The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project

Abstract

Severe asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown. We sought to determine the burden (prevalence, mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethiopia. Using the American Thoracic Society/European Respiratory Society case definition of severe asthma, we analyzed for the prevalence of severe asthma (requiring Global Initiative for Asthma [GINA] steps 4-5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4-5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA-recommended medications. Asthma control was assessed by the asthma control questionnaire (ACQ). Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% confidence interval [CI], 23.1-28.3) and 4.6% (95% CI, 3.5-6.0), respectively. Patients with severe asthma were (nonsevere vs severe vs severe refractory) older (39, 42, 45 years, P= .011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, P= .004), had lower forced expiratory volume in 1 second percentage (81%, 61%, 55.5%, P< .001), had lower quality of life score (129, 127 vs 121, P< .001), and had higher activity impairment (10%, 30%, 50%, P< .001). Factors independently associated with severe asthma were hypertension comorbidity; adjusted odds ratio 2.21 (1.10-4.47), P = .027, high bronchial hyperresponsiveness questionnaire score; adjusted odds ratio 2.16 (1.01-4.61), P = .047 and higher ACQ score at baseline 2.80 (1.55-5.08), P = .001. The prevalence of severe asthma in Africa is highand is associated with high morbidity and poor quality of life.