Asthma control in cities of developing countries: results of a five-city survey

Introduction Over 80% of asthma-related deaths occur in low and lower-middle income countries,1 with asthmatic children in low and middle income countries having more severe symptoms than those in high income settings.2-4 Asthmaassociated symptoms, sleep disturbances, impairment of lung function, increased use of rescue medication, and limitation of daily activity and quality of life impose a significant burden on affected individuals, the updated Global Initiative for Asthma (GINA) guidelines5 therefore emphasise that asthma management should be based on achieving and maintaining clinical asthma control.6–9 Surveys assessing the current level of asthma control in asthmatic children and adults in different regions of the world10–20 have indicated that asthma control was suboptimal and that the disease was still under-diagnosed and under-treated globally. Inadequate asthma control results in poor health outcomes; including greater numbers of emergency room visits and hospitalization/ urgent healthcare utilization, increased mortality, lower physical and mental health-related quality of life scores, absenteeism from work/school, and higher levels of activity impairment/overall work productivity loss.20, 22–26 Most of these observations are based on information from Western Europe and North America. In view of the dearth of asthma control information from developing countries, the objectives of this study were to understand, for urban settings of developing countries from diverse regions of the world, the perception of asthma in the general population through a household survey and the level of asthma control through a complementary survey with asthmatics.