African Severe Asthma Program: A Research Network for Characterisation of Severe Asthma in Africans (ASAP)

Study Overview
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Brief Summary
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This study is a prospective observational multicentre cohort study of asthma patients in Eastern Africa whose objectives will be; The primary objective of this project is to identify and characterize severe asthma in Eastern Africa in order to understand its demographic, clinical, physiologic, pathologic, genomic and immunologic determinants. Secondary objective(s) are; Compare the annual healthcare utilisation (HCU) (emergency room visits, hospitalization including admission to critical care units and unscheduled outpatient clinic or office visits), exacerbation, quality of life and mortality rates of severe and not- severe asthma patients Determine the factors associated with the asthma HCU events, quality of life, exacerbations and mortality The study will enroll 1676 patients aged between 12 and 70 years and follow up each patient for up to one year.

Detailed Description
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This study is a prospective observational multicentre cohort study of asthma patients in Eastern Africa. whose objectives will be; The primary objective of this project is to identify and characterize severe asthma in Eastern Africa in order to understand its demographic, clinical, physiologic, pathologic, genomic and immunologic determinants. Secondary objective(s) are; Compare the annual healthcare utilisation (HCU) (emergency room visits, hospitalization including admission to critical care units and unscheduled outpatient clinic or office visits), exacerbation, quality of life and mortality rates of severe and not- severe asthma patients Determine the factors associated with the asthma HCU events, quality of life, exacerbations and mortality. The study will enroll 1676 patients aged between 12 and 70 years and follow up each patient for up to one year. Measurements; The following will be done Asthma Diagnosis. This will be done and will be an entry point to the study. It will be done to ensure patients enrolled onto the study fulfill a clinical diagnosis of Asthma. Cohort Characterisation. Through use of a predeveloped clinical review form, data on demographics, symptoms, exposures to pollutants, known asthma triggers, tobacco smoking, psychosocial issues, comorbidities, asthma control, adherence to medication and inhaler technique will be collected. Asthma quality of life will also be ascertained through use of a questionnaire. Further measurements to characterise asthma will be performed and include; Spirometry Bronchial hyperresponsiveness testing using methacholine challenge tests Skin prick test (SPT), total IgE assays and complete blood count (for eosinophils) FeNO for airway inflammation according to published guidelines. Stool microscopy for helminths infestation Replicative single nucleotide polymorphisms (SNP) genotying HIV testing Each patient will be followed up at intervals (initially monthly for 6 months and then at month 9 and 12). At each clinic visit, treatment will be optimised.

Official Title
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African Severe Asthma Program

Conditions
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Severe Asthma

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All Asthma Patients presenting at study clinics who are between 12 and 70 years and older resident within 30km of the enrolling sites. Exclusion Criteria: Asthma patients with contra-indications to any of the study procedures and tests. In addition the following patients will be excluded: Patients with a primary diagnosis of an alternative lung disease (e.g.: COPD, or bronchiectasis, pulmonary fibrosis.), Patients with another significant disease likely to confound assessment of asthma (e.g: active tuberculosis), Patients unable to perform study tests and procedures, Patients over 70 years of age, patients who have been exposed to experimental treatments within the past three months Pregnant women.

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients with Severe Asthma. | The primary end point in this study is severe asthma. We shall document the proportion of the enrolled patients that have severe asthma and perform a factor analysis to identify factors independently associated with severe asthma. | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment Severe Asthma | Incidences rates of this outcome between groups (severe and not severe asthma) will be compared and predictors of this outcome analysed. | 3 years | 
| Health Care Utilisation rates | Incidences rates of this outcome between groups (severe and not severe asthma) will be compared and predictors of this outcome analysed. | 3 years | 
| Exacerbations | Incidences rates of this outcome between groups (severe and not severe asthma) will be compared and predictors of this outcome analysed. | 3 years | 
| Mortality rates | Incidences rates of this outcome between groups (severe and not severe asthma) will be compared and predictors of this outcome analysed. | 3 years |