Clinical standards for the diagnosis and management of asthma in low- and middle-income countries

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dc.contributor.author Jayasooriya, S.
dc.contributor.author Stolbrink, M.
dc.contributor.author Khoo, E.M.
dc.contributor.author Sunte, I.T.
dc.contributor.author Awuru, J.I.
dc.contributor.author Cohen, M.
dc.contributor.author Lam, D.C.
dc.contributor.author Spanevello, A.
dc.contributor.author Visca, D.
dc.contributor.author Centis, R.
dc.contributor.author Migliori, G.B.
dc.contributor.author Ayuk, A.C.
dc.contributor.author Buendia, J.A.
dc.contributor.author Awokola, B.I.
dc.contributor.author Del-Rio-Navarro, B.E.
dc.contributor.author Muteti-Fana, S.
dc.contributor.author Lao-araya, M.
dc.contributor.author Chiarella, P.
dc.contributor.author Badellino, H.
dc.contributor.author Somwe, S.W.
dc.contributor.author Anand, M.P.
dc.contributor.author Garc ı-Corzo, J.R.
dc.contributor.author Bekele, A.
dc.contributor.author Soto-Martinez, M.E.
dc.contributor.author Ngahane, B.H.M.
dc.contributor.author Florin, M.
dc.contributor.author Voyi, K.V.V. (Kuku)
dc.contributor.author Tabbah, K.
dc.contributor.author Bakki, B.
dc.contributor.author Alexander, A.
dc.contributor.author Garba, B.L.
dc.contributor.author Salvador, E.M.
dc.contributor.author Fischer, G.B.
dc.contributor.author Falade, A.G.
dc.contributor.author Zivkovic, Zorica
dc.contributor.author Romero-Tapia, S.J.
dc.contributor.author Erhabor, G.E.
dc.contributor.author Zar, H.
dc.contributor.author Gemicioglu, B.
dc.contributor.author Brandao, H.V.
dc.contributor.author Kurhasani, X.
dc.contributor.author El-Sharif, N.
dc.contributor.author Singh, V.
dc.contributor.author Ranasinghe, J.C.
dc.contributor.author Kudagammana, S.T.
dc.contributor.author Masjedi, M.R.
dc.contributor.author Velasquez, J.N.
dc.contributor.author Jain, A.
dc.contributor.author Cherrez-Ojeda, I.
dc.contributor.author Valdeavellano, L.F.M.
dc.contributor.author Gomez, R.M.
dc.contributor.author Mesonjesi, E.
dc.contributor.author Morfin-Maciel, B.M.
dc.contributor.author Ndikum, A.E.
dc.contributor.author Mukiibi, G.B.
dc.contributor.author Reddy, B.K.
dc.contributor.author Yusuf, O.
dc.contributor.author Taright-Mahi, S.
dc.contributor.author Merida-Palacio, J.V.
dc.contributor.author Kabra, S.K.
dc.contributor.author Nkhama, E.
dc.contributor.author Filho, N.R.
dc.contributor.author Zhjegi, V.B.
dc.contributor.author Mortimer, K.
dc.contributor.author Rylance, S.
dc.contributor.author Masekela, R.R.
dc.date.accessioned 2024-10-18T10:58:40Z
dc.date.available 2024-10-18T10:58:40Z
dc.date.issued 2023-09
dc.description.abstract BACKGROUND : The aim of these clinical standards is to aid the diagnosis and management of asthma in lowresource settings in low- and middle-income countries (LMICs). METHODS : A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards. RESULTS : Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and postbronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94–98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3–5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding drypowder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0–3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6–11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12–18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS. The following standards (14–18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual’s lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available. CONCLUS ION : These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings. en_US
dc.description.department School of Health Systems and Public Health (SHSPH) en_US
dc.description.librarian am2024 en_US
dc.description.sdg SDG-03:Good heatlh and well-being en_US
dc.description.sponsorship The Oskar-Helene-Heim Foundation (OHH; Berlin, Germany) and the Gunther Labes Foundation (Berlin, Germany). en_US
dc.description.uri https://theunion.org/our-work/journals/ijtld en_US
dc.identifier.citation Jayasooriya, S., Stolbrink, M., Khoo, AE.M. et al. 2023, 'Clinical standards for the diagnosis and management of asthma in low- and middle-income countries', International Journal of Tuberculosis and Lung Disease, vol. 27, no. 9, pp. 658-667. http://dx.DOI.org/10.5588/ijtld.23.0203. en_US
dc.identifier.doi 10.5588/ijtld.23.0203
dc.identifier.issn 1027-3719 (print)
dc.identifier.issn 1815-7920 (online)
dc.identifier.uri http://hdl.handle.net/2263/98671
dc.language.iso en en_US
dc.publisher International Union Against Tuberculosis and Lung Disease en_US
dc.rights © 2023 The Union. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. en_US
dc.subject Asthma en_US
dc.subject Chronic respiratory disease en_US
dc.subject Clinical standards en_US
dc.subject Non-communicable diseases (NCDs) en_US
dc.subject Low- and middle-income countries (LMICs) en_US
dc.subject SDG-03: Good health and well-being en_US
dc.title Clinical standards for the diagnosis and management of asthma in low- and middle-income countries en_US
dc.type Article en_US


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