Date Published: April 18, 2019
Publisher: Public Library of Science
Author(s): Benoit Obel Kabengele, Jean-Marie Ntumba Kayembe, Patrick Kalambayi Kayembe, Zacharie Munogolo Kashongue, Didine Kinkodi Kaba, Pierre Zalagile Akilimali, Heinz Fehrenbach.
The ultimate goal of asthma treatment is long-term control. Uncontrolled asthma is a major public health problem worldwide, but there is a lack of data on asthma control and its causes in the Democratic Republic of Congo (DRC).
To determine the socio-demographic, environmental, clinical, and biological factors and comorbidities associated with uncontrolled adult asthma in Kinshasa, DRC.
We performed a cross-sectional study of 216 male and female asthmatics aged 18 and over consecutively recruited from tertiary clinics and the community in Kinshasa between June 2017 and February 2018. For each subject, socio-demographic, clinical, para clinical and environmental data were recorded. Forced Expiratory Volume in one second (FEV1) values were obtained by Spirometry, allergen testing performed using the skin prick test, serum vitamin D levels measured by radioimmunoassay, and asthma control assessed using the asthma control test (ACT) score. Multiple logistic regression identified factors associated with uncontrolled asthma.
The average age of participants was 45.2 (SD 17.6) years, 74% were female, and 42% had a low educational level. Among all asthmatics, the prevalence of uncontrolled asthma was 56%, abnormal serum vitamin D level 95%, abnormal FEV1 65%, sensitization to two allergens (cat dander and dust mites) 18%, sleep disorders 37%, and heartburn 60%. Male (aOR 2.24; 95% CIs 1.04–4.79), low educational level (aOR 3.26; 95% CIs 1.54–6.67), sensitization to both cat dander and dust mites (aOR 2.67; 95% CIs 1.16–6.14), FEV1 ≤80% (aOR 2.07; 95% CIs 1.08–3.96), abnormal serum vitamin D level (aOR 5.11; 95% CIs 1.17–22.33), sleep disorders (aOR 1.96; 95% CIs 1.04–3.71), and heartburn (aOR 2.02; 95% CIs 1.04–3.92) were significantly associated with uncontrolled asthma.
Uncontrolled asthma is common in Kinshasa, and these factors associated with uncontrolled asthma may be considered as targets for future intervention strategies.
Asthma, a heterogeneous disease with a complex and multifactorial physiopathology, is a major global public health problem. The estimated global prevalence of asthma is 334 million, including 50 million affected individuals in Africa, and 9% of young adults aged 18–45 have experienced asthmatic symptoms [1–3]. In Kinshasa, the capital of the Democratic Republic of Congo (DRC), the reported prevalence of asthma in adults is 6.9%, with even more (7.3%) reporting chest wheeze at some point in their lives . Asthma affects affected individuals’ quality of life and increases hospitalizations and medication use .
This was a cross-sectional study conducted between June 14, 2017 and February 27, 2018 in Kinshasa. Given the lack of asthma registers in health facilities, including information on patients with asthma, the University Clinics of Kinshasa and some parishes and revival churches in Kinshasa were selected for subject recruitment.
Here we report that just over half of subjects in this sample of adult asthmatics in Kinshasa had uncontrolled asthma (56%). We found that male, low educational level, sensitization to at least two allergens, decreased FEV1, heartburn, sleep disorders, and abnormal serum vitamin D level were significantly associated with uncontrolled asthma.
Here we report that a significant proportion of adult asthmatics in Kinshasa have uncontrolled asthma. Male, low educational level, simultaneous sensitization to cat dander and house dust mites, decreased FEV1, heartburn, sleep disorders, and abnormal serum vitamin D level are significantly associated with uncontrolled asthma. These observations are important to consider when developing context-specific intervention strategies.