Asthma control among adults in Saudi Arabia

ىدل هب مكحتم ريغلا وأ جلاعم ريغلا وبرلا تاببسم ديدتح :فادهلأا .ةيدوعسلا ةيبرعلا ةكلملما يف هب ينباصلما ىضرلما ينباصلما ينغلابلا ىضرلما نم ةعومجم ةساردلا هذه تلمش :ةقيرطلا ،يسفنتلا بطلل تادايع 3 ىلإ اًقبسم ةلجسم ديعاوبم اوتأ نيذلاو وبرلاب قيرط نع مهنم تانايبلا عمج تم دقلو .ةيدوعسلا ةيبرعلا ةكلملما ،ضايرلا نم ددعتلما يتسجوللا رادحنلاا مادختسا تم اميف .ةيصخشلا تلاباقلما .ةساردلا تانايب ليلتح لجأ 68.1% ىلإ هب مكحتم ريغلا وبرلا ىضرم ةبسن تلصو دقل :جئاتنلا لخدلا وأ ،يمويلا ينخدتلا نم لاك ناكو .)260 لصأ نم 177( 4.6 لداعي ابم ةطبترم يدوعس لاير 15.000 نم لقلأا يرهشلا يرسلأا )95%CI=1.8-6.6( اًفعض 3.4 و ،)95%CI=1.3-16.4( اًفعض متي ملف كلذ ىلإ ةفاضلإاب .جلاعم ريغلا وبرلاب ةباصلإا حيجرت يف ةدايز ةيميلعت جرخت تاداهش ينلمالحا ريغ نم ىضرلما ىدل وبرلاب مكحتلا ،ينقوعلماو ،لمعلا نع ينلطاعلاو ،)OR=3.1; 95%CI=1.0-9.5( .)OR=3.1; 95%CI=1.4-6.9( لمعلا ىلع نيرداقلا ريغ كلذكو نم ةيضالما عبرلأا عيباسلأا للاخ ةيدعلما ةضوملحا ثودح للقو امك امك .)95%CI=1.3-4.9( 2.5 لدعبم ضرلماب مكحتلا ةيحجرأ عيباسلأا عبرلأا للاخ نمزلما ةيفنلأا بويلجا باهتلا ثودح للقو 2.0 لدعبم ينباصلما ىدل ضرلماب مكحتلا ةيحجرأ نم ةيضالما ثانلإا ناك دقف كلذ ىلع ةولاعو .)95%CI=1.0-4.0( اًفعض يواست وأ نم رثكلأا رامعلأا وأ ،)OR=2.0; 95%CI=1.0-4.0( مدعب اًضيأ ةطبترم )OR=2.0; 95%CI=1.0-3.9( اًماع 35 .وبرلاب ينباصلما ىضرلما ىدل ضرلماب مكحتلا وبرلا نم نوناعي اوناك ةساردلا ةنيع ةيبلغأ نأ ىلا جئاتنلا ريشت :ةتمالخا اهليدعت نكيم لا يتلا ةيناكسلاو ةيعامتجلاا لماوعلا نأو ،هب مكحتم ريغلا نم ديزت دق )رمعلاو ،سنلجاو ،ةنهلماو ،ميلعتلاو ،يرسلأا لخدلا( ةلوهسب نكيم يتلا رطلخا لماوع نإف سكعلا ىلعو .هب مكحتلما ريغ وبرلا ةبسن ةيفنلأا بويلجاو ةدعلما ةقرحك ةيريرسلا لماوعلاو ينخدتلا لثم اهليدعت .هنم نوناعي نيذلا ىضرلما دنع وبرلاب مكحتلل اهفادهتسا نكيم ةنمزلما Objectives: To explore the determinants of uncontrolled asthma in Saudi Arabia. Methods: A consecutive series of adult asthma patients attending 3 pulmonary primary care clinics in Riyadh, Saudi Arabia for a scheduled appointment were interviewed. A multiple logistic regression analysis was used. Results: The proportion of patients with uncontrolled asthma was 68.1% )177/260(. Daily tobacco smoking or monthly household income less than 15,000 Saudi Arabian Riyals were associated with a 4.6 )95% confidence interval [CI]=1.3-16.4( and 3.4 )95% CI=1.8-6.6( times increase in the odds of having uncontrolled asthma. Patients with less than a graduate degree )odds ratio [OR]=3.1; 95% CI=1.0-9.5( or patients who were unemployed, disabled, or too ill to work )OR=3.1; 95% CI=1.4-6.9( had poorer asthma control. Having heartburn during the past 4 weeks decreased the odds of asthma control by 2.5 )95% CI=1.3-4.9(, and having chronic sinusitis during the past 4 weeks decreased the odds of asthma control by 2.0 )95% CI=1.0-4.0( times. Being female )OR=2.0; 95% CI=1.0-4.0( or ≥35 years of age )OR=2.0; 95% CI=1.0-3.9( was also associated with having uncontrolled asthma. Conclusion: Our findings suggest that most respondents had uncontrolled asthma. Less modifiable socio-demographic factors )for example, income, education, occupation, gender, and age( significantly increased the odds of having uncontrolled asthma. However, modifiable risk factors such as tobacco smoking and clinical factors such as heartburn and chronic sinusitis could also be targeted for intervention. Saudi Med J 2015; Vol. 36 (5): 599-604 doi: 10.15537/smj.2015.5.10929 From the Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. Received 16th December 2014. Accepted 16th February 2015. Address correspondence and reprint request to: Prof. Abdulaziz A. BinSaeed, Department of Family and Community Medicine (34), College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. Fax. +966 (11) 4671967. E-mail: [email protected] OPEN ACCESS 599 www.smj.org.sa Saudi Med J 2015; Vol. 36 )5( 600 Determinants of asthma control in adults ... BinSaeed Saudi Med J 2015; Vol. 36 )5( www.smj.org.sa A is a chronic disease that is caused by airway inflammation and obstruction. The prevalence of asthma is approximately 300 million worldwide and continues to increase. Common asthma symptoms include coughing, wheezing, chest tightness, and shortness of breath. These symptoms range from mild to severe and can lead to a fatal outcome. Symptoms of uncontrolled asthma can appear several times a day and can considerably decrease the quality of life of asthma patients and their family members. The economic burden of asthma is substantial and includes medical and non-medical costs.1-4 Currently, the main goal of asthma treatment is to control the disease and minimize the number of episodes of exacerbation. Asthma can be effectively controlled in most patients by avoiding common triggers and by adhering to prescribed treatment regimens.5 However, even in developed countries, 40-70% of patients have inadequately controlled asthma.6,7 The proportion of patients with uncontrolled asthma is also high in Kingdom of Saudi Arabia )KSA(, with reports as high as 64% in adults,8 and 59.3% in children.9 Factors affecting asthma control include socio-demographic characteristics, psychosocial factors, asthma severity, adherence to treatment, an appropriate inhaler technique, and exposure to infectious agents )especially viruses(, and to indoor and outdoor allergens or pollutants.1,10-14 The presence of comorbidities )for example, hypertension, chronic sinusitis, and gastroesophageal reflux disease( also contribute to an increased risk of poor asthma control.11,15-17 Uncontrolled asthma is an important public health problem in KSA, but only a very limited number of studies have been conducted to explore this issue. The objectives of the current study were to determine the proportion and determinants of uncontrolled asthma in adults who presented at 3 pulmonary primary care clinics Riyadh, KSA. Methods. Study design. The study design was a cross-sectional survey of asthma patients. Target population. A consecutive series of adults asthma patients )≥18 years of age( who attended the pulmonary primary care clinic of King Khalid University Hospital, King Fahad Medical City, and the Advanced Medicine Center in Riyadh, Kingdom of Saudi Arabia during the study period from February to March 2014 for a scheduled appointment were approached by clinic staff nurses and were referred to the interviewer. Patients who had been diagnosed by a physician at least 3 months before joining the study, were not pregnant, and did not have respiratory diseases other than asthma were included in the study. Study participants signed the consent form and completed the questionnaire before being examined by the doctor. The Institutional Review Boards of King Fahad Medical City and the College of Medicine of King Saud University approved this study. Instruments. A structured, self-administered questionnaire was used to assess the socio-demographic and clinical characteristics of the asthma patients. Asthma control was measured using an Arabic version of a valid and reliable asthma control test )ACT( designed to be used for individuals ≥12 years of age.18,19 The original questionnaire was developed and validated by Nathan and colleagues.18 The asthma control score ranged from 5 to 25. Higher scores indicated a higher level of asthma control. A patient’s asthma was considered to be uncontrolled if the ACT score was ≤19. The specificity of the questionnaire were 69.2%, and the sensitivity was 76.2%, compared with the specialist’s rating. An internal consistency reliability was 0.84.18 A linguistic validation of the Arabic version of the ACT was conducted by the MAPI research institute )MAPI Institute, Lyon, France(. The questionnaire was piloted among 25 patients by trained interviewers before it was used for the study. Statistical analysis. Data entry and statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21.0 )IBM Corp, Armonk, NY, USA(. Descriptive statistics were used to characterize the overall sample. Pearson’s Chi-square test, Fisher’s exact test, linear-by-linear association test, or simple logistic regression analysis was used to evaluate associations between outcome and exposure variables. Statistically significant )p<0.05( or near to significant variables were included in the multiple logistic regression model. Covariates included in the model were age, gender, education, occupation, marital status, monthly household income, body mass index )BMI(, tobacco smoking, and comorbidities )for example, allergic rhinitis, chronic sinusitis, and heartburn(. Only statistically significant variables )p<0.05( were maintained in the final model. The Hosmer-Lemeshow test was used to assess the goodness-of-fit. All covariates were checked for co-linearity and assessed for interaction effects. Results. Out of 304 eligible patients who were approached in the waiting area, 260 )85.5%( agreed to participate in the study. Almost one-half of the patients were female )48.8%(. The median age of Disclosure. Authors have no conflict of interests. This project was supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Kingdom of Saudi Arabia.