Global Asthma Network Phase I Syria asthma surveillance and the impact of the war.

Background: Asthma is the most prevalent chronic respiratory disease (CRD) in children. It causes extensive morbidity and mortality worldwide. Since the International Study of Asthma and Allergies in Childhood (ISAAC Phase III 2001-3), there have been no worldwide standardised surveys of prevalence and severity of asthma in school children. The Global Asthma Network (GAN) Phase I aims to provide this information. We participated in GAN with the aim of tracking changes in Syria and comparing the results to those of ISAAC Phase III. We also aimed to track the impact of war pollutants and stress. Methods: GAN Phase I, following the same methodology of ISAAC in a cross-sectional study. The same ISAAC questionnaire translated into Arabic was repeated. We added questions about displacement from home, and the impact of war pollutants. We also added the Depression, Anxiety and Stress Scale (DASS Score). In this article, we focused on the prevalence of 5 core asthma indicators (wheezing in the past 12 months, wheezing ever, severe wheeze, exercise wheeze and night cough) in adolescents from two centres in Syria: Damascus and Latakia. Additionally, we investigated the impact of the war on our two centres, while the DASS score was investigated only in Damascus. We surveyed 1,100 adolescents from 11 schools in Damascus and 1,215 adolescents from 10 schools in Latakia. Results: In Syria, which is a low-income country, wheeze prevalence before the war in ISAAC III was 5.2% for 13-14-year-old, whilst it was 19.28% in GAN during the war. Prevalence of severe asthma symptoms was 2.5% in ISAAC III and 12.8% in GAN. Wheezing appearing after the war or becoming more severe was statistically significant p=0.0001. War is associated with higher exposure to new environmental chemicals and pollutants and higher anxiety and depression scores. Conclusions: It is paradoxical to note that in Syria, current wheeze and severity are much higher in GAN (19.8%) than in ISAAC III (5.2%), which seems positively associated with war pollution and stress.

Erratum to uncontrolled and under-diagnosed asthma in a Damascus shelter during the Syrian crisis.

[This corrects the article DOI: 10.21037/jtd.2017.08.86.].

Uncontrolled and under-diagnosed asthma in a Damascus shelter during the Syrian crisis.

Background: Studies have shown that poor shelter or dwelling conditions may lead to deteriorations in health. Those with asthma may be more susceptible to compromised living conditions and stress leading to a higher risk of asthma exacerbations. To describe the asthma control and quality of life of individuals with diagnosed asthma living in a shelter in Damascus, Syria and estimate the prevalence of respiratory symptoms in shelter dwellers without diagnosed asthma. Methods: In this cross-sectional study, all individuals 5 years and older living in Al-Herjalleh shelter with diagnosed asthma were recruited to complete a questionnaire, which included items related to their respiratory symptoms, asthma exacerbations, exposure to asthma triggers, medication use, and health-related quality of life before and since entering the shelter. A representative sample of shelter dwellers without diagnosed asthma also completed a questionnaire to establish their demographics, respiratory symptoms, environment and chronic disease co-morbidities, in order to identify factors associated with under-diagnosed asthma. All participants underwent spirometry to measure their lung function. Descriptive statistics were calculated, and chi-square tests and Student's t-tests were used to compare individuals with asthma before and since entering the shelter, as well as to compare those with under-diagnosed asthma and individuals without asthma. Results: The prevalence of asthma at the Al-Herjalleh shelter in those aged 5 years and older was approximately 8.5%. Nearly 70% of the asthma group felt their asthma had worsened since entering the shelter, and there was a significant drop in the proportion of individuals using inhaled corticosteroids (ICS), with only 4.3% using daily ICS in the shelter (P<0.0001). The proportion of individuals experiencing a severe asthma attack did not change after entering the shelter (P=0.97), but almost all individuals with asthma (94.4%) reported worsening in their health-related quality of life. In the non-asthma group, 44.2% of participants reported episodes of wheezing, coughing and breathlessness at night, consistent with under-diagnosed asthma. A higher proportion of those with under-diagnosed asthma had allergic rhinitis (57.1%), symptoms of post-traumatic stress disorder (PTSD) (35.1%), and abnormal spirometry (60.0%), compared to those without asthma. Conclusions: The findings of our study highlight the need for asthma programs in Syrian shelters as significant gaps exist in both the screening and management of chronic respiratory diseases to minimize asthma deterioration in Syrian shelter dwellers.