Guidelines for the management of asthma in adults and adolescents: Position statement of the South African Thoracic Society – 2021 update

Lalloo, Umesh; Kalla, I S; Abdool-Gaffar, Sabeer; Dheda, Keertan; Koegelenberg, C F N; Greenblatt, Michael; Feldman, Charles; Wong, Man Sau; Zyl-Smit, Richard van

doi:10.7196/ajtccm.2021.v27i4.189

Cited by 8 publications

(11 citation statements)

References 42 publications

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“…[5 , 35 - 37] Therefore, asthma remains relatively poorly controlled across the country, suggestive of undertreatment, inappropriate treatment and/or a lack of patient and HCP education. Despite an active national education programme, and the work of the National Asthma Education Programme and professional societies that are closely involved in the development of evidence-based guidelines, [38 , 39] it is apparent that further educational initiatives targeting patients, pharmacists and physicians are required to improve asthma care.…”

Section: Discussionmentioning

confidence: 99%

Over-prescription of short-acting β2-agonists for asthma in South Africa: Results from the SABINA III study

Smith¹,

Ambaram²,

Mitha³

et al. 2022

Afr J Thoracic Crit Care Med

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Background. Asthma medication prescription trends, including those of short-acting β2-agonists (SABAs), are not well documented for South Africa (SA).Objectives. To describe demographics, disease characteristics and asthma prescription patterns in the SA cohort of the SABA use IN Asthma (SABINA) III study. Methods. An observational, cross-sectional study conducted at 12 sites across SA. Patients with asthma (aged ≥12 years) were classified by investigator-defined asthma severity, guided by the Global Initiative for Asthma (GINA) 2017 recommendations, and practice type (primary/ specialist care). Data were collected using electronic case report forms.Results. Overall, 501 patients were analysed − mean (standard deviation) age, 48.4 (16.6) years; 68.3% female − of whom 70.6% and 29.4% were enrolled by primary care physicians and specialists, respectively. Most patients were classified with moderate-to-severe asthma (55.7%; GINA treatment steps 3 - 5), were overweight or obese (70.7%) and reported full healthcare reimbursement (55.5%). Asthma was partly controlled/uncontrolled in 60.3% of patients, with 46.1% experiencing ≥1 severe exacerbations in the 12 months before the study visit. Overall, 74.9% of patients were prescribed ≥3 SABA canisters in the previous 12 months (over-prescription); 56.5% were prescribed ≥10 SABA canisters. Additionally, 27.1% of patients reported purchasing SABA over-the-counter (OTC); among patients with both SABA purchase and prescriptions, 75.4% and 51.5% already received prescriptions for ≥3 and ≥10 SABA canisters, respectively, in the preceding 12 months. Conclusion. SABA over-prescription and OTC purchase were common in SA, demonstrating an urgent need to align clinical practices with the latest evidence-based recommendations and regulate SABA OTC purchase to improve asthma outcomes.

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Section: Discussionmentioning

confidence: 99%

Over-prescription of short-acting β2-agonists for asthma in South Africa: Results from the SABINA III study

Smith¹,

Ambaram²,

Mitha³

et al. 2022

Afr J Thoracic Crit Care Med

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“…This study was a retrospective folder review of patients with severe theophylline toxicity admitted to LTH's 16-bed ICU between 1 January 2013 and 31 December 2018. The hospital serves ~1.7 million people [10] from an area of 60 000 km 2 . [11] The ICU is a multidisciplinary, closed unit and admits patients aged ≥12 years.…”

Section: Design Setting and Populationmentioning

confidence: 99%

“…This change is in line with the recommendations of the South African Thoracic Society, which sees a limited role for the use of theophylline. [2,3]…”

Section: Researchmentioning

confidence: 99%

“…

Theophylline has been used to treat obstructive airway diseases since the 1920s. [1] In view of toxicity risk (particularly in the elderly), drug interactions, variable metabolism and inferior efficacy compared with long-acting beta-agonists, theophylline is no longer being recommended as a first-or second-line treatment in local guidelines for asthma [2] and chronic obstructive pulmonary disease (COPD). [3] In spite of this, its use is still widespread in the communities served by Livingstone Tertiary Hospital (LTH) in Eastern Cape Province, South Africa (SA).

…”

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confidence: 99%

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The characteristics and costs of severe theophylline toxicity in a tertiary critical care unit in Eastern Cape Province, South Africa

Oxley-Oxland

Freercks²,

Baker³

et al. 2022

S Afr Med J

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Background. Severe theophylline toxicity requiring haemodialysis accounts for approximately one-third of drug toxicity cases admitted to the Livingstone Tertiary Hospital (LTH) intensive care unit (ICU) in Gqeberha, South Africa, imposing a significant resource burden. Objectives. To investigate the characteristics and burden of severe theophylline toxicity in an Eastern Cape Province tertiary hospital adult ICU. Methods. A retrospective review of all severe theophylline toxicity admissions to the ICU from 1 January 2013 to 31 December 2018 was conducted. Demographic and clinical data were captured and analysed. The National Department of Health 2019 fees schedule was used to calculate costs based on duration of ICU stay and number of haemodialysis sessions received. Results. Of the 57 patients included in the study, 84% were cases of deliberate self-harm. The majority were aged <40 years (77%) and female (79%). The mean (standard deviation (SD)) initial serum theophylline level was 612 (269) µmol/L. Complications included convulsions (n=12; 21%), arrhythmias (n=9; 16%), need for mechanical ventilation (n=7; 12%) and death (n=4; 7%). The main risk factors for these complications were age ≥30 years, an inappropriately normal or elevated initial serum potassium level, an elevated serum creatinine kinase level and an elevated initial serum theophylline level. Receiver operator characteristic curve analysis assessing the initial serum theophylline level as a discriminator for life-threatening complications produced an area under the curve of 0.71 for serum theophylline >400 µmol/L (sensitivity 88%, specificity 12%). All the 4 patients who died had an initial serum theophylline level >1 000 µmol/L. The mean (SD) cost per admission amounted to ZAR16 897 (10 718), with a mean of one 4-hour dialysis session per admission. Conclusion. Severe theophylline toxicity, usually in the context of deliberate self-harm, is a preventable yet life-threatening toxicity encountered at LTH. Demographic risk factors include young females from certain areas in and around Gqeberha. Risk factors for complications include older age, paradoxically normal or elevated serum potassium levels, elevated serum creatinine kinase levels and an initial serum theophylline level >400 µmol/L. Patients with these clinical features should be closely monitored and treated timeously at an appropriate level of care. The need for ICU admission and dialysis, both limited resources, makes the treatment of severe theophylline toxicity costly. Further studies of the underlying psychosocial drivers, local prescribing practices and preventive interventions related to severe theophylline toxicity are required.

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“…The adoption of the new GINA guidelines, which have been endorsed by our local SA asthma guidelines, advocate for the use of the maintenance and reliver therapy approach. [14] We as the advocates and custodians of respiratory healthcare in SA need use this data to engage with clinicians and policy-makers to make sustainable changes that will impact asthma outcomes. We now have the data to support the implementation of our local asthma guidelines and to prioritise the incorporation of ICS/ long-acting β2-agonists into the essential drug list as a therapeutic option that should be available to all citizens of the country.…”

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confidence: 99%

The plight of the ‘asthmatic patient’ in South Africa – a subgroup analysis of the SABINA III study

Kalla

2022

Afr J Thoracic Crit Care Med

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Guidelines for the management of asthma in adults and adolescents: Position statement of the South African Thoracic Society – 2021 update

Cited by 8 publications

References 42 publications

Over-prescription of short-acting β2-agonists for asthma in South Africa: Results from the SABINA III study

Over-prescription of short-acting β2-agonists for asthma in South Africa: Results from the SABINA III study

The characteristics and costs of severe theophylline toxicity in a tertiary critical care unit in Eastern Cape Province, South Africa

The plight of the ‘asthmatic patient’ in South Africa – a subgroup analysis of the SABINA III study

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