The European initiative for quality management in lung cancer care.

Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.

Smoking habits in the Middle East and North Africa: results of the BREATHE study.

Few recent comparative data exist on smoking habits in the Middle East and North Africa (MENA) region. The objective of this analysis was to evaluate smoking patterns in a large general population sample of individuals aged ≥ 40 years in ten countries in the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan, using a standardised methodology. A random sample of 457,258 telephone numbers was generated and called. This identified 65,154 eligible subjects, of whom 62,086 agreed to participate. A screening questionnaire was administered to each participant, which included six questions relating to cigarette consumption and waterpipe use. The age- and gender-adjusted proportion of respondents reporting current or past smoking of cigarettes or waterpipes was 31.2% [95% CI: 30.9-31.6%]. This proportion was significantly higher (p < 0.001) in men (48.0%) than in women (13.8%), but no relevant differences were observed between age groups. Smoking rates were in general lowest in the Maghreb countries and Pakistan and highest in the Eastern Mediterranean countries, ranging from 15.3% in Morocco to 53.9% in Lebanon. Consumption rates were 28.8% [28.4-29.2%] for cigarette smoking and 3.5% [3.4-3.6%] for waterpipe use. Use of waterpipes was most frequent in Saudi Arabia (8.5% of respondents) but remained low in the Maghreb countries (< 1.5%). Cumulative cigarette exposure was high, with a mean number of pack · years smoked of 18.5 ± 20.5 for women and 29.1 ± 26.2 for men. In conclusion, smoking is a major health issue in the MENA region.

Management of chronic obstructive pulmonary disease in the Middle East and North Africa: results of the BREATHE study.

Chronic obstructive pulmonary disease (COPD) is a potentially severe chronic progressive respiratory condition requiring long-term treatment and frequently involving episodic hospitalisations to manage exacerbations. The objective of this analysis was to document diagnosis, evaluation, treatment and management of COPD-related respiratory symptoms in 1,392 subjects fulfilling an epidemiological definition of COPD identified in a general population sample of 62,086 individuals aged ≥ 40 years in ten countries in the Middle East and North Africa region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan. 442 subjects (31.8%) claimed to have received a diagnosis of COPD from a physician and 287 (20.6%) had undergone spirometry in the previous year. Use of specific treatments for respiratory symptoms was reported by 218 subjects (15.7%). Use of inhaled long-acting bronchodilators together with corticosteroids (53 subjects; 3.8%) and use of oxygen therapy (31 subjects; 2.3%) was very low. 852 subjects (61.2%) had consulted a physician about their respiratory condition at least once in the previous year, with a mean number of consultations of 3.4 ± 3.6. Moreover, 284 subjects (20.4%) had been hospitalised overnight for their COPD, with a mean of 2.3 ± 3.7 hospitalisations per year. Use of all healthcare resources was significantly higher (p < 0.001) in subjects with CAT scores ≥ 10 than in those with scores < 10, and greater in those with exacerbations than in those without. In conclusion, COPD in the region is under-diagnosed, inadequately evaluated and inadequately treated. Nonetheless, COPD symptoms are responsible for considerable healthcare consumption, with high levels of physician consultation and hospitalisation.

Chronic obstructive pulmonary disease and associated healthcare resource consumption in the Middle East and North Africa: the BREATHE study.

Data on COPD-related healthcare resources use are rarely documented in developing countries. This article presents data on COPD-related healthcare resource consumption in the Middle East, North Africa and Pakistan and addresses the association of this variable with illness severity. A large survey of COPD was conducted in eleven countries of the region, namely Algeria, Egypt, Jordan, Lebanon, Morocco, Pakistan, Saudi-Arabia, Syria, Tunisia, Turkey and United Arab Emirates, using a standardised methodology. A total of 62,086 subjects were screened. This identified 2,187 subjects fulfilling the "epidemiological" definition of COPD. A detailed questionnaire was administered to document data on COPD-related healthcare consumption. Symptom severity was assessed using the COPD Assessment Test (CAT). 1,392 subjects were analysable. Physician consultations were the most frequently used healthcare resource, ranging from 43,118 [95% CI: 755-85,548] consultations in UAE to 4,276,800 [95% CI: 2,320,164-6,230,763] in Pakistan, followed by emergency room visits, ranging from 15,917 [95% CI: 0-34,807] visits in UAE to 683,697 [95% CI: 496,993-869,737] in Turkey and hospitalisations, ranging from 15,563 [95% CI: 7,911-23,215] in UAE to 476,674 [95% CI: 301,258-652,090] in Turkey. The use of each resource increased proportionally with the GOLD 2011 severity groups and was significantly (p < 0.0001) higher in subjects with more symptoms compared to those with lower symptoms and in subjects with exacerbations to those without exacerbations. The occurrence of exacerbations and the CAT score were independently associated with use of each healthcare resource. In conclusion, the BREATHE study revealed that physician consultation is the most frequently COPD-related healthcare resource used in the region. It showed that the deterioration of COPD symptoms and the frequency of exacerbations raised healthcare resource consumption.

Control of asthma in the Maghreb: results of the AIRMAG study.

BACKGROUND: The goal of asthma management is to achieve disease control, defined. as the ability to lead a normal life with normal pulmonary function. However, many epidemiological surveys have demonstrated that asthma control is unacceptable in the majority of patients. OBJECTIVE: To evaluate asthma control in 624 adults with asthma in the Maghreb, participating in the AIRMAG survey. METHODS: As part of a general population survey of asthma in the Maghreb conducted by structured telephone interview, information was obtained on asthma control and treatment. Control was determined with the Asthma Control Test (ACT) and using an algorithm based on the GINA control guidelines. RESULTS: The mean ACT score was 16.6 +/- 4.6, corresponding to uncontrolled asthma. Asthma was uncontrolled (ACT score

Prevalence of asthma in North Africa: the Asthma Insights and Reality in the Maghreb (AIRMAG) study.

BACKGROUND: Bronchial asthma is the most frequent chronic respiratory disease in both adults and children. The prevalence and burden of asthma vary considerably between different regions of the world. Information on asthma in Africa is fragmentary and relatively old. OBJECTIVE: The objective of this cross-sectional epidemiological survey was to determine the prevalence and burden of asthma in the North African countries of Algeria, Morocco and Tunisia using the methodology developed in the Asthma Insights and Reality (AIR) programme. METHODS: A general population sample was generated using a stratified sampling method based on randomly-generated lists of telephone numbers. The target sample consisted of 10,000 households in each country, which were contacted by telephone. A structured interview was proposed. Two screening questions were asked to identify subjects with asthma. Subjects who met these criteria were then questioned in more detail about their asthma. RESULTS: Of 30 350 households contacted, 1090 subjects with asthma were identified of whom 872 provided complete data. The age- and gender-adjusted prevalence of asthma was 3.45% [95% CI: 3.09 3.80%] in Algeria, 3.89% [95% CI: 3.52 4.27%] in Morocco and 3.53% [95% CI: 3.18 3.89%] in Tunisia. Prevalence was highest in children and older adults, and in urban areas. Annual incidence rates ranged between 28/10,000 in Tunisia and 46/10,000 in Algeria. 74.3% of adults reported being handicapped by their asthma all or most of the time, 26.4% reported a visit to a hospital emergency department in the previous year and 23.9% absence from work or school due to asthma. 48.0% reported that their sleep was very or quite disturbed by asthma. CONCLUSIONS: The prevalence of asthma in the Maghreb countries is moderate, but its impact is high.

Paediatric asthma in North Africa: the Asthma Insights and Reality in the Maghreb (AIRMAG) study.

BACKGROUND: Bronchial asthma is the most frequent chronic childhood disease and can have a marked impact on educational development, activities and quality of life. The AIRMAG survey provides an opportunity to assess asthma and its impact in children in North Africa. OBJECTIVE: To describe the prevalence, burden and management of asthma in children in the Maghreb. METHODS: A general population sample was generated using a stratified sampling method based on randomly-generated lists of telephone numbers. The target sample consisted of 10,000 households in each country, which were contacted by telephone. A structured interview was proposed. Two screening questions were asked to identify subjects with asthma. Children who met these criteria were then questioned in more detail about their asthma. RESULTS: Of 30,350 households contacted, 1090 subjects with asthma were identified, of whom 248 were aged under sixteen and interviewed by proxy. The prevalence of paediatric asthma ranged from 3.5% in Tunisia to 4.4% in Morocco. 22.8% of children were rated as severe persistent and 30.9% as intermittent. Asthma control was adequate in 7.6% of children and unacceptable in 46.2%. Control was best in Tunisia and worst in Morocco. 12.2% had been hospitalised for their asthma in the previous year and 32.9% had needed to attend an emergency department. Short-acting beta-agonists were used by 52.8% of children and prophylactic inhaled corticosteroids (alone or in association with long-acting beta-agonists) by 27.0%. CONCLUSIONS: Asthma has a major impact on the lives of children with asthma in the Maghreb. This could be improved by offering more appropriate care as recommended in the GINA guidelines.