Severe asthma: Clinical features and management in Tunisia

Chronic severe asthma (CSA) is a complex and heterogeneous condition with distinct subphenotypes leading to impaired quality of life and excessive healthcare need. Aim of the study was to describe the different subphenotypes of CSA and to assess its management in Tunisia. Methods: The clinical data of 54 patients (1998-2011) with CSA were analysed. Three groups were identified according to the CSA WHO definition. G1: untreated CSA due to unavailability of therapy, G2: difficult-to-treat CSA due to compliance issues and inappropriate use of medicines, and G3: treatment-resistant CSA. The latter includes 2 subgroups: uncontroled asthma despite the highest level of recommended treatment (G3a) and asthma which is controled only with the highest level of recommended treatment (G3b). Results: Patients are distributed as follows: G1: 27 patients (50%), G2: 8 patients (15%), G3: 19 patients (25%) including 9 cases of G3a (17%) and 10 cases of G3b (18%). Treatment included high doses of inhaled corticosteroids in all groups, long acting β2-agonists were available for G2 and G3 but not for G1 due to absence of social coverage. Oral corticosteroids were prescribed in 18 patients (33%), among whom 50% belong to G1. Admissions in intensive care unit for severe exacerbation were recorded in 18 cases (29%) and near-fatal-asthma was diagnosed in 13 cases (21%). CSA aetiologies were allergy: 37 cases, allergic bronchopulmonary aspergillosis: 3 cases, gastro oesophageal reflux: 4 cases and sensitivity to aspirin: 1 case. Conclusions: Management of CSA in Tunisia hospitals still suffers from unavailability of appropriate therapy for an important proportion of patients, which makes recourse to oral corticosteroids more frequent than in the reported literature.