Characterization of Asthma and Its Determinants in Ethiopia: Part of the African Severe Asthma Project (ASAP)


  • Amsalu Bekele AAU




Asthma is a major public health problem globally affecting 339 million people with 300,000 deaths annually. African Severe Asthma Program (ASAP) was a multi-country prospective cohort study designed to characterize severe asthma in three African countries Ethiopia, Uganda and Kenya.  In this study, we describe the baseline characteristics and disease severity among asthmatics enrolled in the Ethiopia site.


Analysis of baseline ASAP data of asthmatics from Tikur Anbessa Specialized Hospital (TASH), who visited the facility from August 2016 to May 2018, were included.  Asthma was diagnosed based on symptoms and spirometry. Baseline demographic and clinical data were collected using a structured questionnaire. Standardized research tools were used to assess asthma severity, asthma control and asthma quality of life. 


A total of 419 asthmatic patients were enrolled in the study; the mean age for the group was 52 ± 8 years and 58.2 % were female. The majority of participants, 365 (87.2%), had a prior diagnosis of asthma with a median (IQR) age at first diagnosis of 29 (IQR: 22 - 36) years. A family history of asthma was present in 149 (35.6%) subjects. Current or previous cigarette smoking was reported in 8.6% of participants. Overall, 93.8% of the participants reported uncontrolled asthma symptoms (ACQ >1.5). More than half of the patients, had severe persistent asthma and 35% presented with one or more comorbidities.


In Ethiopia, asthmatics can be characterized as predominantly female with late onset disease, with poor control  and associated comorbidity.








Asher I, Billo N Bissell K,et al. The Global Asthma Report 2018. Auckland, New Zealand: Global Asthma Network, 2018.

Christopher J L Murray. Global, regional, and national deaths, prevalence, disability adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691–706.

Adelove D, Chan KY, Rudan I, Campbell H. An estimate of asthma prevalence in Africa: a systematic analysis. Croat Med J 2013; 54(6):519-31

Tefereedgn EY, Ayana AM. Prevalence of asthma and its association with daily habits in Jimma Town, Ethiopia. Open J Asthma. 2018;2(1):011–7. https :// /oja.00000 9

Wjst M, Boakye D. Asthma in Africa. PLoS Med. 2007;4(2):e7203–5. https :// al.pmed.00400 72.

Korinan F, Fanta DF. Asthmatic patients on follow-up at chest clinic of Jimma University. Indo Am J Pharm Res. 2016;6:7089–97

Sharma S, Sood M, Sood A. Environmental risk factors in relation to childhood asthma in rural area. Curr Pediatr Res. 2011;15(1):29–32.

Elfaki NK, Shiby AY. Risk factors associated with asthma among Saudi adults in Najran. J Clin Respir Dis Care. 2017. https ://doi. org/10.4172/2472-1247.10001 33.

Hekking WP, Wener RR, Amelink M,et al.The Prevalence of severe Asthma.J Allergy Clin Immunol 2014.Volume 350,Number 4.

Busse WW, Banks-Schlegel S, Wenzel SE. Pathophysiology of Severe Asthma. J Allergy Clin Immunol 2000;106:1033-42

O` Byme PM, Naji N, Gauvreau GM. Severe asthma future treatment. Clin Exp Allergy 2012;42:706-11

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020. Available from:

Humbert M, Holgate S, Boulet LP, Bousquet J. Asthma control or severity: that is the question. Allergy 2007; 62: 95–101.

Bateman ED, Boushey HA, Bousquet J, et al. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control study. Am J Respir Crit Care Med 2004; 170: 836–844.

American Thoracic Society, Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. Am J Respir Crit Care Med 2000; 162: 2341–2351.

Chanez P, Wenzel SE, Anderson GP, et al. Severe asthma in adults: what are the important questions?J Allergy Clin Immunol 2007; 119: 1337–1348.

Boulet L, Becker A, Bowie D, et al. Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD. Can Respir J 2006; 13: Suppl. A, 5–47.

Chapman KR, Boulet LP, Rea RM, Franssen E. Suboptimal asthma control: prevalence, detection and consequences in general practice. Eur Respir J 2008; 31: 320–325.

Ellwood P, Asher MI, Beasley R, Layton TO, Stewart AW. International Study of Asthma and Allergies in Childhood, Phase Three Data, ISAAC International Data Centre, Auckland, NewZealand, July 2000. Available from:

Wjst M, Boakye D. Asthma in Africa. PLoS Med 2007;4:e72.

Shine S, Muhamud S, Demelash A. Prevalence and associated factors of bronchial asthma among adult patients in Debre Berhan Referral Hospital, Ethiopia 2018: a cross-sectional study. Shine et al. BMC Res Notes (2019) 12:608

Demissie M, Kumie A. Prevalence of symptom of Asthma and Associated factors among primary school children in Addis Ababa. Ethiop Med J, 2018; . 56 (. 4 ): Pages

Kirenga B , Chakaya J, Yimer G et al . Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project. BMJ Open Resp Res 2020;7:e000484. doi:10.1136/bmjresp-2019-000484

Juniper, E.; O′ byrne, P.; Guyatt, G.; Ferrie, P.; King, D., Development and validation of a questionnaire to measure asthma control. European Respiratory Journal 1999: 14 (4):, 902-907

National Heart, Lung and Blood Institute, Expert panel report 3 (EPR3): guidelines for the diagnosis and management of asthma. http://www. nhlbi. nih. gov/guidelines/asthma/ 2007.

Kroenke, K.; Spitzer, R. L.; Williams, J. B., The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine 2001; 16(9): 606-613.

Juniper, E. F.; Guyatt, G.; Epstein, R.; Ferrie, P. J.; Jaeschke, R.; Hiller, T. K., Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax 1992, 47, (2), 76-83.

Reilly, M. C.; Zbrozek, A. S.; Dukes, E. M., The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics 1993, 4, (5), 353-365

Miller, M. R.; Hankinson, J.; Brusasco, V. et al. Standardisation of spirometry. Eur Respir J 2005, 26, (2), 319-38.

Ford, E. S., The epidemiology of obesity and asthma. Journal of allergy and clinical immunology 2005, 115, (5), 897-909.

Dreborg, S., The skin prick test in the diagnosis of atopic allergy. Journal of the American Academy of Dermatology 1989, 21, (4), 820-821.

Deschildre, A., [Allergens causing respiratory allergy: the aeroallergens]. Arch Pediatr 1999, 6, (1), 48S-54S.

Reddel, H. K.; Taylor, D. R.; Bateman et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. American journal of respiratory and critical care medicine 2009, 180, (1), 59-99

Schatz, M.; Meckley, L. M.; Kim, M.; Stockwell, B. T.; Castro, M., Asthma exacerbation rates in adults are unchanged over a 5-year period despite high-intensity therapy. The Journal of Allergy and Clinical Immunology: In Practice 2014, 2, (5), 570-574. e1.

Owens, L.; Laing, I. A.; Zhang, G.; Turner, S.; Le Souëf, P. N., Prevalence of allergic sensitization, hay fever, eczema, and asthma in a longitudinal birth cohort. Journal of asthma and allergy 2018, 11, 173

Hirano T, Matsunaga K. Review article, Late-onset asthma: current perspectives. Journal of Asthma and Allergy 2018:11 19–27. Open Access Full Text Article

Woo-Jung Song, Gray W.K.Wong. Paradigms and Perspectives. Changing trends and challenges in the management of asthma in Asia. J Allergy Clin Immunol 2017;140:1272-4

Sood A, Qualls C, Schuyler M et al., “Adult-onset asthma becomes the dominant phenotype among women by age 40 years :the longitudinal CARDIA study,” Annals of the American ThoracicSociety. 2013: 10 (.3): 188–197.

de Nijs SB, Venekamp LN, Bel EH, Adult-onset asthma: is it really different? European Respiratory Review. 2013: . 22 (127): .44–52.

Wenzel SE., Asthma phenotypes: the evolution from clinical to molecular approaches. Nature Medicine: 2012:.18 (.5): 716– 725

Ilmarinen P, Tuomisto LE, . Kankaanranta H “Phenotypes, risk factors, and mechanisms of adult-onset asthma,” Mediators of Inflammation, 2015;2015:514868. doi: 10.1155/2015/514868

. Antonicelli L, Bucca C, Neri M, De Benedetto F, Sabbatani P, Bonifazi F, Eichler HG, Zhang Q, Yin DD. Asthma severity and medical resource utilization Eur Respir J 2004; 23: 723.

Serra-Batlles J, Plaza V, Morejon E, Comella A, Brugues J. Costs of asthma according to the degree of severity. Eur Respir J 1998;12:1322–1326.

Godard P, Chanez P, Siraudin L, Nicoloyannis N, Duru G. Costs of asthma are correlated with severity: a 1-yr prospective study. Eur Respir J 2002;19:61–67.

Vermeire PA, Rabe KF, Soriano JB, Maier WC. Asthma control and differences in management practices across seven European countries. Respir Med. 2002,Volume 96, Issue 3, March 2002, Pages 142-149.

Wang E, Michael E. Wechsler et al. Characterization of severe asthma worldwide: data from the International 4 Severe Asthma Registry (ISAR). Year, volume and pages

Price D, Fletcher M, Van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. Prim Care Respir Med. 2014. https://doi. org/10.1038/npjpcrm.2014.

Demoly P, Annunziata K, Gubba E, Adamek A. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years. Eur Respir Rev. 2012;21(123):66–74.

Cazzoletti L, Marcon A, Janson C, et al. Asthma control in Europe: a realworld evaluation based on an international population-based study. J Allergy Clin Immunol. 2007;120(6):1360–7.

Mintz M, Gilsenan AW, Bui CL, et al. Assessment of asthma control in primary care. Curr Med Res and Opin. 2009;25(10):2523–31.

Philip M, Renee JG, Sean E, et al. A retrospective randomized study of asthma control in the US: results of the CHARIOT study. Curr Med Res Opin. 2008;24(12):3443–52.

Reddel HK, Sawyer SM, Everett PW, Flood PV, Peters MJ. Asthma control in Australia: a cross-sectional web-based survey in a nationally representative population. Med J Aust. 2015;202(9):492–7.

Boonsawat W, Boonsawat W, Thinkhamrop B. Evaluation of asthma control by inhale corticosteroids in general practice in Thailand. Asian Pac J Allergy Immunol. 2015;33(1):21–5.

Christopher KW, Teresita SG, You-Young K, et al. Asthma control in the Asia-Pacific region: the asthma insights and reality in Asia-Pacific study. J of Allergy and Clin Immunol. 2003;111(2):263–8.

Tewodros HG, Amsalu BB, Abebe SM et al.. Level of asthma control and risk factors for poor asthma control among clinic patients seen at a Referral Hospital in Addis Ababa, Ethiopia. BMC Res Notes (2017) 10:558 DOI 10.1186/s13104-017-2887-z

Yohanes Ayele, Ephrem Engidawork, Tola Bayisa. Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia. BMC Res Notes (2017) 10:314 DOI 10.1186/s13104-017-2645-2

Tadesse M. Abegaz, Efrata A. Shegena, N. F. Gessie, Barriers to and competency with the use of metered dose inhaler and its impact on disease control among adult asthmatic patients in Ethiopia. BMC Pulmonary Medicine (2020) 20:48

Kebede B, Mamo G, Molla A. Association of Asthma Control and Metered-Dose Inhaler UseTechnique among Adult Asthmatic Patients Attending Outpatient Clinic, in Resource-Limited Country: A Prospective Study. Hindawi Canadian Respiratory Journal Volume 2019, Article ID 6934040, 6 pages

Zewudie A, Nigussie T, Mamo Y, Kumela K. Determinants of poorly controlled asthma among asthmatic patients in Jimma University Medical Center, Southwest Ethiopia: a case control study.. BMC Res Notes (2019) 12:525

Zelalem T. Tesfaye, Nebeyu T. Gebreselase, Boressa A. Horsa. Appropriateness of chronic asthma management and medication adherence in patients visiting ambulatory clinic of Gondar University Hospital: a cross-sectional study. World Allergy Organization Journal (2018) 11:18

S.Yimer,C.Holm-Hansen,T.Yimaldu,andG.Bjune,“Healthcare seeking among pulmonary tuberculosis suspects andpatients in rural Ethiopia: a community-based study,”BMCPublic Health,vol.9,article454,2009

Mebratie AD, Van dePoel E, YilmaZ,Abebaw D, AlemuG, BediAS: Healthcare-seeking behavior in rural Ethiopia: evidence from clinical vignettes. BMJopen2014, 4(2):e004020.doi:10.1136/bmjopen2013-004020PMID:24525391

Boulet LP. Influence of comorbid conditions on asthma. REVIEW ARTICLE. Eur Respir J 2009; 33: 897–906 DOI: 10.1183/09031936.00121308

American Thoracic Society, Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. Am J Respir Crit Care Med 2000; 162: 2341–2351.

Woledesenbet MA, Mekonen SS , Melese L , Melaku Abegaz TM. Epidemiology of Depression and Associated Factors among Asthma Patients in Addis Ababa, Ethiopia. Hindawi Psychiatry Journal Volume 2018, Article ID 5934872, 7 pages






Original Article