The Assessment of Asthma Control in Diagnosed African Adolescents

Rationale: The International Study of Asthma and Allergies in Childhood (ISAAC) has highlightedthe increased prevalence of severe asthma symptoms in African adolescents. The Global AsthmaReport (2018) has reported barriers to good asthma control including underdiagnosis of asthma,but data to highlight its impact, in many African countries, is lacking. The Achieving Control ofAsthma in Children in Africa (ACACIA) study aims to further explore asthma symptoms, severity andcontrol, as well as identify barriers in six urban cities in sub-Saharan Africa. Methods: 12-14 year-old urban school children, with current asthma symptoms, in Ghana, Malawi, Nigeria, South Africa,Uganda, and Zimbabwe completed a survey as well as spirometry and exhaled nitric oxide (FeNO)testing. Asthma control was determined using the Global Initiative for Asthma (GINA) assessment ofasthma control and the Asthma Control Test (ACT). Results: We identified 418 children who hadwheeze in the last 12 months. 65% (n=272) of these children had severe asthma symptoms andonly 28% (n=76) had a confirmed doctor diagnosis of asthma. 53% (n=40) of these diagnosedchildren with severe symptoms, had uncontrolled asthma according to the GINA assessment. Only51% (n=39) of the diagnosed children with severe symptoms (n=76), had a reliever inhaler. 77%(n=30) of these children had poor asthma control according to the ACT (ACT ≤19). Over half (57%)of these children with poor control, had an ACT score of ≤15 (very poorly controlled asthma). 75%(n=56) of the diagnosed children with severe symptoms who participated in testing (n=75), hadeither obstructive spirometry (an FEV1 < 80% of predicted or an FEV1/FVC ratio < the lower limit ofnormal), significant bronchodilator reversibility (increase in FEV1 ≥ 12% and 200 ml) or an elevatedFeNO reading (≥25ppb). Conclusions: The assessment of asthma control in these children indicatean increased risk of poor and adverse future outcomes for children diagnosed with asthma incertain African countries. It is imperative that the impact of poor asthma control be highlighted andidentified in order to address barriers and to encourage the development of interventions toimprove and maintain good asthma control

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