The reality of managing asthma in sub-Saharan Africa – Priorities and strategies for improving care

Abstract

Asthma is the most common non-communicable disease in children and remains one of the most common throughout the life course. The great majority of the burden of this disease is seen in low-income and middle-income countries (LMICs), which have disproportionately high asthma-related mortality relative to asthma prevalence. This is particularly true for many countries in sub-Saharan Africa. Although inhaled asthma treatments (particularly those containing inhaled corticosteroids) markedly reduce asthma morbidity and mortality, a substantial proportion of the children, adolescents, and adults with asthma in LMICs do not get to benefit from these, due to poor availability and affordability. In this review, we consider the reality faced by clinicians managing asthma in the primary and secondary care in sub-Saharan Africa and suggest how we might go about making diagnosis and treatment decisions in a range of resource-constrained scenarios. We also provide recommendations for research and policy, to help bridge the gap between current practice in sub-Saharan Africa and Global Initiative for Asthma (GINA) recommended diagnostic processes and treatment for children, adolescents, and adults with asthma.

Factors associated with sensitisation to selected aero‐allergens in children and adolescents with asthma followed up at Laquintinie Hospital Douala, Cameroon

“…The selection of treatment depends on the severity of the condition and the specific allergens implicated. However, it should be noted that immunotherapy and certain biologic therapies, such as omalizumab, 48 are not currently accessible in sub‐Saharan African countries like Cameroon, 49 thus emphasizing the significance of prevention strategies as the primary approach to treatment.…”

Global initiative for asthma: 30 years of promoting evidence‐based asthma care

“…GINA is involved in worldwide advocacy initiatives to ensure affordable access to effective, quality-assured medications in LMICs. [5][6][7][8][9] GINA shares concerns about planetary health and supports efforts to minimise the impact of health care, including inhaled respiratory medicines, on the environment. In this we place a high priority on patient safety and on ensuring that LMICs are not further disadvantaged.…”

“…Implementation of the GINA strategy would greatly improve quality of life in these regions and prevent most premature deaths due to asthma. GINA is involved in worldwide advocacy initiatives to ensure affordable access to effective, quality‐assured medications in LMICs 5–9 …”

TITLE: Reference lung function of Nigerian school-age children measured with electronic peak flow meter: comparison with local and Global-Lung-Initiative equations

“…[1][2][3] Despite a high and growing burden of CRDs, low-resource settings like Nigeria have grossly inadequate access to spirometry, especially in paediatric respiratory care, due to high cost, inadequate expertise and poor maintenance. [3][4][5][6] Here, cheaper and simplerto-use mechanical peak flow meters (mPFM) like the mini-Wright PFM serve limited but useful utility in the management of childhood CRDs. 1,6,7 Several authors have thus published reference equations (REs) [8][9][10][11][12] for peak expiratory flow (PEF) which is the maximum flow of air expired during a forced expiration after a maximal inspiration.…”

“…[3][4][5][6] Here, cheaper and simplerto-use mechanical peak flow meters (mPFM) like the mini-Wright PFM serve limited but useful utility in the management of childhood CRDs. 1,6,7 Several authors have thus published reference equations (REs) [8][9][10][11][12] for peak expiratory flow (PEF) which is the maximum flow of air expired during a forced expiration after a maximal inspiration. Although PEF aids asthma diagnosis and monitoring, for example, through percentage change from baseline, percentage of predicted values or percentage of personal best, its accurate measurement is limited by its being highly effort-dependent, resulting in wide inter-and intra-person variability.…”