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A Prospective Cohort Study of Severe Asthma and Its Determinants in an African Population: The African Severe Asthma Program
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A2494 - A Prospective Cohort Study of Severe Asthma and Its Determinants in an African Population: The African Severe Asthma Program
Author Block: B. Kirenga1, W. Muttamba1, L. Mugenyi2, W. Katagira2, G. Nyale3, N. Lugogo4, A. B. Binegdie5, T. Haile6, W. O. Worodria7, H. T. Aanyu8, C. De Jong9, M. Joloba10, F. Mukumbi11, G. Yimer12, T. Van Der Molen13, J. Chakaya14; 1Makerere University, Kampala, Uganda, 2Makerere University Lung Institute, Kampala, Uganda, 3Respiratory and Infectious Diseases Unit, Kenyatta National Hospital, Nairobi, Kenya, 4Department of Medicine, University of Michigan, Ann Arbor, MI, United States, 5College of Health Sciences, Addis Ababa University, AddisAbaba, Ethiopia, 6College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, 7Pulmonology Unit, Department of Medicine, Makerere University/Mulago Hospital, Kampala, Uganda, 8Department of Pediatrics, Makerere University/Mulago Hospital, Uganda, Kampala, Uganda, 9GRIAC-Primary Care, department of general practice and elderly care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, Groningen, Netherlands, 10Department of Microbiology, Makerere University/Mulago Hospital, Kampala, Uganda, 11Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda, 12GRIAC-Primary Care, department of general practice and elderly care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands, Groningen, Netherlands, 13University Medical Center Groningen, Groningen, Netherlands, 14Respiratory and Infectious Diseases Unit, Kenyatta National Hospital, Nairobi, Kenya.
RATIONALE
The prevalence of uncontrolled and severe asthma in East Africa is unknown. The African Severe Asthma Program (ASAP) is a prospective cohort study aimed at characterization of severe asthma in Africa. In this abstract we aim to describe the study design and characteristics of subjects enrolled at one site in this ongoing trial.
METHODS
We enrolled asthmatics in national hospitals in Uganda, Kenya and Ethiopia. At baseline standard tools are used to assess asthma severity, asthma control (ACQ), medication adherence using the Morisky scale (MMAS), depression (PHQ-9), asthma quality of life (AQLQ), and bronchial hyper responsiveness (BHQ). Spirometry, FeNO and skin prick testing (SPT) are obtained. We assess stool helminths, HIV, complete blood count (CBC) with differential and total IgE. PBMCs, RNA, serum, plasma and DNA are bio banked. Asthma is confirmed using a standardized form that incorporates symptoms, prior asthma diagnosis, medication use and spirometry. Monthly visits occur for the first six months then at 9 and 12 months. GINA based stepwise therapy is utilized to adjust treatment. All asthma medications are provided.
RESULTS
Of the 1032 enrolled subjects (62% of the target sample size), 540 are from Uganda. The Ugandan cohort is 76.2% female with a mean(SD) age of 34.1(15.5) years. The majority (82.1%) have a prior diagnosis of asthma with the median(IQR) age at first diagnosis of 21.5(IQR: 10 - 34) years. Obesity (21%), hypertension (8.5%) and depression (92.4%) were common. A family history of asthma was present in 59.8% of subjects. Current wheeze was reported by 39.3% of subjects. The distribution of severities includes intermittent (2.6%), mild
(27.8%), moderate (47.3%) and severe (22.3%) persistent asthma. Overall, 75.7% of the cohort reported uncontrolled asthma symptoms (ACQ >1). Only 16.2% of patients were on inhaled medications at baseline while 45.6% were on systemic corticosteroids and 29.3% were on salbutamol tablets/syrup. The median(IQR) FeNO was 17(7.5-38) ppb and absolute eosinophil count was 220 (100-410) cells/ul. Median (IQR) AQLQ score was 4.3 (3.5-5.1) and BHQ score was 2.2 (1.5 - 2.9). Low adherence by MMAS was noted in 44.8% of subjects.
CONCLUSIONS
Implementation of a high quality clinical research project in Africa is possible. The prevalence of moderate, severe and uncontrolled asthma is high; however, this may be confounded by the limited use of controller asthma therapies such as inhaled corticosteroids. Comorbidities including obesity, hypertension and depression are a common occurrence in this cohort.
Funding: GSK African NCD
Author Block: B. Kirenga1, W. Muttamba1, L. Mugenyi2, W. Katagira2, G. Nyale3, N. Lugogo4, A. B. Binegdie5, T. Haile6, W. O. Worodria7, H. T. Aanyu8, C. De Jong9, M. Joloba10, F. Mukumbi11, G. Yimer12, T. Van Der Molen13, J. Chakaya14; 1Makerere University, Kampala, Uganda, 2Makerere University Lung Institute, Kampala, Uganda, 3Respiratory and Infectious Diseases Unit, Kenyatta National Hospital, Nairobi, Kenya, 4Department of Medicine, University of Michigan, Ann Arbor, MI, United States, 5College of Health Sciences, Addis Ababa University, AddisAbaba, Ethiopia, 6College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, 7Pulmonology Unit, Department of Medicine, Makerere University/Mulago Hospital, Kampala, Uganda, 8Department of Pediatrics, Makerere University/Mulago Hospital, Uganda, Kampala, Uganda, 9GRIAC-Primary Care, department of general practice and elderly care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, Groningen, Netherlands, 10Department of Microbiology, Makerere University/Mulago Hospital, Kampala, Uganda, 11Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda, 12GRIAC-Primary Care, department of general practice and elderly care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands, Groningen, Netherlands, 13University Medical Center Groningen, Groningen, Netherlands, 14Respiratory and Infectious Diseases Unit, Kenyatta National Hospital, Nairobi, Kenya.
RATIONALE
The prevalence of uncontrolled and severe asthma in East Africa is unknown. The African Severe Asthma Program (ASAP) is a prospective cohort study aimed at characterization of severe asthma in Africa. In this abstract we aim to describe the study design and characteristics of subjects enrolled at one site in this ongoing trial.
METHODS
We enrolled asthmatics in national hospitals in Uganda, Kenya and Ethiopia. At baseline standard tools are used to assess asthma severity, asthma control (ACQ), medication adherence using the Morisky scale (MMAS), depression (PHQ-9), asthma quality of life (AQLQ), and bronchial hyper responsiveness (BHQ). Spirometry, FeNO and skin prick testing (SPT) are obtained. We assess stool helminths, HIV, complete blood count (CBC) with differential and total IgE. PBMCs, RNA, serum, plasma and DNA are bio banked. Asthma is confirmed using a standardized form that incorporates symptoms, prior asthma diagnosis, medication use and spirometry. Monthly visits occur for the first six months then at 9 and 12 months. GINA based stepwise therapy is utilized to adjust treatment. All asthma medications are provided.
RESULTS
Of the 1032 enrolled subjects (62% of the target sample size), 540 are from Uganda. The Ugandan cohort is 76.2% female with a mean(SD) age of 34.1(15.5) years. The majority (82.1%) have a prior diagnosis of asthma with the median(IQR) age at first diagnosis of 21.5(IQR: 10 - 34) years. Obesity (21%), hypertension (8.5%) and depression (92.4%) were common. A family history of asthma was present in 59.8% of subjects. Current wheeze was reported by 39.3% of subjects. The distribution of severities includes intermittent (2.6%), mild
(27.8%), moderate (47.3%) and severe (22.3%) persistent asthma. Overall, 75.7% of the cohort reported uncontrolled asthma symptoms (ACQ >1). Only 16.2% of patients were on inhaled medications at baseline while 45.6% were on systemic corticosteroids and 29.3% were on salbutamol tablets/syrup. The median(IQR) FeNO was 17(7.5-38) ppb and absolute eosinophil count was 220 (100-410) cells/ul. Median (IQR) AQLQ score was 4.3 (3.5-5.1) and BHQ score was 2.2 (1.5 - 2.9). Low adherence by MMAS was noted in 44.8% of subjects.
CONCLUSIONS
Implementation of a high quality clinical research project in Africa is possible. The prevalence of moderate, severe and uncontrolled asthma is high; however, this may be confounded by the limited use of controller asthma therapies such as inhaled corticosteroids. Comorbidities including obesity, hypertension and depression are a common occurrence in this cohort.
Funding: GSK African NCD
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