Asthma control and use of short-acting beta-2-agonists for symptom relief in Africa – A narrative review

Abstract

More than 100 million people in Africa live with Asthma. With appropriate treatment, predominantly inhaled corticosteroids (ICSs), asthma is controllable in most people. However, in Africa, multiple factors constrain the accessibility, availability, and quality of asthma services, which lead to underdiagnosis and sub-optimal treatment of the disease. These constraints include weak healthcare systems and inadequate knowledge of healthcare providers on asthma diagnosis and treatment. There is also a poor awareness of asthma as a long-term disease in the general population. There are several myths and misconceptions about asthma as a disease. There is also poor access to ICSs, the most effective controller medicines for asthma. This is mostly due to the high cost. Furthermore, the non-use or delays in initiating treatment with inhaled steroids commonly leads to overuse and overreliance on rapid relievers of asthma symptoms, and in particular, short-acting beta-2-agonists (SABAs), both in oral and inhaled forms. This practice is very common and contributes to the sub-optimal treatment and resultant poor control of asthma, which is highly prevalent in Africa. In this paper, we highlight the burden of asthma in Africa, the effects of overuse/overreliance of SABA use on asthma control and provide suggestions to reduce the dependency on SABAs to improve asthma treatment and enhance asthma control on the African continent.