Asthma management and control in Nigeria: the asthma insight and reality Nigeria (AIRNIG) study

ABSTRACT

Background: The state of asthma management and asthma control at the population level in Nigeria is unknown. We aimed to determine the level of asthma control and asthma management practices in Nigeria.

Methods: A cross-sectional population-based study of 405 participants with current asthma (physician-diagnosed with use of asthma medication or asthma symptoms in the preceding 12 months). We determined the level of asthma control, self-perception of asthma control, health-care use, missed work/school, and medication use.

Results: Asthma was controlled in 6.2% of the participants. Night-time awakening and limitation in activity in the preceding 4 weeks were reported by 77.5% and 78.3%, respectively, 56.3% and 14.1% missed work/school and had emergency room visits, respectively, and 11.6% and 38.8% used inhaled corticosteroid and short-acting beta-2 agonist, respectively, in the preceding year. About a third (34.3%) had spirometry ever performed and 46.7% had training on inhaler technique. Nearly 90% with uncontrolled asthma had self-perception of asthma control between somewhat and completely controlled.

Conclusion: The level of asthma control in Nigeria is poor with a high burden of asthma symptoms and limitation in activities. This calls for a broad-based approach for the improvement in asthma care that encompasses education and access to medications.

KEYWORDS:

• Asthma
• control
• Nigeria

Article highlights

• This was the first AIR survey in sub-Saharan Africa that assessed the level of asthma control and asthma management practice at the population level.

• The rate of asthma control among children and adults in Nigeria is poor and asthma management practices are also not optimal.

• Only 6.2% of the participants had well-controlled asthma based on the GINA criteria and there was a poor perception of the level of asthma control.

• There was a high burden of asthma with frequent episodes of nighttime symptoms (77.5%), limitations in daily activities (78.3%), absenteeism (56.3%), and emergency room visits (14.1%) in the preceding year.

• Only 27.9% made scheduled hospital visits for asthma, one third had spirometry testing ever performed and 46.7% and 24.7% had received training on inhaler technique and differences between controller and reliever medications, respectively.

• Reliever medications were the most frequently used medications and only 11.6% and 6.4% used inhaled steroids and oral montelukast, respectively. Most participants (67.8%) were non-adherent to medications and only used them when symptomatic.

• Poor asthma control and asthma management practice have been reported in previous AIR studies and this situation had not changed in the last decade.

Author contributions

OBO: Conceptualization and design, data analysis and interpretation of data, drafting of the manuscript, revision for intellectual content and approval of the final version for publication. ACA: Conceptualization and design, drafting of the manuscript, revision for intellectual content and approval of the final version for publication. KNU: Conceptualization and design, interpretation of data, revision for intellectual content and approval of the final version for publication.OOD: Conceptualization and design, drafting of the manuscript, revision for intellectual content and approval of the final version for publication.

OO: Conceptualization and design, revision for intellectual content and approval of the final version for publication. SAA: Data analysis and interpretation of data, drafting of the manuscript, revision for intellectual content and approval of the final version for publication.

EE: Conceptualization and design, revision for intellectual content and approval of the final version for publication. OO: Conceptualization and design, revision for intellectual content and approval of the final version for publication. SKD: Data analysis and interpretation of data, revision for intellectual content and approval of the final version for publication. AS: Conceptualization and design, revision for intellectual content and approval of the final version for publication. MB: Conceptualization and design, revision for intellectual content and approval of the final version for publication.

Acknowledgments

We thank the project supervisors and data managers for their contribution to the success of this work. We are also grateful to the American Thoracic Society/Pan African Thoracic Society MECOR program for the training that contributed to the implementation of this project.

Declaration of interest

OB Ozoh is the principal investigator of the Research Grant from GlaxoSmithKline Nigeria. AC Ayuk, KN Ukwaja, OO Desalu, E Egbagbe, and M Babashani are co-investigators of the Research Grant from GlaxoSmithKline Nigeria. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary materials

Supplemental Materials data for this article can be accessed here.

Additional information

Funding

This work was funded by a non-interventional grant from GlaxoSmithKline Nigeria [Grant number ISS 8210]. The funders had no role in study design, data collection and analysis, preparation of the manuscript, or decision to publish.