The prevalence, burden and risk factors associated with bronchial asthma in commonwealth of independent states countries (Ukraine, Kazakhstan and Azerbaijan): results of the CORE study

Abstract

BackgroundIn the Commonwealth of Independent States (CIS) countries epidemiology of Bronchial Asthma (BA) is poorly characterized. The objective of this analysis is to present the prevalence, burden and risk factors associated with BA in the CIS countries as part of the CORE study (Chronic Obstructive REspiratory diseases).MethodsA total of 2842 adults (≥18 years) were recruited (964 in Kiev, Ukraine, 945 in Almaty, Kazakhstan, and 933 in Baku, Azerbaijan) in 2013–2015 during household visits. A two-step cluster random sampling strategy was used. All respondents were interviewed about respiratory symptoms, smoking, medical history. Two definitions were used: (i) “doctor diagnosed asthma” when the respondent reported that he/she had ever been diagnosed with BA by a doctor, (ii) “wheezing symptoms” (when the respondent reported wheezing at the ATS Respiratory Symptoms Questionnaire during the study) using GINA (2012) recommendations. Chi-square tests were used to assess differences in proportions. Binary logistic regression was used to estimate odds ratios (OR) and 95% CI for association between risk factors and BA.ResultsPrevalence of “doctor diagnosed asthma” was 12.5, 19.0 and 26.8 per 1000 persons, and prevalence of “wheezing symptoms” was 74.4, 254.8 and 123.4 per 1000 in Ukraine, Kazakhstan, and Azerbaijan, respectively. Statistically significant relationship with “wheezing symptoms” was shown for smoking (OR 1.99 (CI 1.22–3.27) in Ukraine, 2.08 (CI 1.54–2.81) in Kazakhstan, 8.01 (CI 5.24–12.24) in Azerbaijan); overweight/obesity (OR: 1.66 (CI 1.02–2.72); 1.94 (CI 1.44–2.62); 1.77 (CI 1.18–2.68), respectively) and dusty work (OR: 3.29 (CI 1.57–6.89); 1.68 (CI 1.18–2.39); 2.36 (CI 1.56–3.59), respectively), and for tuberculosis in Azerbaijan (OR: 10.11 (CI 3.44–29.69)). Co-morbidities like hypertension, cardiovascular diseases, abnormal blood lipids and a history of pneumonia occurred significantly (p < 0.05) more frequently in respondents with BA compared to those without BA across all participating countries.ConclusionIn CIS countries (Ukraine, Kazakhstan and Azerbaijan) the prevalence of doctor diagnosed asthma was significantly lower compared to prevalence of wheezing symptoms underlining that BA is likely to be underreported in these countries. The information provided in this paper will be helpful for healthcare policy makers in CIS countries to instruct BA management strategies and to allocate healthcare resources accordingly.

A review on the effect of COVID-19 in type 2 asthma and its management

“…Asthma is quite a common but non-reportable disease due to which many asthmatic patients remain undiagnosed. According to an epidemiological study conducted in Russia, only 6.9% of the adults were previously diagnosed with asthma, whereas 25.7% of that same population reported asthma symptoms like wheezing or breathlessness that were not diagnosed earlier in their life [56] .…”

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“…This can partly be explained by the different points in time in which the studies took place, but also by different geographic locations, method of data collection, underlying populations, and diagnostic methods. For instance, Shilova et al [ 26 ] reported that 245 per 100,000 patients had active TB in Russia in 1999. Their data were collected from hospitals, where X-ray screening was done in only 57% of the total population and the quality of the bacteriology laboratory was lower compared to previous years.…”

“…Three papers were from Russia, and one was from Kazakhstan. Nugmanova D. et al [ 26 ] was the only study that reported asthma prevalence in Kazakhstan as doctor-diagnosed (19.5 per 1000, 2%) and as wheezing symptoms in adults (254 per 1000, 25%). Notably, this doctor-diagnosed prevalence was in between the rates in Ukraine and Azerbaijan (assessed in the same study, using the same methods), while the prevalence of wheezing symptoms was two-to-three times higher than the other two countries, suggestive of profound underdiagnosis.…”

“… Overview of geographic locations of respiratory disease prevalence studies in Russia and Central Asia. (1) Russia (nationwide) [ 12 ]; (2) Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan, Russia (nationwide) [ 13 ]; (3) Kazakhstan (nationwide) [ 14 ]; (4) Almaty, Kazakhstan [ 26 ]; (5) Almaty, Kazakhstan [ 23 ]; (6) Uzbekistan [ 16 ]; (7) Sughd province, Tajikistan [ 15 ]; (8) Vladimir region, Russia [ 17 ]; (9) Murmansk region, Russia [ 18 ]; (10) Krasnoyarsk region, Russia [ 19 ]; (11) Moscow, Russia [ 29 ]; (12) Altay region, Russia [ 28 ]; (13) St. Petersburg, Russia [ 25 ]; (14) Russia [ 20 ]; (15) Vologda, Chelyabinsk, Yakutsk, Russia [ 21 ]; (16) Russia [ 22 ]; (17) St. Petersburg and Arkhangelsk, Russia [ 24 ]; and (18) Nikel, Russia [ 27 ]. …”

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“…[27] Similarly, in other western countries, a prevalence of “wheezing symptoms” of 74.4, 254.8, and 123.4/1000 adults in Ukraine, Kazakhstan, and Azerbaijan, was found, respectively. [28] A study in India found a prevalence of BA of 9.9% (95% CI = 7.53%–12.27%). [29]…”