Medical Affairs Department, GSK Saudi Arabia, 22nd Floor Head Quarters Business Park, Jeddah, Kingdom of Saudi Arabia.
Medical Affairs Department, GSK Gulf Countries, Arenco Towers, Dubai Medial City, Dubai, United Arab Emirates.
BMC Public Health. 2020 Aug 8;20(1):1211. doi: 10.1186/s12889-020-09259-3.
Asthma control is influenced by multiple factors. These factors must be considered when appraising asthma interventions and their effectiveness in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates [UAE]). Based on published studies, the most prevalent asthma treatment in these countries are fixed dose combinations (FDC) of inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). This study is a rapid review of the literature on: (a) factors associated with asthma control in the GCC countries and (b) generalisability of ICS/LABA FDC effectiveness studies.
To review local factors associated with asthma control and, generalisability of published ICS/LABA FDC studies, two rapid reviews were conducted. Review 1 targeted literature pertaining to asthma control factors in GCC countries. Eligible studies were appraised, and clustering methodology used to summarise factors. Review 2 assessed ICS/LABA FDC studies in conditions close to actual clinical practice (i.e. effectiveness studies). Eligibility was determined by reviewing study characteristics. Evaluation of studies focused on randomised controlled trials (RCTs). In both reviews, initial (January 2018) and updated (November 2019) searches were conducted in EMBASE and PubMed databases. Eligible studies were appraised using the Critical Appraisal Skills Program (CASP) checklists.
We identified 51 publications reporting factors associated with asthma control. These publications reported studies conducted in Saudi Arabia (35), Qatar (5), Kuwait (5), UAE (3), Oman (1) and multiple countries (2). The most common factors associated with asthma control were: asthma-related education (13 articles), demographics (11articles), comorbidities (11 articles) and environmental exposures (11 articles). Review 2 identified 61 articles reporting ICS/LABA FDC effectiveness studies from countries outside of the GCC. Of these, six RCTs were critically appraised. The adequacy of RCTs in informing clinical practice varied when appraised against previously published criteria.
Asthma-related education was the most recurring factor associated with asthma control in the GCC countries. Moreover, the generalisability of ICS/LABA FDC studies to this region is variable. Hence, asthma patients in the region, particularly those on ICS/LABA FDC, will continue to require physician review and oversight. While our findings provide evidence for local treatment guidelines, further research is required in GCC countries to establish the causal pathways through which asthma-related education influence asthma control for patients on ICS/LABA FDC therapy.
哮喘控制受到多种因素的影响。在评估海湾合作委员会（GCC）国家（巴林、科威特、阿曼、卡塔尔、沙特阿拉伯和阿拉伯联合酋长国）的哮喘干预措施及其有效性时，必须考虑这些因素。根据已发表的研究，这些国家最常见的哮喘治疗方法是吸入皮质类固醇和长效β激动剂（ICS/LABA）的固定剂量组合（FDC）。本研究是对以下方面文献的快速综述：（a）与 GCC 国家哮喘控制相关的因素，以及（b）ICS/LABA FDC 有效性研究的可推广性。
为了综述与哮喘控制相关的本地因素，以及已发表的 ICS/LABA FDC 研究的可推广性，我们进行了两次快速综述。综述 1 针对 GCC 国家哮喘控制因素的文献进行了检索。对合格的研究进行了评估，并使用聚类方法对因素进行了总结。综述 2 评估了接近实际临床实践的条件下的 ICS/LABA FDC 研究（即有效性研究）。通过审查研究特征来确定合格性。对研究的评估侧重于随机对照试验（RCT）。在这两次综述中，分别于 2018 年 1 月和 2019 年 11 月在 EMBASE 和 PubMed 数据库中进行了初始和更新的检索。使用批判性评价技能计划（CASP）检查表对合格的研究进行了评估。
我们确定了 51 篇报告与哮喘控制相关的因素的出版物。这些出版物报告了在沙特阿拉伯（35 篇）、卡塔尔（5 篇）、科威特（5 篇）、阿联酋（3 篇）、阿曼（1 篇）和多个国家（2 篇）进行的研究。与哮喘控制最相关的常见因素包括：哮喘相关教育（13 篇文章）、人口统计学（11 篇文章）、合并症（11 篇文章）和环境暴露（11 篇文章）。综述 2 确定了 61 篇来自 GCC 以外国家的报告 ICS/LABA FDC 有效性研究的文章。其中，对六项 RCT 进行了批判性评估。根据之前发表的标准，评估 RCT 对临床实践的指导作用的充分性存在差异。
与哮喘相关的教育是 GCC 国家与哮喘控制最相关的因素。此外，ICS/LABA FDC 研究在该地区的可推广性是可变的。因此，该地区的哮喘患者，特别是使用 ICS/LABA FDC 的患者，将继续需要医生的审查和监督。虽然我们的研究结果为当地治疗指南提供了证据，但 GCC 国家仍需要进一步研究，以确定哮喘相关教育影响 ICS/LABA FDC 治疗患者哮喘控制的因果途径。
