Understanding the Gaps in the Reporting of COPD Exacerbations by Patients: A Review.

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.

Greenhouse Gas Emissions from Respiratory Treatments: Results from the SABA CARBON International Study.

INTRODUCTION: Healthcare systems are looking to reduce their carbon impact. Short-acting ß2-agonist (SABA) overuse (≥ 3 canisters/year) is common in asthma and linked to poor outcomes; however, its environmental impact remains unknown. As part of the CARBON programme, this study retrospectively quantified the carbon footprint of SABA and controller inhalers across all respiratory indications and SABA overuse in asthma in lower-middle-income countries (LMICs), upper-middle-income countries and high-income countries across Africa, Asia Pacific, Latin America and the Middle East. METHODS: Two data sources were utilised to evaluate the carbon contribution of inhalers to respiratory care. To quantify greenhouse gas (GHG) emissions associated with total inhaler use across all respiratory indications, inhaler sales data were obtained from IQVIA MIDAS® (Q4/2018-Q3/2019) and compared by dose to prevent confounding from differences in canister actuation counts. GHG emissions associated with SABA overuse in asthma were evaluated using prescription and self-reported over-the-counter purchase data from the SABA use IN Asthma (SABINA) III study (2019-2020). Inhaler-related GHG emissions were quantified using published data and product life cycle assessments. RESULTS: SABA accounted for > 50% of total inhaler use and inhaler-related emissions in most countries analysed. The total SABA-related emissions were estimated at 2.7 million tonnes carbon dioxide equivalents, accounting for 70% of total inhaler-related emissions. Among the countries, regions and economies analysed, per capita SABA use and associated emissions were higher in Australia, the Middle East and high-income countries. Most SABA prescriptions for asthma (> 90%) were given to patients already overusing SABA. CONCLUSIONS: Globally, SABA use/overuse is widespread and is the greatest contributor to the carbon footprint of respiratory treatment, regardless of the economic status of countries. Implementing evidence-based treatment recommendations, personalising treatment and reducing healthcare inequities, especially in LMICs, may improve disease control and patient outcomes, thereby reducing SABA overuse and associated carbon emissions beyond SABA use alone.

The healthcare sector is a large emitter of greenhouse gases (GHGs); therefore, healthcare systems will need to reduce their carbon footprint to meet their carbon reduction targets. In respiratory care, the environmental impact of controller inhalers has received considerable attention due to the global warming potential of the propellants used in metered-dose inhalers. In contrast, little is known about the contribution made by short-acting ß₂-agonist (SABA) relievers globally, which are often the only inhaled medication used by many patients with milder asthma. The SABA use IN Asthma (SABINA) programme reported that SABA overuse (3 or more SABA canisters/year) is common and associated with an increased risk of asthma attacks. Since all inhalers have a carbon footprint, SABA overuse may result in an avoidable excess carbon footprint. Therefore, to provide a complete picture of the carbon footprint of respiratory care, we examined the contribution of SABA relievers and their potential overuse. The total SABA-related GHG emissions accounted for 70% of total inhaler-related GHG emissions, and > 90% of prescriptions for SABA relievers for asthma were given to patients who were already overusing their SABA. Overall, SABA use/overuse is commonly observed worldwide and is likely a significant contributor to the carbon footprint of respiratory treatment. Therefore, there is an urgent need for healthcare providers to follow the latest international treatment guidelines to reduce high SABA use in respiratory care and improve patient outcomes. This, in turn, will enable healthcare systems to reduce their carbon footprint from both treatment and patient interactions.

Over-prescription of short-acting ß2-agonists and asthma management in the Gulf region: a multicountry observational study.

BACKGROUND: The overuse of short-acting ß2-agonists (SABA) is associated with poor asthma control. However, data on SABA use in the Gulf region are limited. Herein, we describe SABA prescription practices and clinical outcomes in patients with asthma from the Gulf cohort of the SABA use IN Asthma (SABINA) III study. METHODS: In this cross-sectional study conducted at 16 sites across Kuwait, Oman, and the United Arab Emirates, eligible patients (aged ≥ 12 years) with asthma were classified based on investigator-defined disease severity guided by the 2017 Global Initiative for Asthma report and by practice type, i.e., respiratory specialist or primary care physician. Data on demographics, disease characteristics, and prescribed asthma treatments, including SABA, in the 12 months prior to a single, prospective, study visit were transcribed onto electronic case report forms (eCRFs). All analyses were descriptive in nature. Continuous variables were summarized by the number of non-missing values, given as mean (standard deviation [SD]) and median (range). Categorical variables were summarized by frequency counts and percentages. RESULTS: This study analyzed data from 301 patients with asthma, 54.5% of whom were treated by respiratory specialists. Most patients were female (61.8%), with a mean age of 43.9 years, and 84.4% were classified with moderate-to-severe disease, with a mean (SD) asthma duration of 14.8 (10.8) years. Asthma was partly controlled or uncontrolled in 51.2% of patients, with 41.9% experiencing ≥ 1 severe exacerbation in the 12 months preceding their study visit. Overall, 58.5% of patients were prescribed ≥ 3 SABA canisters, 19.3% were prescribed ≥ 10 canisters, and 13.3% purchased SABA over-the-counter (OTC) in the 12 months before the study visit. Most patients who purchased OTC SABA (92.5%) also received SABA prescriptions. Inhaled corticosteroid/long-acting ß2-agonist combinations and oral corticosteroid bursts were prescribed to 87.7% and 22.6% of patients, respectively. CONCLUSIONS: SABA over-prescription was highly prevalent in the Gulf region, compounded by purchases of nonprescription SABA and suboptimal asthma-related outcomes. Increased awareness among policymakers and healthcare practitioners is needed to ensure implementation of current, evidence-based, treatment recommendations to optimize asthma management in this region. TRIAL REGISTRATION: NCT03857178 (ClinicalTrials.gov).

Effectiveness of BBIBP-CorV vaccine against severe outcomes of COVID-19 in Abu Dhabi, United Arab Emirates.

The effectiveness of the inactivated BBIBP-CorV vaccine against severe COVID-19 outcomes (hospitalization, critical care admission and death due to COVID-19) and its long-term effectiveness have not been well characterized among the general population. We conducted a retrospective cohort study using electronic health records of 3,147,869 adults, of which 1,099,886 vaccinated individuals were matched, in a 1:1 ratio to 1,099,886 unvaccinated persons. A Cox-proportional hazard model with time varying coefficients was used to assess the vaccine effectiveness adjusting for age, sex, comorbidity, ethnicity, and the calendar month of entry into the study. Our analysis showed that the effectiveness was 79.6% (95% CI, 77.7 to 81.3) against hospitalization, 86% (95% CI, 82.2 to 89.0) against critical care admission, and 84.1% (95% CI, 70.8 to 91.3) against death due to COVID-19. The effectiveness against these severe outcomes declined over time indicating the need for booster doses to increase protection against severe COVID-19 outcomes.

Thoracic surgery in United Arab Emirates.

The United Arab Emirates (UAE) has undergone a significant change in its population and economy in the last decades and in parallel its healthcare system has evolved rapidly to provide advanced, innovative and world-leading care. At the forefront of this revolution in healthcare is the development of a multidisciplinary multimodality thoracic service provision, offered at quaternary referral hospitals amalgamating academics, training, research and innovation. Previously, thoracic service care was limited to single providers at various public and private hospitals, usually performing lower complexity cases. Most complex thoracic cases were repatriated outside the UAE. This practice was replaced with the opening of Cleveland Clinic Abu Dhabi (CCAD), in 2015, which created a multidisciplinary thoracic program. This included the start of a mini-invasive surgical and lung transplantation program. Since that time other public and private hospitals have emerged providing care in a similar model. The impact of these programs has been a decreased transfer of patients abroad for treatment. Under the umbrella of the Emirates Thoracic Society (ETS) a platform for greater collaboration aimed at improving patient care, potential research and physician education has been created. Direct links have been established with world-leading Thoracic surgery and Respiratory Medicine Centers facilitating this development and offering support and guidance. This article charts these changes in thoracic care in the recent past, present, and delineates plans for the future in the UAE.

Vitamin D Regulates the Expression of Glucocorticoid Receptors in Blood of Severe Asthmatic Patients.

PURPOSE: Vitamin D (VitD) deficiency is a significant public health concern in many areas around the globe and has been associated with many immune-mediated diseases, including asthma. Severe asthma has been linked to a decreased glucocorticoid receptor (GR) ratio (GR-α/GR-ß ratio), indicating steroid hyporesponsiveness. Using a combination of in silico and in vivo approaches, we aimed to explore the immunomodulatory effect of VitD on asthmatic patients diagnosed with hypovitaminosis D. METHODS: In silico tools were used to identify the regulatory effect of VitD supplementation on GR genes. We measured the expression levels of GR-α and the inactive isoform, GR-ß, in the blood of adult asthmatics diagnosed with hypovitaminosis D before and after VitD supplementation. Moreover, the blood levels of inflammatory cytokines associated with asthma severity were determined. RESULTS: Using an in silico approach, we identified specific genes commonly targeted by VitD as well as corticosteroids, the mainstay of asthma therapy. NR3C1 gene encoding GR was found to be significantly upregulated on Th2 CD4 cells and NK cells. Interestingly, blood expression level of NR3C1 was lower in severe asthmatics compared to nonsevere asthmatics and healthy controls, while the blood level of VitD receptor (VDR) was higher. Upon VitD supplementation of severe asthmatic patients, there was a significant increase in the blood levels of GR-α with no change in GR-ß mRNA expression. VitD supplementation also suppressed the blood levels of IL-17F and IL-4. CONCLUSION: VitD may enhance steroid responsiveness by upregulating the expression of steroid receptor GR-α.

Longitudinal changes in IgG levels among COVID-19 recovered patients: A prospective cohort study.

OBJECTIVES: To quantify SARS-CoV2 IgG antibody titers over time and assess the longevity of the immune response in a multi-ethnic population setting. SETTING: This prospective study was conducted in a tertiary hospital in Abu Dhabi city, UAE, among COVID-19 confirmed patients. The virus-specific IgG were measured quantitatively in serum samples from the patients during three visits over a period of 6 months. Serum IgG levels ≥15 AU/ml was used to define a positive response. PARTICIPANTS: 113 patients were analyzed at first visit, with a mean (SD) age of participants of 45.9 (11.8) years 87.5% of the patients were men. 63 and 27 participants had data available for visits 2 and 3, respectively. PRIMARY OUTCOME: Change in SARS-CoV2 IgG antibody titers over the visits. RESULTS: No mortality or re-infection were reported. 69% of the patients developed positive IgG response within the first month after the onset of symptoms. The levels of IgG showed a consistent increase during the first three months with a peak level during the third month. Increasing trend in the levels of IgG were observed in 82.5%, 55.6% and 70.4% of patients between visit 1 to visit 2, visit 2 to visit 3, and from visit 1 to visit 3, respectively. Furthermore, about 64.3% of the patients showed sustained increase in IgG response for more than 120 days. CONCLUSIONS: Our study indicates a sustained and prolonged positive immune response in COVID-19 recovered patients. The consistent rise in antibody and positive levels of IgG titers within the first 5 months suggest that immunization is possible, and the chances of reinfection minimal.

Demographic and clinical patterns of severe asthma in the Middle East.

BACKGROUND: Severe asthma is a major burden on health-economic resources; hence, knowing the epidemiology of these patients is important in planning and provision of asthma care. In addition, identifying and managing the comorbidities helps improve symptoms and reduce associated morbidity and mortality. OBJECTIVES: Epidemiology of difficult asthma has not been well studied in the Middle East, so in this study, we present the demographic and clinical characteristics of severe asthma in the United Arab Emirates (UAE). METHODS: We retrospectively reviewed the notes of severe asthma patients attending three tertiary care hospitals between May 2015 and December 2019. Data on baseline demographics, asthma characteristics, treatment, and comorbidities were collected. RESULTS: We reviewed the notes of 458 patients (271 females and 187 males) that fulfilled the 2019 Global Initiative for Asthma guidelines for the diagnosis of severe asthma. The mean age was 47.7 (standard deviation 17.2) years. Males had significantly higher asthma control test scores (17.9 vs. 16, P = 0.01) and mean blood eosinophils (0.401 vs. 0.294, P <0.01) than females. The most common comorbidity observed was allergic rhinitis (52.2%) followed by gastroesophageal reflux disease (27.1%). In total, 109 (23.8%) patients were on biological therapies with most patients being on omalizumab and dupilumab (29 and 18 patients, respectively). Most patients were nonsmokers (97.2%), and majority were of TH2-high phenotype (75.7%). CONCLUSIONS: In this first report of severe asthma characteristics in the UAE, we found a pattern of female preponderance and most patients having a Th2-high phenotype. The findings are likely to help optimize asthma care in the region in the era of biologic therapies.

Patients' and physicians' attitudes and perception about asthma in the Gulf: A subset analysis from the Asthma Insights and Management Survey in the Gulf and Russia.

Background: Asthma is a prevalent disorder in the Gulf region. However, available data concerning asthma control and patients' perception with regard to their disease are still insufficient. Objective: To investigate patients' perception and behavior with regard to the asthma-related burden, the level of asthma control, and asthma management in three Gulf countries. Methods: This study presented a subset analysis of the Asthma Insights and Management survey about the asthma burden and management in the Gulf region and Russia. In this subset analysis, we retrieved the data of the patients from Saudi Arabia, United Arab Emirates, and Kuwait. Results: The current survey's population was composed of 452 patients. One hundred fifty-four patients (34.1%) rated themselves as having poorly controlled asthma, whereas 60.3% of the patients perceived their asthma as completely or well controlled. However, only two patients (0.4%) had controlled asthma according to the global asthma guidelines criteria for asthma control. Most of the patients (67.7%) reported that their asthma got worse when outdoors. Almost 70% of the patients on daily control plus a quick relief regimen reported that their asthma got worse when they were outdoors. Over the past 12 months, 95 patients (21%) reported asthma exacerbation. More than half of the included patients experienced an asthma attack that stopped their activities, whereas 54.2% of the patients were forced to leave work or school due to an asthma attack, and 53.1% had to cancel an appointment or had to go to bed due to the severity of the attack. With concern to asthma management, only 30.5% of the patients were given a lung function test for the assessment of their asthma. A written action plan for asthma treatment was developed by the physician or the practice nurse for only 21.7% of the patients. Conclusion: In the Gulf region, asthma exerts a substantial burden on patients who are affected. Such a burden significantly impacted patients' quality of life.

Direct and Indirect Costs of Asthma Burden in Abu Dhabi: A Retrospective Analysis of Insurance Claims Data from 2015 to 2018.

PURPOSE: Asthma causes a high economic burden on the health-care system. Previous research on the cost of asthma in Abu Dhabi was in 2011 and revealed high medical costs. This work aimed to estimate both direct and indirect costs of asthma with trend analysis over a period of four years. PATIENTS AND METHODS: All data on medical costs, work absenteeism, and mortality were collected from the e-claims system of the national health insurance database. Medical costs included medication use, emergency room (ER) visits, non-ER visits, outpatient care, and hospitalization from 2015 to 2018. Indirect costs in terms of work absenteeism were calculated by multiplying the average daily income per employer by the number of workdays missed due to sick leaves documented in the database in 2019. RESULTS: Over the years, the total medical costs increased from AED 161,843,698 in 2015 to AED 206,548,620 in 2018. The largest contribution was attributed to outpatient care, while hospitalization accounted for the smallest proportion of the total costs in 2018. Likewise, the mean annual per-patient cost in 2015 was AED 1119 and increased to AED 1162 in 2018. Indirect costs were estimated to be AED 27,482,319 resulting from 30,948 sick leaves in the year 2019 only. CONCLUSION: Asthma is a cause for huge expenditure from the health-care system perspective in Abu Dhabi. It also has a large impact on society through work absenteeism. Costs of asthma management are increasing every year, which suggests a call-to-action to improve the disease management status using cost-effective strategies.

Prevalence of diabetes and cardio-metabolic risk factors in young men in the United Arab Emirates: A cross-sectional national survey.

INTRODUCTION: The aim of the study was to determine the prevalence of cardio-metabolic risk factors in men under 30 in the United Arab Emirates. METHODS: This cross-sectional observational study included 33 327 Emirati men aged 18-29 attending an obligatory standardized medical examination between May 2015 and February 2017. Body mass index, fasting blood glucose, total cholesterol, triglycerides and blood pressure were assessed. RESULTS: Overall, 7720 subjects (24.4%) were overweight and 8835 (28.0%) obese. The age-adjusted prevalence was 4.7% [95% CI: 4.4-5.0] for diabetes, 41.3% [40.6-41.9] for impaired fasting glucose, 5.5% [5.2-5.8] for hypercholesterolaemia (total cholesterol ≥ 240 mg/dL), 11.5% [11.1%-12.0%] for hypertriglyceridaemia (≥150 mg/dL) and 10.4% [10.0%-10.8%] for hypertension (diastolic or systolic blood pressure-or both-above upper limit of normal). These conditions were already present in the youngest age groups and rise progressively and rapidly with age. Of the 26 648 subjects with valid data for all cardio-metabolic risk factors, 16 563 subjects (62.2%) presented ≥ 1 factor, 6392 subjects presented ≥2 factors (24.0%) and 63 (0.2%) presented all five. Patients who were obese were more likely to present multiple cardio-metabolic risk factors and to have hypertension (P < 0.0001). All cardio-metabolic risk factors were highly correlated with each other. CONCLUSIONS: This national cohort study in the UAE revealed that obesity, diabetes, impaired fasting glucose, hypercholesterolaemia, triglyceridaemia and hypertension are already highly prevalent in young adulthood. Public health initiatives are required to address these and to anticipate the future burden of diabetes and major cardiovascular disease for which these men are at high risk.

A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa.

Purpose: This study was performed to assess symptom variability and its impact on morning activities in stable patients with severe COPD in the Middle East and Africa (MEA) countries. Patients and methods: Non-interventional, cross-sectional study (NCT03425760) in patients with severe COPD (GOLD 2015, C, or D categories). Symptom variability was assessed directly by interviewing the patient and using the Global Chest Symptoms Questionnaire (GCSQ). The impact on morning activities was assessed using the Capacity of Daily Living during the Morning (CDLM) and the Morning Activities and Symptoms Questionnaire (MASQ). Results: A total of 3253 patients (mean±SD age: 64.1±9.5 years, 90.3% males) were enrolled. Overall, 81.6% and 83.4% of patients reported weekly and daily symptom variability, respectively. The number of exacerbations in the previous year, smoking cessation, and COPD GOLD D were the most consistent factors associated with symptom variability. The GCSQ score was significantly higher (p<0.001) in GOLD D than in GOLD C patients at each time during the day. In GOLD D, the mean (±SD) GCSQ score was higher at night (1.6±1.2, p<0.001) and in the morning (1.5±1.0, p<0.001) than in the afternoon (1.3±0.9), suggesting daytime variability of breathlessness and chest tightness. Overall, 60.0% of GOLD D patients (versus 13.6% GOLD C, p<0.0001) had difficulty getting out of bed due to COPD. Patients with symptom variability had significantly more difficulty to get out of bed, especially patients with chest tightness variability (p<0.0001) and wheezing variability (p<0.0001). The CDLM global score was significantly lower (p<0.0001) in GOLD D than in GOLD C patients (3.5±1.1 and 4.6 ± 3.5, respectively). Daily variability in chest tightness and wheezing was also significantly associated with CDLM scores (p<0.0001). Conclusion: In MEA countries, patients with severe stable COPD reported significant daily and weekly symptom variability which affects morning activities, particularly in GOLD D patients.

Cross-sectional study on Asthma Insights and Management in the Gulf and Russia.

Background: Asthma is a chronic and complex lung disease that is not completely understood. It involves airway inflammation, reversible airflow obstruction, and bronchial hyperresponsiveness. The most common symptoms are recurrent wheezing, chest tightness, shortness of breath, and coughing. Objective: The Asthma Insights and Management study gathered information on the burden of asthma in the Gulf region (United Arab Emirates, Kuwait, Saudi Arabia) and Russia. Methods: This was a cross-sectional, multinational, noninterventional, two-phase study that collected data from patients ages ≥ 12 years, through interviews and a survey questionnaire. Phase 1 consisted of survey questions focused on estimating the asthma prevalence in the community. Phase 2 was designed to assess the level of asthma control, asthma-related perceptions and behaviors, and presentation patterns. Data were summarized by using descriptive analyses. Results: Analysis of data of 711 patients revealed that the prevalence of asthma among patients who lived in the community was 7.9% and that 66% subjectively perceived their asthma as being controlled. However, 97% of the patients' asthma were partially controlled or uncontrolled based on the Global initiative for Asthma control classification. Troubling symptoms were daytime coughing (33.3%) and shortness of breath (20.3%). With respect to medications for asthma, 76.2% of the patients reported the use of quick relief medication and 80.8% of maintenance medication during the past 4 weeks. Asthma exacerbation in the past year was reported by 40% of adults and adolescents in the study. Conclusion: The results showed that a significant proportion of the patients experienced bothersome symptoms and that many had a lack of knowledge about asthma control and treatment recommendations, which indicated that there is a need for improvements in patient education and asthma care in the Gulf and Russia regions.

Waterpipe Use in the Middle East and North Africa: Data From the Breathe Study.

INTRODUCTION: In recent decades, waterpipe use has gained popularity, notably in the Middle East and North Africa (MENA) region. This study describes waterpipe use and characteristics of waterpipe users among the general population of the MENA region. METHODS: This study was a sub-analysis of the BREATHE study, a cross-sectional survey of chronic obstructive respiratory disease conducted in the general population of 11 countries of the MENA region. The study population consisted of subjects aged ≥40 years who completed the screening questionnaire and who reported waterpipe use (alone or with cigarettes). This questionnaire collected data on demographics, self-reported respiratory symptoms (breathlessness and productive cough), smoking habits (cigarettes or waterpipe) and diagnosis of chronic obstructive respiratory disease, chronic bronchitis or emphysema. RESULTS: Of the 62 086 subjects screened in the BREATHE study, waterpipe use was reported by 2173 subjects (3.5% [95% CI: 3.4%-3.6%]), of whom 934 subjects (43.0%) smoked both waterpipes and cigarettes. The majority of waterpipe users were men (82%) and aged from 40 to 49 years (53.7%). Over 90% of users smoked their waterpipe for ≥1 hour per day. Waterpipe use was associated with an increased risk of productive cough (odds ratio [OR]: 1.49), breathlessness (OR: 1.33), and chronic bronchitis (OR: 1.43), independently of the risk associated with cigarette smoking. In subjects using waterpipe alone (N = 1239), breathlessness was the most frequently self-reported symptom (11.3%), followed by productive cough (6.0%) and chronic bronchitis (2.2%). CONCLUSIONS: Waterpipe smoking in the region is widespread and is associated with an increased risk of respiratory pathology independently of cigarette smoking. IMPLICATIONS: This large general population study reports an elevated risk of respiratory disease associated with waterpipe use independently of cigarette smoking; this finding emphasizes the need for public health policies to curtail the growing spread of waterpipe use by young people in the MENA region.

Comorbidities associated with COPD in the Middle East and North Africa region: association with severity and exacerbations.

OBJECTIVE: To assess the frequency of comorbidities in subjects with COPD and their association with respiratory symptom severity and COPD exacerbations. MATERIALS AND METHODS: This was an analysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of eleven countries in the Middle East and North Africa, including Pakistan. The study population consisted of a sample of subjects with COPD for whom the presence of comorbidities was documented. Three questionnaires were used. The screening questionnaire identified subjects who fulfilled an epidemiological case definition of COPD and documented any potential comorbidities; the detailed COPD questionnaire collected data on respiratory symptoms, COPD exacerbations, and comorbidities associated with COPD; the COPD Assessment Test collected data on the impact of respiratory symptoms on well-being and daily life. RESULTS: A total of 2,187 subjects were positively screened for COPD, of whom 1,392 completed the detailed COPD questionnaire. COPD subjects were more likely to report comorbidities (55.2%) than subjects without COPD (39.1%, P<0.0001), most frequently cardiovascular diseases. In subjects who screened positively for COPD, the presence of comorbidities was significantly (P=0.03) associated with a COPD Assessment Test score ≥10 and with antecedents of COPD exacerbations in the previous 6 months (P=0.03). CONCLUSION: Comorbidities are frequent in COPD and associated with more severe respiratory symptoms. This highlights the importance of identification and appropriate management of comorbidities in all subjects with a diagnosis of COPD.

Economic burden of asthma in Abu Dhabi: a retrospective study.

This study evaluates the direct costs of treating asthma in Abu Dhabi in the United Arab Emirates. Data was compiled for 2011 from health insurance claims covering all medical interventions or treatments coded as asthma. Costs were calculated from a health care perspective. The total direct cost of treating 139,092 asthma patients was estimated to be United Arab Emirates Dirhams (AED) 105 million (US$29 million), corresponding to around AED 750 per patient per annum. The total cost is principally generated by outpatient visits (>AED 85 million; 81% of the total cost). Ten point four percent of patients had made an emergency room visit. The cost per visit seems to be higher during hospital admissions (AED 7,123) compared to outpatient visits and emergency room visits. The direct cost of asthma medications was around AED 33 million (31% of the total cost). The economic burden of asthma in Abu Dhabi is high and the number of emergency visits suggests that the disease is not optimally controlled.

IL-4 receptor alpha single-nucleotide polymorphisms rs1805010 and rs1801275 are associated with increased risk of asthma in a Saudi Arabian population.

BACKGROUND: The IL-4 receptor alpha subunit (IL-4Rα), when associated with the common gamma chain receptor, or the IL-13Rα1 subunit, transduces signals to STAT6 in response to IL-4 and IL-13 stimulations. This results in a number of cell-specific responses including Th2 differentiation, lymphocyte proliferation and IgE production. Given the prominent role of IL-4Rα in allergic disorders, several single-nucleotide polymorphisms (SNPs) have been found associated with asthma and other atopic disorders, including rs1805010 (I75V) and rs1801275 (Q576R) SNPs; however, lack of significant association have also been reported for some ethnic groups. The objective of this study was to determine whether IL-4Rα rs1805010 and rs1801275 polymorphisms are associated with asthma in patients from Saudi Arabia. MATERIALS AND METHODS: One hundred and ninety severe asthmatic patients (11-70 years old) and 194 healthy subjects of equivalent age range were recruited for blood donation. DNA was purified and genotyping for rs1801275 and rs1805010 polymorphisms in the IL-4Rα gene was performed by PCR amplification, followed by cycle sequencing of the purified PCR fragments using BigDye chain terminator and capillary electrophoresis. RESULTS: Pearson's Chi-square tests showed that the minor alleles, G, for both rs1805010 and rs1801275 SNPs, were significantly more frequent in asthmatics than in the healthy group (Yates' P < 0.05); conversely, the major alleles, A, were significantly more frequent in healthy than in asthmatics (P < 0.05). Concerning association analysis, odds for A/G-G/G genotypes were significantly higher to be associated with asthma predisposition (rs1801275: OR = 2.12; 95% CI = 1.39-3.22; P < 0.001*; rs1805010: OR = 1.6; 95% CI = 1.01-2.53; P < 0.05*; dominant model). Analysis of gender-genotype interactions, with genders nested within A/G-G/G, indicated higher odds for females than males of significant association with asthma (rs1801275: OR = 5.19, 95% CI = 2.09-12.94*; rs1805010: OR = 3.73, 95% CI = 2.06-6.74*). Rs1805010 and rs1801275 were in linkage disequilibrium (D' = 0.27; P < 0.0004*), with G-G haplotype being more frequent in asthmatics than in healthy subjects (OR = 2.43, 95% CI = 1.59-3.71*). CONCLUSIONS: The risk alleles, G, of IL-4Rα rs1805010 and rs1801275 SNPs and corresponding A/G-G/G genotypes were significantly associated with asthma predisposition in asthmatics from Saudi Arabia.

Case-finding of chronic obstructive pulmonary disease with questionnaire, peak flow measurements and spirometry: a cross-sectional study.

BACKGROUND: Spirometry is commonly accepted as the gold standard for the diagnosis of COPD, but the reality remains that quality assured spirometry is not or cannot be provided universally around the globe. Adding PEF measurement to a screening questionnaire may rule out airflow limitation compatible with COPD rationalizing spirometry testing. METHODS: We conducted a cross-sectional survey in a sample of individuals 40-80 yrs. old in Dubai, UAE. They were invited to answer a short socio-demographic questionnaire including a report on current, past history of smoking, and had PEF measured, then they conducted spirometry to identify airflow limitation compatible with COPD. RESULTS: Overall, 525 (91.0%) participants performed PEF and spirometry (68% male, with a mean age of 59 years, 17% UAE Nationals), 24% reported smoking of different sorts. Overall, 68 participants (12.9%, 95% C.I. 10.3% to 16.1%) had airflow limitation compatible with COPD. PEFR alone identified 141 participants with airflow limitation compatible with COPD, with specificity of 80% and sensitivity of 73.5%. CONCLUSIONS: PEFR could be an easy, cheap, and non-biased tool to assist with the case-finding of COPD before confirmation with spirometry.

Prevalence of symptoms and risk of sleep apnea in Dubai, UAE.

PURPOSE: The United Arab Emirates (UAE) ranks 18th on the 2007 Forbes list of fattest countries with 68.3% of its citizens with an unhealthy weight and it is well known that weight gain and obesity are important determinants in the progression of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to estimate the prevalence of symptoms and risk of OSAS in the primary health care setting in Dubai, and the relationship between obesity and sleep apnea. METHODS: In this prospective survey, a trained medical nurse administered the Berlin Questionnaire to a consecutive random sample of patients in the age group older than 14 years, who attended the primary health care center in Dubai Health Authority, Dubai, UAE, from September 2011 to March 2012. Based on the questionnaire answers, individuals were classified into high risk and low risk groups for OSAS. RESULTS: Based on the responses and measurement of the Berlin Questionnaire of 1214 subjects studied, 58% (n = 704) of the respondents were female, while 42% (n = 510) were male. Two-hundred-fifty-four respondents met the criteria for the high risk scoring. This gives a prevalence rate of 20.9% (out of which 22.9% of the male respondents were high risk for OSAS, while 19.5% of the females were high risk for OSAS), while the remainder of the participants were classified as low risk. The overall mean age of the high risk for OSAS female respondents was 39.95 years (standard deviation [SD] 11.73 years) and was 41.18 years (SD 14.95 years) for male respondents The highest prevalence was observed between age 51 to 60 in both genders. Seventy percent of the high risk group had a body mass index (BMI) ≥ 30 kg/m(2) and nearly 75% of the low risk group had a BMI < 30 kg/m(2), and the mean BMI was 32.06 kg/m(2) (SD 5.67 kg/m(2)) for males and 33.59 kg/m(2) (SD 6.44 kg/m(2)) for females. CONCLUSION: In the primary health care setting, the prevalence of symptoms of OSAS among adult UAE citizens is very high, and UAE patients are at risk for OSAS and may benefit from proper evaluation for OSAS.

Obesity hypoventilation syndrome in obstructive sleep apnea patients in the United Arab Emirates: a retrospective cross-sectional study.

OBJECTIVES: To estimate the frequency of symptoms of obesity hypoventilation syndrome (OHS) in patients with obstructive sleep apnoea (OSA) and to evaluate comorbidities associated with OHS. DESIGN: Retrospective study based on patients' medical records and on further sleep tests performed in the study centre during the inclusion visit. SETTING: Respiratory Care Unit and Sleep Disorder Centre of the Zayed Military Hospital United Arab Emirates. PARTICIPANTS: All patients referred to the study centre for a suspicion of sleep-disordered breathing. MAIN OUTCOME MEASURES: Prevalence of OSA and OSA + OHS and comorbidities in patients with OSA and OHS. RESULTS: A total of 212 adult patients participated in the study. Of these, 107 patients (50.5% [43.8-57.1% CI 95%]) fulfilled diagnostic criteria for OSA, and the majority were men (79.4%). Among patients with OSA, 18 patients (16.8% [10.8-25.1% CI 95%]) fulfilled diagnostic criteria for OHS. In this group, women were more frequently affected than men (31.8% [7/22] vs. 12.9% [11/85], respectively; p = 0.03) and tended to be older than affected men, with a mean age of 55 ± 10.6 years versus 46 ± 13 for men. After adjustment for gender, OHS was significantly associated with hypertension (OR = 3.5; p = 0.03), diabetes mellitus (OR = 4.6; p = 0.02), ischaemic heart disease (OR = 5.1; p = 0.04) and pulmonary hypertension (OR = 16.1; p = 0.001). CONCLUSION: OHS is a common condition in obese patients in the UAE and is associated with an increased risk of cardiovascular comorbidities and diabetes.