Factors Associated With Difficult Asthma In Outpatient Chest Clinics In Mukalla District, Yemen

Abstract

Background: Bronchial asthma is the commonest
chronic respiratory disorder worldwide. Difficult
asthma is characterized by difficulty to achieve disease control despite high-dose inhaled glucocorticoids plus long-acting β2-agonists (LABAs) or oral
corticosteroids (OCSs). In difficult asthma some
factors should be considered like occupational factors, indoor and outdoor exposure, non-adherence
and non-compliance to therapy, allergic rhinitis and
GERD. This study was conducted to analyze different factors associated with difficult asthma.
Methodology: A cross-sectional study was conducted in the period between December 2016 to February
2017. All patients with bronchial asthma attending
the chest clinics in Mukalla during enrolled in the
study. The data were collected by interview questionnaire. Analysis was done by using SPSS for
Windows version 20. Descriptive statistics and Chi
square analysis were used to show frequency distributions and association. The data was presented in
tables and graphs.
Results: Two hundred and ten bronchial asthma patients were included in the study; 76 of them had difficult asthma, the majority were at age group (49-60
y.) with female predominance. Many factors affected
their difficult asthma; half of them had indoor and
outdoor exposure, more than half of them had occupational factors and allergic rhinitis. Only one third
of patients were using inhaler technique correctly,
and more than one third had financial difficulties as
barrier to adherence, while less than one third believed that inhaled therapy well be a habit forming
in their life. About comorbidities more than half of
patients had GERD and anxiety with significant association, on the other hand less than one third had food
allergy and obesity.
Conclusion: Difficult asthma is common in middle
age. Many factors should be considered in diagnosing difficult asthma such as indoor and outdoor exposure, non-adherence and incorrect use of inhaler
therapy. Most common comorbidities were allergic
rhinitis followed by GERD, anxiety and obesity.