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A1893 - Predictive Factors of Asthma Control in the Middle East and North Africa
Author Block: B. Khassawneh1, N. H. Behbehani2, H. H. Al-Jahdali3, A. Al Qaseer4, A. Gjurovic5, H. Haouichat6, B. H. Mahboub7, E. Malvoti8, R. Naghshin9, F. Montestruc10, M. Tabbal11, H. N. Tarraf12; 1Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan, 2Faculty of Medicine, SaFat 13110, Kuwait, 3King Fahad Natl Guard Hosp, Riyadh 3939-13215, Saudi Arabia, 4College of Medicine Al Mustansiriah University, Bagdhad, Iraq, 5Astra Zeneca, Dubai, United Arab Emirates, 6University of Algiers, Algiers, Algeria, 7Rashid Hospital, Dubai 505070, United Arab Emirates, 8Astra Zeneca, London, United Kingdom, 9University of Medical Sciences, Tehran, Iran, Islamic Republic of, 10eXYSTAT, Malakoff, France, 11AstraZeneca, Londres, United Kingdom, 12University, Cairo, Egypt.
Introduction and Rationale
Asthma is a substantial burden to both the individual and to public health care. Despite availability of effective treatments and an increasing number of international recommendations, asthma control remains unsatisfactory in the Middle East and North Africa and predictive factors of poor control need to be explored.
Methods:
ESMAA is an epidemiological, cross-sectional study that was conducted from 2014 to 2015 with a random sample of general practitioners and specialists (pulmonologists and allergists) from the public and private sectors. Patients diagnosed with asthma for at least 12 months, without an acute asthma episode within 4 weeks prior to enrollment were included. The primary objective was to assess asthma control levels per GINA 2012. One of the main secondary objectives was to assess predictive factors influencing control levels by univariate and multivariate logistic analysis.
Results:
Eleven countries participated (Algeria, Egypt, Iran, Iraq, Jordan, Lebanon, Kuwait, Qatar, Saudi Arabia, Tunisia and United-Arab-Emirates), with 7306 patients included from 577 sites.
Median age was 45 years (range, 18-98 years) and 58% were female. Median BMI was 27.7 kg/m2 (13-85 kg/m2; 34.1 % were obese (BMl >30 kg/m2), 63.1% had been educated to secondary school or university level, while nearly 10% could not read or write; 69.1% had medical coverage, 10.8% were active smokers and 58.5% had a history of allergic rhinitis. Asthma was controlled in 29.4% of patients (95% Cl, [28.4%; 30.5%1), partly controlled in 29.1% [28.1%; 30.2%], while 41.5% [40.3%; 42.6%] had uncontrolled asthma.
In the univariate analysis, most variables correlated significantly with the level of asthma control, with the exception of the presence of allergic rhinitis. Multivariate analysis identified several factors with a significantly lower likelihood of having uncontrolled asthma: poor medication adherence (OR, 0.55 [95% CI, 0.49; 0.63]), active smoking (OR, 0.57 [95% CI, 0.48; 0.67]), absence of medical insurance (OR, 0.65 [95% CI, 0.58; 0.72]), or diagnosis at least 5 years earlier (OR, 0.73 [95% CI 0.62;0.88]). Patients with a higher level of education were less likely to have uncontrolled asthma (OR, 2.31 [95% CI 1.72;3.09]). BMI, age, and professional status did not significantly influence asthma control in the multivariate model.
Conclusions
Poor medication adherence, active smoking and absence of medical insurance are predictive factors of uncontrolled asthma among adults in the Middle East and North Africa. These factors should be addressed in the first 5 years of diagnosis to improve care.