Current concepts in Asthma control: Is it achievable?

Asthma control is the central focus of Global Initiative for Asthma (GINA) guidelines, which is defined as the extent to which the various manifestations of asthma observed in the patient are reduced or removed by treatment. It is determined by the interaction between the patient's genetic background, underlying disease processes, the treatment that they are tak-ing, environment and psychological factors.The long-term goals of asthma management are to achieve good symptom control, and to minimise future risk of exacer-bations, fixed airflow limitation and side-effects of treatment. The patient's own goals regarding their asthma and its treat-ment should also be identified.Several factors have been identified which contribute to failure in achieving asthma control despite adequate drug therapy. To assist in assessing asthma control, several validated questionnaires have been developed.Despite the goal of asthma management is attaining optimal control; majority of asthmatics are not well controlled. Global surveys of asthma care have suggested only 5% of asthmatics meet the goals of asthma management as set out in guidelines.Global multi centre research should be conducted especially in developing countries on asthma control to assess the impact and adequacy of asthma care in all the regions of the wor

Assessing Control of Asthma in Jush; Jimma; South West Ethiopia

BACKGROUND: Despite international guidelines; asthma control is short of the goal in different parts of the world. The objective of this study was to assess control of asthma in patients older than 14 years at the Chest Clinic of Jimma University Specialized Hospital/JUSH; South West Ethiopia. METHODS: A cross sectional hospital based study was conducted on 234 physician diagnosed asthmatic patients attending the chest follow up clinic from June 01 to July 31; 2012. Asthma control was assessed using the GINA algorithm and the ACT questionnaire. Pulmonary function test was measured using a spirometer for 160 subjects. Data were cleared; entered and analyzed using SPSS version 16 and independent variables were assessed for association with the level of asthma control using bivariate and multinomial analyses. RESULTS: Using the GINA based algorithm; 42 respondents (26.2) were considered to have partly controlled asthma and the majority 117 (76.1) had uncontrolled asthma. Asthma was uncontrolled (ACT score 19) in 71.4 subjects and well controlled (ACT score

Acteurs de sante dans la prise en charge de l'asthme au Burkina Faso

Objectif : Identifier les entraves a la meilleure prise en charge du patient asthmatique par les acteurs de la sante a Ouagadougou. Methode: Etude transversale a visee descriptive de Janvier a decembre 2012; associee a une revue de la litterature portant sur le role des acteurs de sante dans la prise en charge de l'asthme. Resultat: La technique de demonstration de la prise de l'aerosol doseur etait maitrisee chez 46 des medecins. Une ordonnance medicale etait exigee par 9 des pharmaciens avant la delivrance des medicaments asthmatiques. La verification de la conformite de la prescription medicale etait faite par 30 des pharmaciens; la demonstration de la prise de l'aerosol doseur a l'officine etait assuree par 73;6 des pharmaciens et bien maitrisee par 34;5. Dans le cadre du traitement de l'asthme; 43;2 des infirmiers savaient que les bronchodilatateurs et les corticoides etaient les medicaments les plus utilises. Les bronchodilatateurs inhales d'action rapide etaient recommandes par 40;6 des infirmiers dans l'asthme intermittent; cette prescription n'est pas conforme aux recommandations de la GINA. Conclusion : Un besoin de formation/recyclage est exprime par la quasi totalite des acteurs de sante intervenant dans la prise en charge de l'asthme au Burkina Faso

A Synopsis of Asthma Research in Nigeria between 1970 and 2010

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Childhood Asthma

Asthma is the most common chronic disease of South African children; affecting growth and development and quality of life. Features supporting the diagnosis are a family or personal history of atopy; night cough; exercise-induced cough and/or wheeze and seasonal variation in symptoms. Asthma is on the increase in both developed and developing countries; in both rural and urban communities. The first part of this series aims to give a brief overview of the epidemiology; pathophysiology and diagnosis of childhood asthma

The criteria used by private general practitioners in Bloemfontein for the diagnosis and referral of asthma patients aged 6­15 years

Background:Participants in the study were general practitioners (GPs) in private practice in Bloemfontein, South Africa. Objectives: To determine and evaluate the criteria employed by GPs in Bloemfontein to diagnose and refer chronic and acute asthma patients aged 6­15 years and to investigate the actual diagnostic criteria used by GPs, as compared to the theoretical (i.e. textbook) criteria. Method: A descriptive study was performed. A questionnaire was designed to investigate which methods of diagnosis were employed by GPs with regard to childhood asthma. The questionnaire was distributed to GPs who fulfilled certain inclusion criteria and were selected by means of simple random sampling. Statistical analysis of data was done by the Department of Biostatistics, University of the Free State, and results were summarised as frequencies and percentages. Results: Certain elements were lacking with regard to the patients' histories taken by GPs. These included severity and frequency of attacks, as well as precipitating factors, such as smoking in the family and allergies. A worrisome number of GPs did not seem to be aware of the exact clinical picture of asthma in children and some failed to use the prescribed guidelines proposed for diagnosis of this condition in young patients. Most GPs indicated that they refer asthmatic children to private specialists, although this practice depended on the medical aid status of the patient's parents/guardian. Conclusion: As portrayed by the feedback obtained from these Bloemfontein-based GPs, it could be presumed that the diagnosis of asthma in children did not always meet the standard criteria

Asthme aigu grave au service de reanimation de l'hopital principal de Dakar

Introduction: L'asthme aigu grave constitue une urgence medicale pouvant mettre en jeu le pronostic vital. L'objectif de ce travail est d'evaluer les aspects epidemiologiques; cliniques; paracliniques et therapeutiques de l'asthme aigu grave en reanimation .Patients et methode: Il s'agissait d'une etude retrospective ayant collige tous les patients de plus de 15 ans admis dans le service de reanimation de l'hopital Principal de Dakar entre octobre 2000 et octobre 2002 pour une crise d'asthme avec presence de criteres de gravite. Nous avions analyse les elements epidemiologiques; les aspects cliniques et paracliniques ainsi que les differentes modalites de prise en charge medicamenteuse et la ventilation artificielle.Resultats: Trente trois patients avaient ete inclus dans cette etude. L'age moyen etait de 44 ans avec un sex-ratio de 1;65. A l'admission 26des patients ventiles presentaient un silence auscultatoire; un etat de choc ou un coma avec score de Glasgow inferieur a 12. Au niveau de la gazometrie; on notait la presence d'une acidose de type respiratoire; metabolique ou mixte chez respectivement 48; 9et 12des patients. La ventilation assistee etait indiquee chez 45des patients. L'evolution etait le plus souvent favorable avec un taux de mortalite de 6.Conclusion: Le pronostic des patients admis dans un service de reanimation pour asthme aigu grave est favorable

Asthme: diagnostic et evaluation

L'asthme est la cause d'une importante morbidite et d'une mortalite qui ne cessent semble-t-il d'augmenter malgre la meilleur connaissance de l'affection et l'existence de therapeutiques symptomatiques efficaces . Tout effort d'amelioration du diagnostic et de suivi de l'evolution de la maladie est essentiel

Management of asthma in sub-Saharan Africa: the Nigerian perspective

Asthma is a very common respiratory disorder with rising prevalence rates worldwide. The advances in our understanding of its pathogenesis and introduction of new medications in its management have not been of much benefit to most patients in Africa. This is due to various complex and interrelated reasons such as lack of proven diagnostic and monitoring facilities; inadequate knowledge of current management of asthma by doctors; poor compliance by patients; use of traditional medicines of unproven efficacy; fake/ substandard drugs; and lack of locally designed guidelines based on local resources. The solutions to these problems require the full participation of all. Governments need to provide the appropriate environment for the care-givers and patients; on the other hand the care-givers need to update themselves on the current management of asthma; while the patients need to take the treatment of their illness seriously and also develop a strong management partnership with their care-givers

Understanding the Concept of 'Family History' in Black Asthmatic Children

Background. Despite the fact that 71.6 of children at Chris Hani Baragwanath Hospital (CHBH) Asthma Clinic in Soweto; Johannesburg were found to have one or more positive skin-prick tests (SPTs) to common aero-allergens; they reported a low rate of positive family history for atopic conditions (22.2reason(s) why a positive family history has been found so seldom in these children. Methods. A random group of parents of the atopic asthmatic children attending the CHBH Children's Asthma Clinic completed a detailed questionnaire regarding their atopic status. Skin-prick testing was performed. Results. Fifty-four sets of parents and 15 single mothers were studied. Of the 48 atopic children; 37 (77). In the past this has minimised the importance of family history in determining the nature of chest symptoms in children in this population group; suggesting that some new environmental exposure; rather than the established familial factor; was creating the allergic milieu in this group. Objective. To determine the predictive value of a family history of symptoms of atopic disease (and allergy) by seeking evidence for this condition in the parents of asthmatic children attending the CHBH Children's Asthma Clinic; and the ) had at least 1 parent with a positive SPT. Fifty-five per cent of mothers had a positive SPT; while 48 of fathers had at least 1 positive SPT. Seven of 69 mothers (10) had a definitive diagnosis of asthma. Of these; 5 (71) were SPT-positive. Only 3 of the fathers (5.5) had asthma. All had positive SPTs. However; if all the symptoms suggestive of asthma; namely chronic cough or wheeze; were taken into account; the number of potential atopic fathers and mothers increased to 10 (19) and 18 (26) respectively. Conclusion. Simple questioning for family history of atopic disease is therefore not a good predictor of atopy in offspring in this cohort of patients. In order to get maximal yield from this question; parents must rather be asked about specific symptoms suggestive of asthma and/or allergic rhinitis

Prevalence de l'asthme et de l'atopie chez les adultes jeunes vivant en climat tropical humide: etude prospective realisee chez 284 sujets

OBJECTIF: Notre etude avait pour objectif de determiner la prevalence de l'asthme et de l'atopie dans une population d'adultes jeunes et d'analyser la relation existant entre ces deux pathologies. MATERIEL ET METHODE: Notre enquete prospective etait de type transversal; menee sur une periode de 7 mois allant de decembre 2004 a juin 2005. Elle avait concerne 284 etudiants inscrits en deuxieme annee de medecine et ages de 18 a 25 ans. Apres avoir rempli un questionnaire auto administre portant sur l'asthme; la rhinite et l'allergie; chaque etudiant avait subit un test allergologique (prick-test) compose de 18 allergenes. RESULTATS : Selon le questionnaire :-29 sujets soit 10;2pour cent etaient des asthmatiques connus et chez 44;8pour cent d'entre eux; les premieres manifestations avaient eu lieu a l'age de 0 a 5 ans. - La rhinite recidivante; l'eczema et la conjonctivite recidivante avaient ete signales respectivement chez 72;9pour cent; 39;1pour cent et 12;7pour cent des sujets. - Tous les asthmatiques avaient une rhinite recidivante et 46pour cent des sujets ayant une rhinite recidivante etaient des asthmatiques. Apres le prick-test : -nous avions depiste 127 sujets atopiques soit une prevalence de 44;7pour cent. - Les allergenes les plus frequents etaient les acariens (70pour cent) suivis par les blattes (43;3pour cent) et les moisissures (39;4pour cent). L'arachide etait le trophallergene le plus frequemment retrouve (14;9pour cent). -L'atopie etait presente chez 86;2 pour cent des asthmatiques et les allergenes en cause etaient les acariens dans 93;1pour cent des cas. -Dans la rhinite l'atopie n'etait presente que dans 51;7pour cent des cas et les allergenes en cause etaient les acariens dans 71;9pour cent des cas. COMMENTAIRES: Cette etude avait mis en evidence la forte prevalence de l'asthme et de l'atopie dans une population d'adultes jeunes vivant en climat tropical humide. En plus de la confirmation du lien etroit entre ces deux pathologies en Cote d'Ivoire; ce travail montrait d'une part l'association tres frequente de l'asthme etde la rhinite allergique et d'autre part la predominance des acariens parmi les allergenes en cause. Par consequent; la maitrise de l'environnement allergenique etait indispensable dans la prise en charge de l'asthmatique et de l'allergique