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

Abstract

RationaleThe relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.MethodsUsing 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.ResultsA 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.DiscussionThe 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.

Evaluation of an Aspergillus IgG/IgM lateral flow assay for serodiagnosis of fungal asthma in Uganda

“…This study was nested within the African Severe Asthma Program (ASAP) clinical study ( ClinicalTrials . gov Identifier : NCT03065920 ) [ 23 – 25 ] at the Makerere University Lung Institute. ASAP is a clinical study with the primary objective being to identify and characterize severe asthma in Uganda, Kenya, and Ethiopia.…”

“…This was a cross-sectional study evaluating the diagnostic performance of the LDBio Aspergillus ICT IgG-IgM lateral flow assay for the serological diagnosis of ABPA and SAFS among Ugandan adult asthmatics. This study was nested within the African Severe Asthma Program (ASAP) clinical study (ClinicalTrials.gov Identifier: NCT03065920) [23][24][25] at the Makerere University Lung Institute. ASAP is a clinical study with the primary objective being to identify and characterize severe asthma in Uganda, Kenya, and Ethiopia.…”

Prevalence of Aspergillus fumigatus skin positivity in adults without an apparent/known atopic disease in Uganda

“…This study was nested within the African Severe Asthma Program (ASAP) clinical study [ClinicalTrials.gov identifier: NCT03065920] at the Makerere University Lung Institute. 15 ASAP is a clinical study with the primary objective being to identify and characterize severe asthma in Uganda, Kenya, and Ethiopia. Participants provided written informed consent to participate in this study.…”

The Korean Severe Asthma Registry (KoSAR): real world research in severe asthma

“…Comparisons of the characteristics and treatment of severe asthma by the SHARP showed wide variation and heterogeneity across 11 European countries [15]. A regional registry of the African Severe Asthma Project (ASAP) showed unique characteristics of severe asth- Severe Asthma Network in Italy (SANI) registry Italy SANI [45] COhort of BRonchial obstruction and Asthma (COBRA) France [46] Belgian Severe Asthma Registry (BSAR) Belgium Belgian Thoracic Society [47] Spanish Registry of Severe Asthma Spain [48] Portuguese Severe Asthma Registry Portugal REAG [49] Austrian Severe Asthma Registry Austria Austrian Severe Asthma Net (ASA-Net) [50] German Severe Asthma Registry Germany German Asthma Net [51] Russian Severe Asthma Registry (RSAR) Russia Russian Respiratory Society [52] National: North America CHRONICLE United States [53] Severe Asthma Research Program (SARP) United States [58] National: Asia-Pacific ma in East Africa (Uganda, Kenya, and Ethiopia), where only 14.0% of patients, including severe asthma patients, used ICS [56]. The International Severe Asthma Registry (ISAR) was organized to collect data from national registries for comparison across countries [57].…”