years, 74% were female, and 42% had a low educational level. Among all asthmatics, the prevalence of uncontrolled asthma was 56%, abnormal serum vitamin D level 95%, abnormal FEV 1 65%, sensitization to two allergens (cat dander and dust mites) 18%, sleep disorders 37%, and heartburn 60%. Male (aOR 2.24; 95% CIs 1.04–4.79), low educational level (aOR 3.26; 95% CIs 1.54–6.67), sensitization to both cat dander and dust mites (aOR 2.67; 95% CIs 1.16–6.14), FEV 1 ≤80% (aOR 2.07; 95% CIs 1.08–3.96), abnormal serum vitamin D level (aOR 5.11; 95% CIs 1.17–22.33), sleep disorders (aOR 1.96; 95% CIs 1.04–3.71), and heartburn (aOR 2.02; 95% CIs 1.04–3.92) were significantly associated with uncontrolled asthma. Conclusion Uncontrolled asthma is common in Kinshasa, and these factors associated with uncontrolled asthma may be considered as targets for future intervention strategies.

Keep the cat, change the care pathway: A transformational approach to managing Fel d 1, the major cat allergen

“…In addition to their role in AR, allergies to cats and dogs are a major risk factor in the development of asthma . It is estimated that pets are the third‐leading cause of IgE‐mediated allergic asthma.…”

“…3,7,9 The prevalence of cat allergy varies between countries, timing of exposure, and allergic predisposition. 9 Cat allergy is found both in developed and developing countries, 46,47 starts early in infancy and progresses up to young adulthood, 13,48 and can be observed in children who live in a house where cats are not present. 49…”

“…53,57 In addition to their role in AR, allergies to cats and dogs are a major risk factor in the development of asthma. 7,19,47,58 It is estimated that pets are the third-leading cause of IgE-mediated allergic asthma. Cat-allergic children experience twice as many days with asthma symptoms and require more frequent dosing of β-agonists and steroids during the second week of the school term in classrooms with moderate-to-high prevalence of home cat ownership.…”

Magnitude and Factors Associated With Uncontrolled Asthma Among Patients at Government Hospitals Follow-Up Clinic in Harar and Dire Dawa, Eastern Ethiopia.

“…The more serious effects are with uncontrolled asthma [8,9]. Several studies in different parts of the world stated the high magnitude of uncontrolled asthma [10][11][12][13][14][15]. Some studies conducted in parts of Ethiopia revealed higher magnitude of poorly controlled asthma ranging from 53.3% − 73.1%.…”

Determinants of Uncontrolled Asthma Among Adult Asthmatic Patients on Follow-Up at Chest Clinic of Jimma Medical Center: Unmatched Case-Control Study

“…Despite the existence of effective treatments, Asthma remains uncontrolled everywhere throughout the world (3,(13)(14)(15)(16). Similarly, a signi cant proportion of asthmatic patients suffer from uncontrolled asthma in Africa (17)(18)(19)(20). Studies conducted in Ethiopia showed different prevalence of uncontrolled asthma ranging from 64.5-85.2%, implying high prevalence of uncontrolled asthma in Ethiopia (21)(22)(23).…”