Uncontrolled and under-diagnosed asthma in a Damascus shelter during the Syrian crisis

Abstract

Background: Studies have shown that poor shelter or dwelling conditions may lead to deteriorations in health. Those with asthma may be more susceptible to compromised living conditions and stress leading to a higher risk of asthma exacerbations. To describe the asthma control and quality of life of individuals with diagnosed asthma living in a shelter in Damascus, Syria and estimate the prevalence of respiratory symptoms in shelter dwellers without diagnosed asthma. Methods:In this cross-sectional study, all individuals 5 years and older living in Al-Herjalleh shelter with diagnosed asthma were recruited to complete a questionnaire, which included items related to their respiratory symptoms, asthma exacerbations, exposure to asthma triggers, medication use, and health-related quality of life before and since entering the shelter. A representative sample of shelter dwellers without diagnosed asthma also completed a questionnaire to establish their demographics, respiratory symptoms, environment and chronic disease co-morbidities, in order to identify factors associated with under-diagnosed asthma. All participants underwent spirometry to measure their lung function. Descriptive statistics were calculated, and chi-square tests and Student's t-tests were used to compare individuals with asthma before and since entering the shelter, as well as to compare those with under-diagnosed asthma and individuals without asthma.Results: The prevalence of asthma at the Al-Herjalleh shelter in those aged 5 years and older was approximately 8.5%. Nearly 70% of the asthma group felt their asthma had worsened since entering the shelter, and there was a significant drop in the proportion of individuals using inhaled corticosteroids (ICS), with only 4.3% using daily ICS in the shelter (P<0.0001). The proportion of individuals experiencing a severe asthma attack did not change after entering the shelter (P=0.97), but almost all individuals with asthma (94.4%) reported worsening in their health-related quality of life. In the non-asthma group, 44.2% of participants reported episodes of wheezing, coughing and breathlessness at night, consistent with underdiagnosed asthma. A higher proportion of those with under-diagnosed asthma had allergic rhinitis (57.1%), symptoms of post-traumatic stress disorder (PTSD) (35.1%), and abnormal spirometry (60.0%), compared to those without asthma. Conclusions:The findings of our study highlight the need for asthma programs in Syrian shelters as significant gaps exist in both the screening and management of chronic respiratory diseases to minimize asthma deterioration in Syrian shelter dwellers.

A worldwide charter for all children with asthma

“…Even in areas of conflict, it is possible to improve systems of care. In Syria, war shelters are now integrated into the system of care to ensure essential anti‐inflammatory inhaled medicines are available 102 . Also, in a systematic review, quality improvement interventions have been shown to improve outcomes in children with asthma 103 …”

Global Asthma Network Phase I Syria asthma surveillance and the impact of the war

“…We added Syria war pollutants and the DASS-Score ( Appendixes 1,2 ). Indeed, in Syria, the war brought new factors ( 10 - 12 ) which were considered in the questions we added ( Appendix 1 ): displacement from home; environmental factors; chemical pollutants of weapons; open fire and fuel combustion like plastic; indoor cooking; higher exposure to passive smoking; and especially stress ( 8 , 10 - 12 ). These factors were associated with a higher incidence of wheezing in the past 12 months, severity, wheezing ever, as well as cough at night and exercise wheeze ( Table 2 ).…”

“…We wanted to take this opportunity to also track the influence of war over a period of ten years. Previous surveys in Syrian shelters showed a high prevalence of asthma symptoms and of post-traumatic stress disorder (PTSD) ( 8 ).…”

Country activities of Global Alliance against Chronic Respiratory Diseases (GARD): focus presentations at the 11th GARD General Meeting, Brussels

“…An ad hoc help by medications was initiated. A national program for asthma and COPD in shelters and conflict zones is under consideration to be integrated with MOH-WHO and Red Cross-Red Crescent dispensaries and mobile clinics (34)(35)(36)(37). In collaboration with national and international organizations on development and expansion of ACOCU network, several interventions were conducted during 2000 and 2017.…”