Prepared by

Etudes

Prepared by:
Zainab M. Al-kilkawi
Supervisor:
Prof.Iman Basheti
Co-Supervisors:
Dr. Muhannad R. M. Salih
Dr. Nather Obedat
Pharmaceutical Sciences – Faculty of Pharmacy
Deanship of Scientific Research and Higher Studies
-Applied Science University
January 2018

????? ?????? ????????? ?????? ????? ?? ?????
????? ???????? ??????
????? ??? ????? ?????????
1.????? ???????:
?. ?????? ???? ????? ??? ???????:
Assessment of knowledge and level of control of asthmatic patients living in Amman and Baghdad: a cross-sectional comparative study.

?. ?????? ??? ???????:
“????? ??????? ?????? ??????? ??? ???? ????? ????? ?????? ?? ???? ??????: ????? ?????? ??????”
Introduction:
Asthma considered one of the most prevalent chronic diseases in the world which is estimated that around 300 million people in the world have asthma ADDIN EN.CITE <EndNote><Cite><Author>Bousquet</Author><Year>2005</Year><RecNum>20</RecNum><DisplayText>(Bousquet, Bousquet et al. 2005)</DisplayText><record><rec-number>20</rec-number><foreign-keys><key app=”EN” db-id=”f5wsprafudwtepezr2lvwf9mxta9fve209zv”>20</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Bousquet, Jean</author><author>Bousquet, Philippe J</author><author>Godard, Philippe</author><author>Daures, Jean-Pierre</author></authors></contributors><titles><title>The public health implications of asthma</title><secondary-title>Bulletin of the World Health Organization</secondary-title></titles><periodical><full-title>Bulletin of the World Health Organization</full-title></periodical><pages>548-554</pages><volume>83</volume><number>7</number><dates><year>2005</year></dates><isbn>0042-9686</isbn><urls></urls></record></Cite></EndNote>(Bousquet, Bousquet et al. 2005).In 2025, asthma is likely to affect 100 million people and cause a death rate of 239,000 people per year (0.4% of all deaths due to disease) ADDIN EN.CITE <EndNote><Cite><Author>Peters</Author><Year>2006</Year><RecNum>76</RecNum><DisplayText>(Masoli, Fabian et al. 2004, Peters, Ferguson et al. 2006)</DisplayText><record><rec-number>76</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>76</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Peters, Stephen P</author><author>Ferguson, Gary</author><author>Deniz, Yamo</author><author>Reisner, Colin</author></authors></contributors><titles><title>Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment</title><secondary-title>Respiratory medicine</secondary-title></titles><pages>1139-1151</pages><volume>100</volume><number>7</number><dates><year>2006</year></dates><isbn>0954-6111</isbn><urls></urls></record></Cite><Cite><Author>Masoli</Author><Year>2004</Year><RecNum>77</RecNum><record><rec-number>77</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>77</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Masoli, Matthew</author><author>Fabian, Denise</author><author>Holt, Shaun</author><author>Beasley, Richard</author></authors></contributors><titles><title>The global burden of asthma: executive summary of the GINA Dissemination Committee report</title><secondary-title>Allergy</secondary-title></titles><periodical><full-title>Allergy</full-title></periodical><pages>469-478</pages><volume>59</volume><number>5</number><dates><year>2004</year></dates><isbn>1398-9995</isbn><urls></urls></record></Cite></EndNote>(Masoli, Fabian et al. 2004, Peters, Ferguson et al. 2006). It leads to a large burden of disability as it represents the similar number of disability-adjusted life years (DALYs) as osteoporosis, liver cirrhosis, diabetes and schizophrenia ADDIN EN.CITE <EndNote><Cite><Author>Peters</Author><Year>2006</Year><RecNum>50</RecNum><DisplayText>(Peters, Ferguson et al. 2006)</DisplayText><record><rec-number>50</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>50</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Peters, Stephen P</author><author>Ferguson, Gary</author><author>Deniz, Yamo</author><author>Reisner, Colin</author></authors></contributors><titles><title>Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment</title><secondary-title>Respiratory medicine</secondary-title></titles><pages>1139-1151</pages><volume>100</volume><number>7</number><dates><year>2006</year></dates><isbn>0954-6111</isbn><urls></urls></record></Cite></EndNote>(Peters, Ferguson et al. 2006).
Asthma affects all age groups and often starts during childhood. It is represented by four main symptoms: shortness of breath, chest tightness, cough and wheezing. However, the exacerbation of asthma varies in frequency and severity from individual to individual. In affected many patients, symptoms might occur many times during a day, week or month, and others may become worse during physical activity, at night or in cold environment ADDIN EN.CITE <EndNote><Cite><Author>Ozair</Author><Year>2017</Year><RecNum>21</RecNum><DisplayText>(Ozair, Baharuddin et al. 2017)</DisplayText><record><rec-number>21</rec-number><foreign-keys><key app=”EN” db-id=”f5wsprafudwtepezr2lvwf9mxta9fve209zv”>21</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Ozair, Mohd Muzammil</author><author>Baharuddin, Kamarul Aryffin</author><author>Yusoff, Muhamad Saiful Bahri</author></authors></contributors><titles><title>Development and validation of the Knowledge and Clinical Reasoning of Acute Asthma Management in Emergency Department (K-CRAMED)</title><secondary-title>Education in Medicine Journal</secondary-title></titles><periodical><full-title>Education in Medicine Journal</full-title></periodical><volume>9</volume><number>2</number><dates><year>2017</year></dates><isbn>2180-1932</isbn><urls></urls></record></Cite></EndNote>(Ozair, Baharuddin et al. 2017).

Causes of asthma can be inherited or passed on to patients from their parents through their genes, sinuses or/and frequent lung infections. Asthmatics may have no history of asthma in their family. Infections can activate longer episodes of wheezing, or/and shortness of breath ADDIN EN.CITE <EndNote><Cite><Author>Barnes</Author><Year>1996</Year><RecNum>41</RecNum><DisplayText>(Barnes 1996)</DisplayText><record><rec-number>41</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>41</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Barnes, Peter J</author></authors></contributors><titles><title>Pathophysiology of asthma</title><secondary-title>British journal of clinical pharmacology</secondary-title></titles><pages>3-10</pages><volume>42</volume><number>1</number><dates><year>1996</year></dates><isbn>1365-2125</isbn><urls></urls></record></Cite></EndNote>(Barnes 1996).
In fact, respiratory viruses are the most common cause of asthma attacks that are terrible enough to keep patients at home from their work or school ADDIN EN.CITE <EndNote><Cite><Author>Barnes</Author><Year>1996</Year><RecNum>41</RecNum><DisplayText>(Barnes 1996)</DisplayText><record><rec-number>41</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>41</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Barnes, Peter J</author></authors></contributors><titles><title>Pathophysiology of asthma</title><secondary-title>British journal of clinical pharmacology</secondary-title></titles><pages>3-10</pages><volume>42</volume><number>1</number><dates><year>1996</year></dates><isbn>1365-2125</isbn><urls></urls></record></Cite></EndNote>(Barnes 1996). However, all of these causes of asthma can have an important effect on the Health-Related Quality Of Life (HRQOL). The degree of its effects depends on several factors; most of these factors are control of asthma, the patient’s knowledge of asthma and the attitude towards drugs and treatments that are likely to play an important role ADDIN EN.CITE ;EndNote;;Cite;;Author;Chen;/Author;;Year;2007;/Year;;RecNum;42;/RecNum;;DisplayText;(Chen, Gould et al. 2007);/DisplayText;;record;;rec-number;42;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;42;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Chen, Hubert;/author;;author;Gould, Michael K;/author;;author;Blanc, Paul D;/author;;author;Miller, Dave P;/author;;author;Kamath, Tripthi V;/author;;author;Lee, June H;/author;;author;Sullivan, Sean D;/author;;author;TENOR Study Group;/author;;/authors;;/contributors;;titles;;title;Asthma control, severity, and quality of life: quantifying the effect of uncontrolled disease;/title;;secondary-title;Journal of Allergy and Clinical Immunology;/secondary-title;;/titles;;pages;396-402;/pages;;volume;120;/volume;;number;2;/number;;dates;;year;2007;/year;;/dates;;isbn;0091-6749;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Chen, Gould et al. 2007).

However, the conception of the Health Related Quality Of Life (HRQOL) is created by Schipper et al, which is known as “the functional effect of disease and treatment.” While understanding of the factors that affect the quality of life permits to schedule management plan, measuring of HRQOL for asthmatic patients is important ADDIN EN.CITE ;EndNote;;Cite;;Author;Lomper;/Author;;Year;2016;/Year;;RecNum;99;/RecNum;;DisplayText;(Lomper, Chudiak et al. 2016);/DisplayText;;record;;rec-number;99;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;99;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Lomper, Katarzyna;/author;;author;Chudiak, Anna;/author;;author;Uchmanowicz, Izabella;/author;;author;Rosi?czuk, Joanna;/author;;author;Jankowska-Polanska, Beata;/author;;/authors;;/contributors;;titles;;title;Effects of depression and anxiety on asthma-related quality of life;/title;;secondary-title;Advances in Respiratory Medicine;/secondary-title;;/titles;;pages;212-221;/pages;;volume;84;/volume;;number;4;/number;;dates;;year;2016;/year;;/dates;;isbn;2543-6031;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Lomper, Chudiak et al. 2016).

Chronic asthma affects the daily life of patients, which leads to their need for continuous health care. Current reports have shown that asthmatics have a low quality of life. Where many researchers confirmed that there is a relationship between the symptoms of the disease and the basic treatment and psychological state of the patient. Therefore, in many cases, airway obstruction seizures have an emotional cause ADDIN EN.CITE ;EndNote;;Cite;;Author;Lomper;/Author;;Year;2016;/Year;;RecNum;78;/RecNum;;DisplayText;(Lomper, Chudiak et al. 2016);/DisplayText;;record;;rec-number;78;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;78;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Lomper, Katarzyna;/author;;author;Chudiak, Anna;/author;;author;Uchmanowicz, Izabella;/author;;author;Rosi?czuk, Joanna;/author;;author;Jankowska-Polanska, Beata;/author;;/authors;;/contributors;;titles;;title;Effects of depression and anxiety on asthma-related quality of life;/title;;secondary-title;Advances in Respiratory Medicine;/secondary-title;;/titles;;pages;212-221;/pages;;volume;84;/volume;;number;4;/number;;dates;;year;2016;/year;;/dates;;isbn;2543-6031;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Lomper, Chudiak et al. 2016).

There are many publications evaluate the quality of life of patients with bronchial asthma. However, there are only a few that describe how asthma control affects the quality of life and the ability to cope with feelings of stress, which are often associated with asthma ADDIN EN.CITE ;EndNote;;Cite;;Author;Lomper;/Author;;Year;2016;/Year;;RecNum;79;/RecNum;;DisplayText;(Lomper, Chudiak et al. 2016);/DisplayText;;record;;rec-number;79;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;79;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Lomper, Katarzyna;/author;;author;Chudiak, Anna;/author;;author;Uchmanowicz, Izabella;/author;;author;Rosi?czuk, Joanna;/author;;author;Jankowska-Polanska, Beata;/author;;/authors;;/contributors;;titles;;title;Effects of depression and anxiety on asthma-related quality of life;/title;;secondary-title;Advances in Respiratory Medicine;/secondary-title;;/titles;;pages;212-221;/pages;;volume;84;/volume;;number;4;/number;;dates;;year;2016;/year;;/dates;;isbn;2543-6031;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Lomper, Chudiak et al. 2016).

In this study, they wanted to show that good asthma control is not the only condition for good clinical outcomes, but improving quality and reducing stress is also important. While there is no universal definition but asthma control is one way to detect the activity of the disease in the patient by picking up the disease through fluctuations in symptoms. The degree to which these symptoms restrict activities, disturb sleep, or require the use of a rescue inhaler (e.g. short-acting ?-agonist) ADDIN EN.CITE ;EndNote;;Cite;;Author;Chen;/Author;;Year;2007;/Year;;RecNum;42;/RecNum;;DisplayText;(Chen, Gould et al. 2007);/DisplayText;;record;;rec-number;42;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;42;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Chen, Hubert;/author;;author;Gould, Michael K;/author;;author;Blanc, Paul D;/author;;author;Miller, Dave P;/author;;author;Kamath, Tripthi V;/author;;author;Lee, June H;/author;;author;Sullivan, Sean D;/author;;author;TENOR Study Group;/author;;/authors;;/contributors;;titles;;title;Asthma control, severity, and quality of life: quantifying the effect of uncontrolled disease;/title;;secondary-title;Journal of Allergy and Clinical Immunology;/secondary-title;;/titles;;pages;396-402;/pages;;volume;120;/volume;;number;2;/number;;dates;;year;2007;/year;;/dates;;isbn;0091-6749;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Chen, Gould et al. 2007).
Patients’ education about how to control asthma is an important and flexible factor because it affects the quality of life. Also, having a written asthma action plan also helps reduce the number of asthma attacks and improve control of the disease. GINA recommends that these plans be updated once a year ADDIN EN.CITE <EndNote><Cite><Author>Lomper</Author><Year>2016</Year><RecNum>79</RecNum><DisplayText>(Lomper, Chudiak et al. 2016)</DisplayText><record><rec-number>79</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>79</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Lomper, Katarzyna</author><author>Chudiak, Anna</author><author>Uchmanowicz, Izabella</author><author>Rosi?czuk, Joanna</author><author>Jankowska-Polanska, Beata</author></authors></contributors><titles><title>Effects of depression and anxiety on asthma-related quality of life</title><secondary-title>Advances in Respiratory Medicine</secondary-title></titles><pages>212-221</pages><volume>84</volume><number>4</number><dates><year>2016</year></dates><isbn>2543-6031</isbn><urls></urls></record></Cite></EndNote>(Lomper, Chudiak et al. 2016).

In addition, some patients with correctly controlled asthma often have limited therapeutic options. This type and degree of control and treatment is still at high risk of morbidity and serious mortality despite their advanced understanding of the inflammatory basis of asthma and acceptance of disease management guidelines ADDIN EN.CITE <EndNote><Cite><Author>Peters</Author><Year>2006</Year><RecNum>50</RecNum><DisplayText>(Peters, Ferguson et al. 2006)</DisplayText><record><rec-number>50</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>50</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Peters, Stephen P</author><author>Ferguson, Gary</author><author>Deniz, Yamo</author><author>Reisner, Colin</author></authors></contributors><titles><title>Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment</title><secondary-title>Respiratory medicine</secondary-title></titles><pages>1139-1151</pages><volume>100</volume><number>7</number><dates><year>2006</year></dates><isbn>0954-6111</isbn><urls></urls></record></Cite></EndNote>(Peters, Ferguson et al. 2006).

However, All of these negative effects of inadequate asthma control can be attributed to insufficient control over increased risk of exacerbation and emergency room visits (ER) to hospitalization and death ADDIN EN.CITE <EndNote><Cite><Author>Demoly</Author><Year>2009</Year><RecNum>32</RecNum><DisplayText>(Demoly, Paggiaro et al. 2009)</DisplayText><record><rec-number>32</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>32</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Demoly, P</author><author>Paggiaro, P</author><author>Plaza, V</author><author>Bolge, SC</author><author>Kannan, H</author><author>Sohier, B</author><author>Adamek, L</author></authors></contributors><titles><title>Prevalence of asthma control among adults in France, Germany, Italy, Spain and the UK</title><secondary-title>European Respiratory Review</secondary-title></titles><pages>105-112</pages><volume>18</volume><number>112</number><dates><year>2009</year></dates><isbn>0905-9180</isbn><urls></urls></record></Cite></EndNote>(Demoly, Paggiaro et al. 2009).

Therefore, the lack of use of asthma prevention guidelines and questionnaires in primary health care or hospitalization is one of the reasons for inadequate diagnosis and poor control of asthma ADDIN EN.CITE <EndNote><Cite><Author>Orozco-Beltrán</Author><Year>2016</Year><RecNum>48</RecNum><DisplayText>(Orozco-Beltrán, Carratalá-Munuera et al. 2016)</DisplayText><record><rec-number>48</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>48</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Orozco-Beltrán, Domingo</author><author>Carratalá-Munuera, Concepción</author><author>Arriero, Juan M.</author><author>Campo, Paloma</author><author>Martínez-Moragón, Eva</author><author>Molina, Jesús</author><author>Quintano-Jiménez, José Antonio</author><author>Gil-Guillén, Vicente F.</author></authors></contributors><titles><title>Management and referral of patients with severe and poorly controlled asthma in primary care</title><secondary-title>Family Practice</secondary-title></titles><pages>678-683</pages><volume>33</volume><number>6</number><dates><year>2016</year></dates><isbn>0263-2136</isbn><urls><related-urls><url>http://dx.doi.org/10.1093/fampra/cmw081</url></related-urls></urls><electronic-resource-num>10.1093/fampra/cmw081</electronic-resource-num></record></Cite></EndNote>(Orozco-Beltrán, Carratalá-Munuera et al. 2016).

However, patients who have uncontrolled asthma reveal the level of their knowledge of their illnesses, and some patients feel that the results of their medications are not satisfactory for them. Many publications highlighted this issue. One of the main findings was that patients who have the higher educational level, have significantly higher knowledge about their disease and medication. Therefore, the patient educational level have made the direct impact on their asthma knowledge ADDIN EN.CITE <EndNote><Cite><Author>HPD</Author><Year>2016</Year><RecNum>47</RecNum><DisplayText>(HPD and Subasinghe 2016)</DisplayText><record><rec-number>47</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>47</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>HPD, Madhushani</author><author>Subasinghe, HWAS</author></authors></contributors><titles><title>Knowledge attitudes and practices of asthma; Does it associate with demographic factors of adult patients?</title></titles><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>(HPD and Subasinghe 2016).

The successful management for good asthma control depends on many factors as well. In this regard, it has been reported that the patients’ knowledge has a significant impact on asthma control. Patients must understand the underlying pathophysiology of asthma, symptoms of acute attacks, identify triggers, and be able to take appropriate steps to manage their disease ADDIN EN.CITE ;EndNote;;Cite;;Author;Mohamed;/Author;;Year;2015;/Year;;RecNum;44;/RecNum;;DisplayText;(Mohamed and Karameh 2015);/DisplayText;;record;;rec-number;44;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;44;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Mohamed, Osama Moheb Ibrahim;/author;;author;Karameh, Wael Karameh;/author;;/authors;;/contributors;;titles;;title;Knowledge, attitude and behaviour of asthmatic patients regarding asthma in primary care setting in Abu Dhabi, United Arab Emirates;/title;;secondary-title;World Family Medicine Journal: Incorporating the Middle East Journal of Family Medicine;/secondary-title;;/titles;;pages;4-11;/pages;;volume;13;/volume;;number;5;/number;;dates;;year;2015;/year;;/dates;;isbn;1839-0196;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Mohamed and Karameh 2015).

Asthma is a disease which has the direct cause of disability and the use of health resources that reduces the quality of life ADDIN EN.CITE ;EndNote;;Cite;;Author;Bender;/Author;;Year;2004;/Year;;RecNum;96;/RecNum;;DisplayText;(Bender and Rand 2004);/DisplayText;;record;;rec-number;96;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;96;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Bender, Bruce G;/author;;author;Rand, Cynthia;/author;;/authors;;/contributors;;titles;;title;Medication non-adherence and asthma treatment cost;/title;;secondary-title;Current opinion in allergy and clinical immunology;/secondary-title;;/titles;;pages;191-195;/pages;;volume;4;/volume;;number;3;/number;;dates;;year;2004;/year;;/dates;;isbn;1528-4050;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Bender and Rand 2004). There are many causes of reducing the quality of life for asthmatic patients, one of these causes is asthma exacerbation that has a significant impact on them and their families. To reduce exacerbation of asthma, treatment should be gradually modified, driven by the level of asthma control of the patient ADDIN EN.CITE ;EndNote;;Cite;;Author;Bateman;/Author;;Year;2008;/Year;;RecNum;97;/RecNum;;DisplayText;(Bateman, Hurd et al. 2008);/DisplayText;;record;;rec-number;97;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;97;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Bateman, Eric D;/author;;author;Hurd, SS;/author;;author;Barnes, PJ;/author;;author;Bousquet, J;/author;;author;Drazen, JM;/author;;author;FitzGerald, M;/author;;author;Gibson, P;/author;;author;Ohta, K;/author;;author;O;apos;byrne, P;/author;;author;Pedersen, SE;/author;;/authors;;/contributors;;titles;;title;Global strategy for asthma management and prevention: GINA executive summary;/title;;secondary-title;European Respiratory Journal;/secondary-title;;/titles;;pages;143-178;/pages;;volume;31;/volume;;number;1;/number;;dates;;year;2008;/year;;/dates;;isbn;0903-1936;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Bateman, Hurd et al. 2008).

Optimal treatment adherence (e.g. taking the drugs as described by their doctor) is important to improve the benefits of medication. Therefore, the treatment can be modified by the patient or caregiver under the guidance of agreed written asthma to a plan of action, but poor adherence can apply to the use of written asthma action plans in addition to environmental recommendations (e.g. allergens Avoid) and follow-up visits. Also, poor inhalation technique also has a great effect on poor adherence treatments ADDIN EN.CITE ;EndNote;;Cite;;Author;Boulet;/Author;;Year;2012;/Year;;RecNum;98;/RecNum;;DisplayText;(Boulet, Vervloet et al. 2012);/DisplayText;;record;;rec-number;98;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;98;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Boulet, Louis-Philippe;/author;;author;Vervloet, Daniel;/author;;author;Magar, Yves;/author;;author;Foster, Juliet M;/author;;/authors;;/contributors;;titles;;title;Adherence: the goal to control asthma;/title;;secondary-title;Clinics in chest medicine;/secondary-title;;/titles;;pages;405-417;/pages;;volume;33;/volume;;number;3;/number;;dates;;year;2012;/year;;/dates;;isbn;0272-5231;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Boulet, Vervloet et al. 2012).

Optimal control of asthma treatment depends on several behavioral factors (such as self- monitoring, adherence to therapy, and management of environmental triggers) that may be affected by chronic negative mood. Chronic negative mood such as anxiety may affect the abilities of daily self-monitoring and adherence to treatment, which may lead to worse levels of control over asthma. Interestingly, rates of mental disorders (especially anxiety disorder) have been shown to be six times more prevalent among asthma patients (16 to 52% for disorders) compared with rates observed in the general population ADDIN EN.CITE ;EndNote;;Cite;;Author;Lavoie;/Author;;Year;2006;/Year;;RecNum;100;/RecNum;;DisplayText;(Lavoie, Bacon et al. 2006);/DisplayText;;record;;rec-number;100;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;100;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Lavoie, Kim L;/author;;author;Bacon, Simon L;/author;;author;Barone, Silvana;/author;;author;Cartier, Andre;/author;;author;Ditto, Blaine;/author;;author;Labrecque, Manon;/author;;/authors;;/contributors;;titles;;title;What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both?;/title;;secondary-title;Chest;/secondary-title;;/titles;;pages;1039-1047;/pages;;volume;130;/volume;;number;4;/number;;dates;;year;2006;/year;;/dates;;isbn;0012-3692;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Lavoie, Bacon et al. 2006).

3. ???????? ???????
Literature Review
In 1993, the Global Asthma Initiative was created to increase health awareness and awareness about asthma among health workers, public health authorities, society, improve prevention and management through a coordinated global effort between health centers and society ADDIN EN.CITE ;EndNote;;Cite;;Author;FitzGerald;/Author;;Year;2015;/Year;;RecNum;80;/RecNum;;DisplayText;(FitzGerald, Bateman et al. 2015);/DisplayText;;record;;rec-number;80;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;80;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;FitzGerald, M;/author;;author;Bateman, ED;/author;;author;Boulet, LP;/author;;author;Cruz, A;/author;;author;Haatela, T;/author;;author;Levy, M;/author;;author;O’Byrne, P</author><author>Ohta, K</author><author>Paggario, P</author><author>Pedersern, S</author></authors></contributors><titles><title>Pocket guide for asthma management and Prevention</title><secondary-title>For adults and children</secondary-title></titles><volume>5</volume><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>(FitzGerald, Bateman et al. 2015).

Therefore, Global Initiative for Asthma Guidelines of GINA define asthma as a chronic inflammatory disease affecting the respiratory system that causes airways hyperresponsiveness, mucous edema and mucosal production. This inflammation is characterized by frequent episodes of symptoms during the day, week or month, such as wheezing, coughing, shortness of breath, chest tightness and sometimes shortness of breath ADDIN EN.CITE <EndNote><Cite><Author>Mow</Author><Year>2005</Year><RecNum>52</RecNum><DisplayText>(Mow, Gu et al. 2005)</DisplayText><record><rec-number>52</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>52</key></foreign-keys><ref-type name=”Generic”>13</ref-type><contributors><authors><author>Mow, VC</author><author>Gu, WY</author><author>Chen, FH</author></authors></contributors><titles><title>Structure and function of articular cartilage and meniscus.(chapter 5) Basic Orthopaedic Biomechanics and Mechanobiology, Mow VC and Huiskes R, eds</title></titles><dates><year>2005</year></dates><publisher>Philadelphia: Lippincott, Williams and Wilkins</publisher><urls></urls></record></Cite></EndNote>(Mow, Gu et al. 2005). It can be triggered by different extrinsic and intrinsic factors, which may eventually lead to asthma exacerbation ADDIN EN.CITE <EndNote><Cite><Author>Saini</Author><Year>2006</Year><RecNum>53</RecNum><DisplayText>(Saini, Smith et al. 2006)</DisplayText><record><rec-number>53</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>53</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Saini, Bandana</author><author>Smith, Lorraine</author><author>Armour, Carol</author><author>Krass, Ines</author></authors></contributors><titles><title>Development and evaluation of an educational intervention to facilitate community pharmacists to provide specialised asthma care</title><secondary-title>International Journal of Pharmacy Practice</secondary-title></titles><pages>A39</pages><volume>14</volume><dates><year>2006</year></dates><isbn>0961-7671</isbn><urls></urls></record></Cite></EndNote>(Saini, Smith et al. 2006), (GINA, 2015).
Asthma is well controlled when its symptoms are repeated at a minimum. There are no symptoms during the day or at night, there are no visits to the hospital, no physical activity or exercise (Busquets. et al., 2000), with the minimum requirement of reliever drugs, normal lung function ((in practice FEV1 (forced exhalation volume in one second)) and/or PEF> 80% ((aspiration flux (expected or better)), free side effects of asthma medications ? ADDIN EN.CITE <EndNote><Cite><Author>Lougheed</Author><Year>2012</Year><RecNum>65</RecNum><DisplayText>(Lougheed, Lemiere et al. 2012)</DisplayText><record><rec-number>65</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>65</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Lougheed, M Diane</author><author>Lemiere, Catherine</author><author>Ducharme, Francine M</author><author>Licskai, Chris</author><author>Dell, Sharon D</author><author>Rowe, Brian H</author><author>FitzGerald, Mark</author><author>Leigh, Richard</author><author>Watson, Wade</author><author>Boulet, Louis-Philippe</author></authors></contributors><titles><title>Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults</title><secondary-title>Canadian respiratory journal</secondary-title></titles><pages>127-164</pages><volume>19</volume><number>2</number><dates><year>2012</year></dates><isbn>1198-2241</isbn><urls></urls></record></Cite></EndNote>(Lougheed, Lemiere et al. 2012).

Repeated asthma attacks or exacerbations can result when the patient doesn’t receive the adequate controller therapy for their case (Bateman. et al., 2008), therefore, the primary objective of the International Asthma Management is to achieve the optimal needed control for each patient by doing many studies to understand the real situation for asthmatic patients (Levy. et al., 2009).

So, there was study that done by Incite Marketing Planning Limited (London, UK), in accordance with the Codes of Conduct of the Market Research Society, European Pharmaceutical Marketing Research Association and Association of the British Pharmaceutical Industry, and guidelines from the British Healthcare Business Intelligence Association on asthma control and management in 8,000 European patients.

Thus, the results of this study of European patients for control of asthma were poor: 45% of patients respondents had uncontrolled asthma; symptoms and acute exacerbation were common: 44% of the patients respondents reported that they used oral steroids to treat asthma in the previous 12 months, 24% of them visited an emergency department and 12% of the patients entered the hospital. Therefore, there is need to evaluate patient control risk and inhalation technique, to ensure patient description, and appropriate treatment ADDIN EN.CITE ;EndNote;;Cite;;Author;Price;/Author;;Year;2014;/Year;;RecNum;101;/RecNum;;DisplayText;(Price, Fletcher et al. 2014);/DisplayText;;record;;rec-number;101;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;101;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Price, David;/author;;author;Fletcher, Monica;/author;;author;Van Der Molen, Thys;/author;;/authors;;/contributors;;titles;;title;Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey;/title;;secondary-title;NPJ primary care respiratory medicine;/secondary-title;;/titles;;pages;14009;/pages;;volume;24;/volume;;dates;;year;2014;/year;;/dates;;isbn;2055-1010;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Price, Fletcher et al. 2014).

Therefore, Health-related quality of life is an important factor of asthma patient to assess the health of the patients that it affects their physical, mental and emotional health. There are many factors other than asthma control that may affect the quality of life related to asthma such as mental disorders, anxiety and depression in the first place in patients with asthma ADDIN EN.CITE ;EndNote;;Cite;;Author;Sundbom;/Author;;Year;2016;/Year;;RecNum;103;/RecNum;;DisplayText;(Sundbom, Malinovschi et al. 2016);/DisplayText;;record;;rec-number;103;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;103;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Sundbom, Fredrik;/author;;author;Malinovschi, Andrei;/author;;author;Lindberg, Eva;/author;;author;Alving, Kjell;/author;;author;Janson, Christer;/author;;/authors;;/contributors;;titles;;title;Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics;/title;;secondary-title;Journal of Asthma;/secondary-title;;/titles;;pages;398-403;/pages;;volume;53;/volume;;number;4;/number;;dates;;year;2016;/year;;/dates;;isbn;0277-0903;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Sundbom, Malinovschi et al. 2016).

So, there were many studies done to analyze the correlation between asthma control and anxiety, study effect of anxiety on them for asthmatic patients ADDIN EN.CITE ;EndNote;;Cite;;Author;Sundbom;/Author;;Year;2016;/Year;;RecNum;103;/RecNum;;DisplayText;(Sundbom, Malinovschi et al. 2016);/DisplayText;;record;;rec-number;103;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;103;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Sundbom, Fredrik;/author;;author;Malinovschi, Andrei;/author;;author;Lindberg, Eva;/author;;author;Alving, Kjell;/author;;author;Janson, Christer;/author;;/authors;;/contributors;;titles;;title;Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics;/title;;secondary-title;Journal of Asthma;/secondary-title;;/titles;;pages;398-403;/pages;;volume;53;/volume;;number;4;/number;;dates;;year;2016;/year;;/dates;;isbn;0277-0903;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Sundbom, Malinovschi et al. 2016)
One of the studies conducted by the Taylor ; Francis Group to analyze the correlation between asthma control and psychiatric disorders (anxiety and depression). The study was included 369 patients between the ages of 12 and 35, with an asthma diagnosis that requires anti-inflammatory treatment for at least 3 months a year, the questionnaire data( including the mini Asthma Quality of Life Questionnaire (mAQLQ), Asthma Control Test (ACT) had the highest explanatory value for the mAQLQ score (51.5%), and Hospital Anxiety and Depression Scale (HADS) had the highest explanatory value for anxiety and depression (17.0%)), quality of sleep, lung function data and blood samples were analyzed ADDIN EN.CITE ;EndNote;;Cite;;Author;Sundbom;/Author;;Year;2016;/Year;;RecNum;104;/RecNum;;DisplayText;(Sundbom, Malinovschi et al. 2016);/DisplayText;;record;;rec-number;104;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;104;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Sundbom, Fredrik;/author;;author;Malinovschi, Andrei;/author;;author;Lindberg, Eva;/author;;author;Alving, Kjell;/author;;author;Janson, Christer;/author;;/authors;;/contributors;;titles;;title;Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics;/title;;secondary-title;Journal of Asthma;/secondary-title;;/titles;;pages;398-403;/pages;;volume;53;/volume;;number;4;/number;;dates;;year;2016;/year;;/dates;;isbn;0277-0903;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Sundbom, Malinovschi et al. 2016).

However, the result of this study was the highest mean mAQLQ score (6.3 units) for the group that didn’t report these conditions (anxiety and depression) while the lowest mAQLQ score (3.8 units) for the group reported these conditions (anxiety and depression) because anxiety that exists among asthma sufferers may be due to poor asthma control, increased drugs use much asthma symptoms and inadequate symptoms perception ADDIN EN.CITE <EndNote><Cite><Author>Sundbom</Author><Year>2016</Year><RecNum>104</RecNum><DisplayText>(Sundbom, Malinovschi et al. 2016)</DisplayText><record><rec-number>104</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>104</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Sundbom, Fredrik</author><author>Malinovschi, Andrei</author><author>Lindberg, Eva</author><author>Alving, Kjell</author><author>Janson, Christer</author></authors></contributors><titles><title>Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics</title><secondary-title>Journal of Asthma</secondary-title></titles><pages>398-403</pages><volume>53</volume><number>4</number><dates><year>2016</year></dates><isbn>0277-0903</isbn><urls></urls></record></Cite></EndNote>(Sundbom, Malinovschi et al. 2016).

In order to prevent anxiety and other negative complications from asthma, there were many kinds of research conducted by the National Asthma Prevention, Asthma Prevention and Control Team, they concluded that patient training in self-management should be part of routine clinical care and should address the relevant cognitive variables, such as asthma, attitudes, and self-efficacy. So, self-management need enough knowledge on their diseases to get good control ADDIN EN.CITE <EndNote><Cite><Author>Health</Author><Year>2009</Year><RecNum>84</RecNum><DisplayText>(Health and Services 2009)</DisplayText><record><rec-number>84</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>84</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>US Department of Health</author><author>Human Services</author></authors></contributors><titles><title>National Heart, Lung and Blood Institute National Asthma Education and Prevention Program. Expert panel report: guidelines for the diagnosis and management of asthma: update on selected topics 2002</title><secondary-title>Public Health Service, NIH</secondary-title></titles><dates><year>2009</year></dates><urls></urls></record></Cite></EndNote>(Health and Services 2009).
Therefore, there are many tools to an assessment of patients’ knowledge of medicine which may help them to detect the problems in therapy and improve the therapeutic outcomes because patient education is one of the backbones of the proper asthma management ADDIN EN.CITE ;EndNote;;Cite;;Author;Elbanna;/Author;;Year;2017;/Year;;RecNum;110;/RecNum;;DisplayText;(Elbanna, Sileem et al. 2017);/DisplayText;;record;;rec-number;110;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;110;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Elbanna, Reham MH;/author;;author;Sileem, Ashraf E;/author;;author;Bahgat, Shereen M;/author;;author;Ibrahem, Gehan A;/author;;/authors;;/contributors;;titles;;title;Effect of bronchial asthma education program on asthma control among adults at Mansoura district;/title;;secondary-title;Egyptian Journal of Chest Diseases and Tuberculosis;/secondary-title;;/titles;;periodical;;full-title;Egyptian Journal of Chest Diseases and Tuberculosis;/full-title;;/periodical;;pages;561-569;/pages;;volume;66;/volume;;number;4;/number;;dates;;year;2017;/year;;/dates;;isbn;0422-7638;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Elbanna, Sileem et al. 2017).

Knowledge about asthma is important because the ability to recognize triggers, understand maintenance, increase aware about the positive attitude towards treatment, rescue roles, develop management plans and avoid worsening disease ADDIN EN.CITE ;EndNote;;Cite;;Author;Scherer;/Author;;Year;2001;/Year;;RecNum;85;/RecNum;;DisplayText;(Scherer and Bruce 2001);/DisplayText;;record;;rec-number;85;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;85;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Scherer, Yvonne Krall;/author;;author;Bruce, Susan;/author;;/authors;;/contributors;;titles;;title;Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma;/title;;secondary-title;Heart ;amp; Lung: The Journal of Acute and Critical Care;/secondary-title;;/titles;;pages;250-257;/pages;;volume;30;/volume;;number;4;/number;;dates;;year;2001;/year;;/dates;;isbn;0147-9563;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Scherer and Bruce 2001). Thus, there are many studies suggests the importance of educating the patient in an achieving better asthma control. However, little is known about the impact of adult’ asthma knowledge on asthma control ADDIN EN.CITE <EndNote><Cite><Author>Ozturk</Author><Year>2015</Year><RecNum>106</RecNum><DisplayText>(Ozturk, Pur et al. 2015)</DisplayText><record><rec-number>106</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>106</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Ozturk, AB</author><author>Pur, L Ozyigit</author><author>Kostek, O</author><author>Keskin, H</author></authors></contributors><titles><title>Association between asthma self-management knowledge and asthma control in the elderly</title><secondary-title>Annals of Allergy, Asthma &amp; Immunology</secondary-title></titles><pages>480-484</pages><volume>114</volume><number>6</number><dates><year>2015</year></dates><isbn>1081-1206</isbn><urls></urls></record></Cite></EndNote>(Ozturk, Pur et al. 2015).

One of these studies was done in Faculty of Medicine/Zagazig University in Egypt to evaluate the level of asthma symptoms control after education program among 84 (45 females and 39 males) adult asthmatic patients. The study was done by Intervention analysis which consisting of sessions of education for each group of asthmatic patients. Asthma control questionnaire (ACQ) was obtained every 2 weeks for 3 months ADDIN EN.CITE <EndNote><Cite><Author>Elbanna</Author><Year>2017</Year><RecNum>111</RecNum><DisplayText>(Elbanna, Sileem et al. 2017)</DisplayText><record><rec-number>111</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>111</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Elbanna, Reham MH</author><author>Sileem, Ashraf E</author><author>Bahgat, Shereen M</author><author>Ibrahem, Gehan A</author></authors></contributors><titles><title>Effect of bronchial asthma education program on asthma control among adults at Mansoura district</title><secondary-title>Egyptian Journal of Chest Diseases and Tuberculosis</secondary-title></titles><periodical><full-title>Egyptian Journal of Chest Diseases and Tuberculosis</full-title></periodical><pages>561-569</pages><volume>66</volume><number>4</number><dates><year>2017</year></dates><isbn>0422-7638</isbn><urls></urls></record></Cite></EndNote>(Elbanna, Sileem et al. 2017).

The result of this study (Table4) was (72.7%) had moderate asthma, no significant difference in the degree of the knowledge between partially and uncontrolled patients pre-education (p = 0.41) but post asthma education program there was significant difference in the degree of the knowledge between well controlled, partially and uncontrolled patients (p = 0.004) ADDIN EN.CITE <EndNote><Cite><Author>Elbanna</Author><Year>2017</Year><RecNum>110</RecNum><DisplayText>(Elbanna, Sileem et al. 2017)</DisplayText><record><rec-number>110</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>110</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Elbanna, Reham MH</author><author>Sileem, Ashraf E</author><author>Bahgat, Shereen M</author><author>Ibrahem, Gehan A</author></authors></contributors><titles><title>Effect of bronchial asthma education program on asthma control among adults at Mansoura district</title><secondary-title>Egyptian Journal of Chest Diseases and Tuberculosis</secondary-title></titles><periodical><full-title>Egyptian Journal of Chest Diseases and Tuberculosis</full-title></periodical><pages>561-569</pages><volume>66</volume><number>4</number><dates><year>2017</year></dates><isbn>0422-7638</isbn><urls></urls></record></Cite></EndNote>(Elbanna, Sileem et al. 2017).

Asthma control requires adequate adherence to many recommendations by the doctors including treatment, controlling asthma control, correct inhaler technique, avoiding environmental triggers and attending follow-up appointment. Thus, in order to achieve this, it is important that the patient agrees and understands the diagnosis and is ready to follow the recommendations provided. This situation is especially true for patients with severe asthma requiring polypharmacology, sometimes with potentially significant side effects ADDIN EN.CITE <EndNote><Cite><Author>Boulet</Author><Year>2012</Year><RecNum>108</RecNum><DisplayText>(Boulet, Vervloet et al. 2012)</DisplayText><record><rec-number>108</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>108</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Boulet, Louis-Philippe</author><author>Vervloet, Daniel</author><author>Magar, Yves</author><author>Foster, Juliet M</author></authors></contributors><titles><title>Adherence: the goal to control asthma</title><secondary-title>Clinics in chest medicine</secondary-title></titles><pages>405-417</pages><volume>33</volume><number>3</number><dates><year>2012</year></dates><isbn>0272-5231</isbn><urls></urls></record></Cite></EndNote>(Boulet, Vervloet et al. 2012).

There was the study done in B.J. Government Medical College & Hospital/Department of Pulmonary Medicine/ India to assess the knowledge, attitude and medication adherence for 154 asthmatic outpatients. The results of this study were in the figures below ADDIN EN.CITE <EndNote><Cite><Author>Shamkuwar</Author><Year>2016</Year><RecNum>109</RecNum><DisplayText>(Shamkuwar, Kumari et al. 2016)</DisplayText><record><rec-number>109</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>109</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Shamkuwar, Chetna A</author><author>Kumari, Nalini</author><author>Meshram, Sushant H</author><author>Dakhale, Ganesh N</author><author>Motghare, Vijay M</author></authors></contributors><titles><title>Evaluation of Knowledge, Attitude and Medication Adherence among Asthmatics Outpatients in Tertiary Care Teaching Hospital-A Questionnaire Based Study</title><secondary-title>Journal of Young Pharmacists</secondary-title></titles><pages>39</pages><volume>8</volume><number>1</number><dates><year>2016</year></dates><isbn>0975-1483</isbn><urls></urls></record></Cite></EndNote>(Shamkuwar, Kumari et al. 2016):
3810013208000
Figure2: Assessment of the scores of knowledge, attitude and medication adherence: (n= 154)
85724000
Figure3: Assessment of level of medication adherence: (n= 154) p<0.05.Low adherence was significantly higher in males 73 (91.25%), with p- value 0.002. Medium level of adherence was significantly higher in females 19 (25.7%) with p-value 0.005.

4. Prevalence of Asthma worldwide
The prevalence of asthma has been increased since the 1950s in the most parts of the world and appears to be growing in countries and regions with rapid urbanization, such as China, in middle- and low-income countries. By contrast, the results of several recent studies suggest that the increase in the prevalence of asthma may have stabilized or even decreased in some countries, particularly in Europe and Australia.

However, the results of the past two decades are very conflicting, the data has been interpreted in different ways ADDIN EN.CITE <EndNote><Cite><Author>Lundbäck</Author><Year>2016</Year><RecNum>113</RecNum><DisplayText>(Lundbäck, Backman et al. 2016)</DisplayText><record><rec-number>113</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>113</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Lundbäck, Bo</author><author>Backman, Helena</author><author>Lötvall, Jan</author><author>Rönmark, Eva</author></authors></contributors><titles><title>Is asthma prevalence still increasing?</title><secondary-title>Expert review of respiratory medicine</secondary-title></titles><periodical><full-title>Expert review of respiratory medicine</full-title></periodical><pages>39-51</pages><volume>10</volume><number>1</number><dates><year>2016</year></dates><isbn>1747-6348</isbn><urls></urls></record></Cite></EndNote>(Lundbäck, Backman et al. 2016).

After the 1960s and 1970s which was the second part of the past century, the prevalence of asthma increased in most of the westernized countries but an increase in the middle- and low-income countries was observed later ADDIN EN.CITE <EndNote><Cite><Author>Mannino</Author><Year>2002</Year><RecNum>116</RecNum><DisplayText>(Mannino, Homa et al. 2002)</DisplayText><record><rec-number>116</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>116</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Mannino, David M</author><author>Homa, David M</author><author>Akinbami, Lara J</author><author>Moorman, Jeanne E</author><author>Gwynn, Charon</author><author>Redd, Stephen C</author></authors></contributors><titles><title>Surveillance for asthma—United States, 1980–1999</title><secondary-title>MMWR Surveill Summ</secondary-title></titles><periodical><full-title>MMWR Surveill Summ</full-title></periodical><pages>1-13</pages><volume>51</volume><number>1</number><dates><year>2002</year></dates><isbn>1546-0738</isbn><urls></urls></record></Cite></EndNote>(Mannino, Homa et al. 2002).

From 1966 to 2003 in Finland, the prevalence of asthma for all men aged 18-20 years were increased from 0.3% to 3.5% ADDIN EN.CITE <EndNote><Cite><Author>Latvala</Author><Year>2005</Year><RecNum>117</RecNum><DisplayText>(Latvala, von Hertzen et al. 2005)</DisplayText><record><rec-number>117</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>117</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Latvala, Jari</author><author>von Hertzen, Leena</author><author>Lindholm, Harri</author><author>Haahtela, Tari</author></authors></contributors><titles><title>Trends in prevalence of asthma and allergy in Finnish young men: nationwide study, 1966-2003</title><secondary-title>Bmj</secondary-title></titles><periodical><full-title>Bmj</full-title></periodical><pages>1186-1187</pages><volume>330</volume><number>7501</number><dates><year>2005</year></dates><isbn>0959-8138</isbn><urls></urls></record></Cite></EndNote>(Latvala, von Hertzen et al. 2005), while from 1972 to 1996 for example in Scotland, the prevalence of asthma increased a threefold from 3.0% to 8.2% among adults ADDIN EN.CITE <EndNote><Cite><Author>Upton</Author><Year>2000</Year><RecNum>118</RecNum><DisplayText>(Upton, McConnachie et al. 2000)</DisplayText><record><rec-number>118</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>118</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Upton, Mark N</author><author>McConnachie, Alex</author><author>McSharry, Charles</author><author>Hart, Carole L</author><author>Smith, George Davey</author><author>Gillis, Charles R</author><author>Watt, Graham CM</author></authors></contributors><titles><title>Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring</title><secondary-title>Bmj</secondary-title></titles><periodical><full-title>Bmj</full-title></periodical><pages>88-92</pages><volume>321</volume><number>7253</number><dates><year>2000</year></dates><isbn>0959-8138</isbn><urls></urls></record></Cite></EndNote>(Upton, McConnachie et al. 2000).

Also, from 1980 to 1996 in the USA and according to the Centre for Disease Control of Asthma, the prevalence of asthma in both children and adults was increased ADDIN EN.CITE <EndNote><Cite><Author>Mannino</Author><Year>2002</Year><RecNum>115</RecNum><DisplayText>(Mannino, Homa et al. 2002)</DisplayText><record><rec-number>115</rec-number><foreign-keys><key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″>115</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Mannino, David M</author><author>Homa, David M</author><author>Akinbami, Lara J</author><author>Moorman, Jeanne E</author><author>Gwynn, Charon</author><author>Redd, Stephen C</author></authors></contributors><titles><title>Surveillance for asthma—United States, 1980–1999</title><secondary-title>MMWR Surveill Summ</secondary-title></titles><periodical><full-title>MMWR Surveill Summ</full-title></periodical><pages>1-13</pages><volume>51</volume><number>1</number><dates><year>2002</year></dates><isbn>1546-0738</isbn><urls></urls></record></Cite></EndNote>(Mannino, Homa et al. 2002).

Several studies have been published that focus on changing the prevalence of asthma over the past years. There were many detailed articles review for published by Anandan et al. that the prevalence of asthma is still increasing globally. However, more than 2000 published articles discussing the spread of asthma, but only 48 articles have fulfilled the author’s predetermined inclusion criteria. Most of the approved studies are originated from studies of children and adolescents which were based on the International Study protocol of Asthma and Allergy in Children (ISAAC), while only limited numbers of adult studies were included ADDIN EN.CITE ;EndNote;;Cite;;Author;Anandan;/Author;;Year;2010;/Year;;RecNum;114;/RecNum;;DisplayText;(Anandan, Nurmatov et al. 2010);/DisplayText;;record;;rec-number;114;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;114;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Anandan, C;/author;;author;Nurmatov, Ulugbek;/author;;author;Van Schayck, OCP;/author;;author;Sheikh, A;/author;;/authors;;/contributors;;titles;;title;Is the prevalence of asthma declining? Systematic review of epidemiological studies;/title;;secondary-title;Allergy;/secondary-title;;/titles;;periodical;;full-title;Allergy;/full-title;;/periodical;;pages;152-167;/pages;;volume;65;/volume;;number;2;/number;;dates;;year;2010;/year;;/dates;;isbn;1398-9995;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Anandan, Nurmatov et al. 2010).

In 2004, the Global Initiative for Asthma (GINA) and Masoli et al., combined data from the European Community Respiratory Health Survey (ECRHS) in 1988-1994 and the International Study of Asthma and Allergies (ISAAC) study collected in 1992-1996 to produce global estimates of asthma burden, which suggested that asthma prevalence ranged from a low of 0.7% in Macau to 18.4% in Scotland (Figure 4) ( ADDIN EN.CITE ;EndNote;;Cite;;Author;Committee;/Author;;Year;1998;/Year;;RecNum;90;/RecNum;;DisplayText;(Committee 1998);/DisplayText;;record;;rec-number;90;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;90;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;ISAAC Steering Committee;/author;;/authors;;/contributors;;titles;;title;Worldwide variations in the prevalence of asthma symptoms: ISAAC;/title;;secondary-title;Eur. Respir. J;/secondary-title;;/titles;;pages;315-335;/pages;;volume;12;/volume;;dates;;year;1998;/year;;/dates;;urls;;/urls;;/record;;/Cite;;/EndNote;(Committee 1998) ADDIN EN.CITE ;EndNote;;Cite;;Author;Masoli;/Author;;Year;2004;/Year;;RecNum;91;/RecNum;;DisplayText;(Masoli, Fabian et al. 2004);/DisplayText;;record;;rec-number;91;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;91;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Masoli, Matthew;/author;;author;Fabian, Denise;/author;;author;Holt, Shaun;/author;;author;Beasley, Richard;/author;;/authors;;/contributors;;titles;;title;The global burden of asthma: executive summary of the GINA Dissemination Committee report;/title;;secondary-title;Allergy;/secondary-title;;/titles;;periodical;;full-title;Allergy;/full-title;;/periodical;;pages;469-478;/pages;;volume;59;/volume;;number;5;/number;;dates;;year;2004;/year;;/dates;;isbn;1398-9995;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Masoli, Fabian et al. 2004) ADDIN EN.CITE ;EndNote;;Cite;;Author;Burney;/Author;;Year;1996;/Year;;RecNum;92;/RecNum;;DisplayText;(Burney, Chinn et al. 1996);/DisplayText;;record;;rec-number;92;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;92;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Burney, UK;/author;;author;Chinn, S;/author;;author;Luczynska, C;/author;;author;Jarvis, D;/author;;author;Neukirch, F;/author;;author;Pin, I;/author;;author;Wichmann, HE;/author;;author;Heinrich, J;/author;;author;Avarlis, P;/author;;author;Gaga, M;/author;;/authors;;/contributors;;titles;;title;Variations in the prevalence of respiratory symptoms, selfreported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS);/title;;secondary-title;European respiratory journal;/secondary-title;;/titles;;pages;687-695;/pages;;volume;9;/volume;;dates;;year;1996;/year;;/dates;;isbn;0903-1936;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Burney, Chinn et al. 1996) ADDIN EN.CITE ;EndNote;;Cite;;Author;Beasley;/Author;;Year;1998;/Year;;RecNum;93;/RecNum;;DisplayText;(Beasley 1998);/DisplayText;;record;;rec-number;93;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;93;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Beasley, Richard;/author;;/authors;;/contributors;;titles;;title;Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC;/title;;secondary-title;The Lancet;/secondary-title;;/titles;;pages;1225-1232;/pages;;volume;351;/volume;;number;9111;/number;;dates;;year;1998;/year;;/dates;;isbn;0140-6736;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Beasley 1998)).

As a result of this report was done in 2004, 300 million people worldwide had asthma, and the probability of increasing this number to 400 million by 2025 as urbanization increases in countries ADDIN EN.CITE ;EndNote;;Cite;;Author;Masoli;/Author;;Year;2004;/Year;;RecNum;94;/RecNum;;DisplayText;(Masoli, Fabian et al. 2004);/DisplayText;;record;;rec-number;94;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;94;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Masoli, Matthew;/author;;author;Fabian, Denise;/author;;author;Holt, Shaun;/author;;author;Beasley, Richard;/author;;/authors;;/contributors;;titles;;title;The global burden of asthma: executive summary of the GINA Dissemination Committee report;/title;;secondary-title;Allergy;/secondary-title;;/titles;;periodical;;full-title;Allergy;/full-title;;/periodical;;pages;469-478;/pages;;volume;59;/volume;;number;5;/number;;dates;;year;2004;/year;;/dates;;isbn;1398-9995;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Masoli, Fabian et al. 2004).

250507577146150centertop00Figure 4: Prevalence of asthma symptoms (%)
From 2011 to 2013, 235–300 million people worldwide suffered from asthma which may be increasing to 400 million in 2025. Asthma prevalence varies (1–18% or even more) among different countries, and also different regions of the same country, due to the diversity in ethnicity race, sex, socioeconomic and environmental conditions, and lifestyle ADDIN EN.CITE ;EndNote;;Cite;;Author;Alavinezhad;/Author;;Year;2017;/Year;;RecNum;34;/RecNum;;DisplayText;(Alavinezhad and Boskabady 2017);/DisplayText;;record;;rec-number;34;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;34;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Alavinezhad, Azam;/author;;author;Boskabady, Mohammad Hossein;/author;;/authors;;/contributors;;titles;;title;The prevalence of asthma and related symptoms in Middle East countries;/title;;secondary-title;The Clinical Respiratory Journal;/secondary-title;;/titles;;dates;;year;2017;/year;;/dates;;isbn;1752-699X;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Alavinezhad and Boskabady 2017).

Although, industrialized countries and urban areas are among risk factors of the disease, but exposure to infections in early years of life may prevent occurrence of asthma ADDIN EN.CITE ;EndNote;;Cite;;Author;Alavinezhad;/Author;;Year;2017;/Year;;RecNum;34;/RecNum;;DisplayText;(Alavinezhad and Boskabady 2017);/DisplayText;;record;;rec-number;34;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;34;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Alavinezhad, Azam;/author;;author;Boskabady, Mohammad Hossein;/author;;/authors;;/contributors;;titles;;title;The prevalence of asthma and related symptoms in Middle East countries;/title;;secondary-title;The Clinical Respiratory Journal;/secondary-title;;/titles;;dates;;year;2017;/year;;/dates;;isbn;1752-699X;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Alavinezhad and Boskabady 2017).

In 2012, there was the study that done in Canada for 181,042 individuals adult asthmatic patients by using the world health survey (WHS) in seven different regionals which include 70 countries: Africa (includes 18 countries), Americas (includes 7 countries), Eastern Mediterranean (includes 4 countries), Europe (includes 30 countries), South East Asia (includes 5 countries), and Western Pacific (includes 6 countries).

The results of the study (Table 5) after got answering the survey from only 178,215 (98.4%) of asthmatic adults were: the highest prevalence asthma was in the Western Pacific region (6.2%) which was largely contributed by the high prevalence in Australia. The prevalence of asthma was similar in rural (4.86%) and urban (4.91%) residents in all regions except the Western Pacific (p-value: 0.840) while the largest differences were observed in the Americans between rural (3.7%) and urban (5.1%) ADDIN EN.CITE ;EndNote;;Cite;;Author;To;/Author;;Year;2012;/Year;;RecNum;112;/RecNum;;DisplayText;(To, Stanojevic et al. 2012);/DisplayText;;record;;rec-number;112;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;112;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;To, Teresa;/author;;author;Stanojevic, Sanja;/author;;author;Moores, Ginette;/author;;author;Gershon, Andrea S;/author;;author;Bateman, Eric D;/author;;author;Cruz, Alvaro A;/author;;author;Boulet, Louis-Philippe;/author;;/authors;;/contributors;;titles;;title;Global asthma prevalence in adults: findings from the cross-sectional world health survey;/title;;secondary-title;BMC public health;/secondary-title;;/titles;;periodical;;full-title;BMC public health;/full-title;;/periodical;;pages;204;/pages;;volume;12;/volume;;number;1;/number;;dates;;year;2012;/year;;/dates;;isbn;1471-2458;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(To, Stanojevic et al. 2012).

% Among Clinical Asthma Population Reported Symptoms in Last 12 Months
Country Regions Prevalence (%) of Clinical Asthma % Current Smokers % Current Smokers Asthma Ever Treated %Wheezing
Africa 4.19 12.65 13.13 78.85 53.20
Americas 4.40 22.20 23.28 82.62 38.12
Eastern Mediterranean 2.99 19.41 17.52 85.52 54.45
Europe 5.28 39.25 35.85 90.24 49.64
South East Asia 3.39 30.23 34.11 78.00 57.86
Western Pacific 6.17 31.46 28.38 77.11 50.84
Global 4.46 23.46 23.33 81.91 49.69
Table 5: Prevalence of clinical asthma, current smoking, symptoms and treatment by regions.

Also, the prevalence of asthma in specific countries of each region was widespread among participating countries 70, ranging from 1.0% in Vietnam to 21.5% in Australia, representing a global variance 21 times. The five countries that have the highest prevalence of asthma in adults were Australia (21.51%), Sweden (20.2%), UK (18.2%), Netherlands (15.3%), and Brazil (13.0%):
Table 6: Region and country-specific estimates of asthma prevalence by 3 definitions
Asthma Prevalence (%)2 Region1 Country Doctor Diagnosed Asthma Clinical Asthma Wheezing Symptoms
Africa Burkina Faso 2.02 2.26 5.32
Chad 3.68 3.94 7.64
Comoros3 7.55 7.80 12.85
Congo3 4.65 4.79 7.93
Cote d’Iviore3 4.22 4.59 7.70
Ethiopia 2.00 2.00 5.53
Ghana 3.65 3.77 4.88
Kenya 2.86 3.12 6.22
Malawi 4.62 4.67 7.76
Mali 2.65 2.82 4.77
Mauritania 6.95 7.54 11.78
Mauritius 3.88 3.92 6.88
Namibia 3.16 3.39 8.14
Senegal 3.43 3.72 8.40
South Africa5 5.92 6.09 12.40
Swaziland5 8.74 9.69 15.37
Zambia4 2.83 2.96 6.25
Zimbabwe 2.28 2.52 5.48
Regional Sub-total 3.94 4.19 7.75
Americas Brazil 12.44 12.98 22.56
Dominican 9.63 9.97 12.39
Ecuador 2.03 2.13 3.83
Guatemala4 2.26 2.42 11.95
Mexico 2.39 2.39 3.87
Paraguay 6.08 6.40 12.74
Uruguay 8.60 9.10 12.02
Regional Sub-total 4.27 4.40 7.61
Eastern Mediterranean Morocco5 2.76 2.84 11.65
Pakistan 3.12 3.13 5.02
Tunisia 2.74 2.79 7.21
United Arab Emirates 5.30 2.79 7.21
Regional Sub-total 2.93 2.99 7.60
Europe Austria4 7.46 7.63 9.48
Belgium4 9.83 10.00 17.22
Bosnia Herzegovina5 1.30 1.41 4.01
Crotia3 4.38 4.57 8.66
Czech Republic 4.56 4.71 6.32
Denmark4 9.50 10.19 15.40
Estonia 2.00 1.99 6.94
Finland 9.39 10.24 17.19
France 10.43 10.59 15.20
Georgia 2.09 2.15 4.83
Germany4 7.58 7.55 9.25
Greece4 6.60 6.84 10.14
Hungar 7.66 7.66 14.72
Ireland 9.41 9.19 11.39
Israel 7.59 8.54 14.98
Italy 6.05 6.26 8.98
Kazakhstan 1.43 1.47 3.36
Latvia 2.70 2.70 5.90
Luxembourg 9.16 9.44 16.63
Netherlands4 15.17 15.32 22.71
Norway 11.05 12.32 15.05
Portugal 7.83 7.83 8.72
Russia3 2.50 2.57 4.98
Slovakia 4.11 4.10 7.41
Slovenia4 8.70 8.66 11.91
Spain 6.79 7.12 12.78
Sweden 20.09 20.18 21.60
Turkey 2.06 2.11 11.34
UK4 17.59 18.15 22.59
Ukraine 2.77 2.90 11.13
Regional Sub-total 5.1 5.28 10.71
South East Asia Bangladesh 2.91 3.23 8.63
India3 3.16 3.30 9.63
Myanmar 2.36 2.41 3.47
Nepal 2.04 2.16 14.37
Sri Lanka 2.60 2.75 6.35
Regional Sub-total 3.24 3.39 9.71
Western Pacific Australia3 20.96 21.51 27.39
China3 0.19 1.42 1.73
Laos 2.72 3.02 5.16
Malaysia 5.21 5.51 7.55
Philippines 7.21 7.46 11.01
Vietnam 0.82 1.04 2.05
Regional Sub-total 5.85 6.17 8.88
Worldwide (95%CI) 4.27
(4.17; 4.36) 4.46
(4.36; 4.55) 8.61
(8.48; 8.74)
1 World Health Organization definition of regions.

2 All asthma prevalence estimates were calculated using post satisfaction weights unless otherwise indicated.

3 Post stratification weights were not available from these countries, so sampling weights were used in calculating the prevalence estimates.

4 Weights were not provided these countries.

5 Standard errors were missing due to a sampling unit.

Asia is the world’s largest and most densely populated continent covering 30% of the Earth’s land area and hosting 60% of the world’s current population. In recent decades, the number of Asian people has quadrupled, and thus chronic diseases have increased. One of these chronic diseases is asthma (Table 5,6). The spread of asthma in childhood continuously for decades in Asia, but in Asian adults, the epidemiological burden of asthma is largely unknown. This deficiency is in contrast to the ongoing systematic and systematic research efforts of childhood asthma epidemiology such as the International Study For asthma and childhood allergies (ISAAC) in Asian children ADDIN EN.CITE ;EndNote;;Cite;;Author;Kuo;/Author;;Year;2015;/Year;;RecNum;119;/RecNum;;DisplayText;(Kuo, Hawkins et al. 2015);/DisplayText;;record;;rec-number;119;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;119;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Kuo, James C;/author;;author;Hawkins, Carolyn A;/author;;author;Yip, Desmond;/author;;/authors;;/contributors;;titles;;title;Application of hypersensitivity skin testing in chemotherapy-induced pneumonitis;/title;;secondary-title;Asia Pacific Allergy;/secondary-title;;/titles;;periodical;;full-title;Asia Pacific Allergy;/full-title;;/periodical;;pages;234-236;/pages;;volume;5;/volume;;number;4;/number;;dates;;year;2015;/year;;/dates;;isbn;2233-8276;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Kuo, Hawkins et al. 2015).

There is no clear and adequate data on the prevalence of asthma in adults. Therefore, a study was conducted at Mashhad University of Medical Sciences of Mashhad/Iran by searching EMBASE, Medline, Web of Science and Google Scholar for articles from 1991-2014 about asthma to determine the prevalence of asthma among Asian adult groups. The current status of epidemiological research on adult asthma in Asia was extracted for study design, population, research questions, case definition, and asthma prevalence ADDIN EN.CITE ;EndNote;;Cite;;Author;Alavinezhad;/Author;;Year;2017;/Year;;RecNum;34;/RecNum;;DisplayText;(Alavinezhad and Boskabady 2017);/DisplayText;;record;;rec-number;34;/rec-number;;foreign-keys;;key app=”EN” db-id=”sr2dwavvndpwdwerve3v9friv9xe9effstf5″;34;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;Alavinezhad, Azam;/author;;author;Boskabady, Mohammad Hossein;/author;;/authors;;/contributors;;titles;;title;The prevalence of asthma and related symptoms in Middle East countries;/title;;secondary-title;The Clinical Respiratory Journal;/secondary-title;;/titles;;dates;;year;2017;/year;;/dates;;isbn;1752-699X;/isbn;;urls;;/urls;;/record;;/Cite;;/EndNote;(Alavinezhad and Boskabady 2017).

The results of the study showed that the highest prevalence of asthma in Iraq and Jordan was by taking a number of different samples from both countries to determine the prevalence of asthma.

Table7: The prevalence of asthma in population aged more than 20 years old from 1985 –2014 in Middle East countries.

Country Population Asthma prevalence
(%) Area of
residence Family history in asthma subjects (%) Smoking in asthma subjects (%) Exposure to animals Rural
(%) Urban
(%) Asthma Allergy/
Atopy Active Passive Cyprus (2000)494411.39.711.9–––––
Cyprus (2008) 2216 17.4 18.4 17.1 – – – – – Egypt 12612 1.4 0.89 0.51 53.4 – – 57.8 47.9 Egypt 1250 13 7.1 14 – 20.7 – – – Egypt 2720 7.7 8 7 76.5 76.6 – 47.8 – Egypt 1048 6.2 5.2 6.4 14.2 31 – 5.1 – Iran 2800 7 – – 27.7 51.4 – – – Iran 3924 9.5 – 9.5 37.5 27.9 – 47 72.6 Iran 100 – – – 70 – – 56 22 Iran 6236 2.6 – – – – – 30 – Iran 2217 2.7 – – 15.9 7.1 – 3.4 – Iran 4781 15.9 – – 31 47.9 – – 34.8 Iran 5534 21.7 – – 39.2 55.2 – 49.1 –
Iran 1508 2 – – – – – 4.3 5.6 Iran 611 3.8 – – 8.3 33.3 – 29.2 – Iran 1309 14.7 – – – – – 17.7 – Iraq 2262 28.47 25.2 29.2 40.2 – – 33.8 – Iraq 424 15.8 15 16.3 44.8 41.8 – 64.2 50.7 Iraq 2875 8.9 – – 53.1 62.5 – 41.8 79.8 38
Israel (1980) 737 5.7 – – 27.3 – – 27.5 – Israel (1989) 963 11.2 – – 28.4 – – 29.6 – Israel 10057 13.7 11.5 14.2 – – – – – Jordan 9108 26.1 25.5 26.8 – – – – – Pakistan 2325 15.8 – – – – – 77.8 49.5 Palestine 7325 8.4 8.3 17 – – – – – Palestine 7030 5.9 6.5 11.6 – – – – – Palestine 3382 9.4 22.9 15.6 – – – – – Qatar 3283 19.8 – – 41.1 47.2 – – – Turkey 4078 11.2 – – – 40.2/20.2 14.7 26.5 12.9 Turkey 2334 12.9 – – – 12.5 – 49.3 – Turkey 2276 13.7 – – – 45.6 – 67.7 21 Turkey 2232 9.8 – – 15.6 – – 63.2 21.7
United Arab Emirates 6543 13.3 – – 25 29 – – – Yemen (Sana) 560 12.6 10.8 14.4 – – – – –
Yemen (Shabwa) 372 20.3 21.2 19.4 – – – – – Iran 5579 2.8 – – 40.3 43.7 – 28.5 – Iraq 225a 25.8 – – 11.5 33.7 – 21.7 15.4 The differences in prevalence of illness between countries may be due to many factors, such as lifestyle, dietary habits, socioeconomic differences, and environmental or climate factors. Awareness of the disease and proper diagnosis are important factors, because that can affect the prevalence and severity of the conditions in the population ADDIN EN.CITE ;EndNote;;Cite;;Author;Organization;/Author;;Year;2007;/Year;;RecNum;11;/RecNum;;DisplayText;(Organization 2007);/DisplayText;;record;;rec-number;11;/rec-number;;foreign-keys;;key app=”EN” db-id=”f5wsprafudwtepezr2lvwf9mxta9fve209zv”;11;/key;;/foreign-keys;;ref-type name=”Journal Article”;17;/ref-type;;contributors;;authors;;author;World Health Organization;/author;;/authors;;/contributors;;titles;;title;Prevalence of asthma and allergies in children;/title;;secondary-title;WHO fact sheet;/secondary-title;;/titles;;periodical;;full-title;WHO fact sheet;/full-title;;/periodical;;number;3.1;/number;;dates;;year;2007;/year;;/dates;;urls;;/urls;;/record;;/Cite;;/EndNote;(Organization 2007).

References
ADDIN EN.REFLIST Abdulwadud, O., et al. (1999). “Evaluation of a randomised controlled trial of adult asthma education in a hospital setting.” Thorax 54(6): 493-500.

Al-Anazi, A., et al. (2014). “The Reliability of the Arabic version of the asthma knowledge questionnaire and assessment of the level of asthma awareness among parents of children with asthma in Saudi Arabia.” Middle-East Journal of Scientific Research 20(4): 412-418.

Alavinezhad, A. and M. H. Boskabady (2017). “The prevalence of asthma and related symptoms in Middle East countries.” The Clinical Respiratory Journal.

Alharbi, M., et al. (2009). “The prevalence of asthma in patients with obstructive sleep apnoea.” Prim Care Respir J 18(4): 328-330.

Anandan, C., et al. (2010). “Is the prevalence of asthma declining? Systematic review of epidemiological studies.” Allergy 65(2): 152-167.

Barnes, P. J. (1996). “Pathophysiology of asthma.” British journal of clinical pharmacology 42(1): 3-10.

Bateman, E., et al. (2008). “Global strategy for asthma management and prevention: GINA executive summary.” European Respiratory Journal 31(1): 143-178.

Bateman, E. D., et al. (2008). “Global strategy for asthma management and prevention: GINA executive summary.” European Respiratory Journal 31(1): 143-178.

Beasley, R. (1998). “Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC.” The Lancet 351(9111): 1225-1232.

Bender, B. G. and C. Rand (2004). “Medication non-adherence and asthma treatment cost.” Current opinion in allergy and clinical immunology 4(3): 191-195.

Bishwajit, G., et al. (2017). “Burden of asthma, dyspnea, and chronic cough in south asia.” International journal of chronic obstructive pulmonary disease 12: 1093.

Boulet, L.-P., et al. (2012). “Adherence: the goal to control asthma.” Clinics in chest medicine 33(3): 405-417.

Bousquet, J., et al. (2005). “The public health implications of asthma.” Bulletin of the World Health Organization 83(7): 548-554.

Burney, U., et al. (1996). “Variations in the prevalence of respiratory symptoms, selfreported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS).” European respiratory journal 9: 687-695.

Chen, H., et al. (2007). “Asthma control, severity, and quality of life: quantifying the effect of uncontrolled disease.” Journal of Allergy and Clinical Immunology 120(2): 396-402.

Committee, I. S. (1998). “Worldwide variations in the prevalence of asthma symptoms: ISAAC.” Eur. Respir. J 12: 315-335.

Demoly, P., et al. (2009). “Prevalence of asthma control among adults in France, Germany, Italy, Spain and the UK.” European Respiratory Review 18(112): 105-112.

Elbanna, R. M., et al. (2017). “Effect of bronchial asthma education program on asthma control among adults at Mansoura district.” Egyptian Journal of Chest Diseases and Tuberculosis 66(4): 561-569.

Fink, J. B. and B. K. Rubin (2005). “Problems with inhaler use: a call for improved clinician and patient education.” Respiratory care 50(10): 1360-1375.

FitzGerald, M., et al. (2015). “Pocket guide for asthma management and Prevention.” For adults and children 5.

Gibson, P. G., et al. (2002). “Self?management education and regular practitioner review for adults with asthma.” The Cochrane Library.

Health, U. D. o. and H. Services (2009). “National Heart, Lung and Blood Institute National Asthma Education and Prevention Program. Expert panel report: guidelines for the diagnosis and management of asthma: update on selected topics 2002.” Public Health Service, NIH.

Horne, R., et al. (2007). “Can asthma control be improved by understanding the patient’s perspective?” BMC Pulmonary Medicine 7(1): 8.

HPD, M. and H. Subasinghe (2016). “Knowledge attitudes and practices of asthma; Does it associate with demographic factors of adult patients?”.

Kritikos, V., et al. (2005). “The validity and reliability of two asthma knowledge questionnaires.” Journal of Asthma 42(9): 795-801.

Kuo, J. C., et al. (2015). “Application of hypersensitivity skin testing in chemotherapy-induced pneumonitis.” Asia Pacific Allergy 5(4): 234-236.

Lababidi, H., et al. (2008). “Validation of the Arabic version of the asthma control test.” Annals of thoracic medicine 3(2): 44.

Latvala, J., et al. (2005). “Trends in prevalence of asthma and allergy in Finnish young men: nationwide study, 1966-2003.” Bmj 330(7501): 1186-1187.

Lavoie, K. L., et al. (2006). “What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both?” Chest 130(4): 1039-1047.

Lomper, K., et al. (2016). “Effects of depression and anxiety on asthma-related quality of life.” Advances in Respiratory Medicine 84(4): 212-221.

Lougheed, M. D., et al. (2012). “Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults.” Canadian respiratory journal 19(2): 127-164.

Lundbäck, B., et al. (2016). “Is asthma prevalence still increasing?” Expert review of respiratory medicine 10(1): 39-51.

Mannino, D. M., et al. (2002). “Surveillance for asthma—United States, 1980–1999.” MMWR Surveill Summ 51(1): 1-13.

Masoli, M., et al. (2004). “The global burden of asthma: executive summary of the GINA Dissemination Committee report.” Allergy 59(5): 469-478.

Meneghini, A. C., et al. (2017). “Accuracy of spirometry for detection of asthma: a cross-sectional study.” Sao Paulo Medical Journal 135(5): 428-433.

Mohamed, O. M. I. and W. K. Karameh (2015). “Knowledge, attitude and behaviour of asthmatic patients regarding asthma in primary care setting in Abu Dhabi, United Arab Emirates.” World Family Medicine Journal: Incorporating the Middle East Journal of Family Medicine 13(5): 4-11.

Mow, V., et al. (2005). Structure and function of articular cartilage and meniscus.(chapter 5) Basic Orthopaedic Biomechanics and Mechanobiology, Mow VC and Huiskes R, eds, Philadelphia: Lippincott, Williams and Wilkins.

Naik?Panvelkar, P., et al. (2015). “A pharmacy asthma service achieves a change in patient responses from increased awareness to taking responsibility for their asthma.” International Journal of Pharmacy Practice 23(3): 182-191.

Organization, W. H. (2007). “Prevalence of asthma and allergies in children.” WHO fact sheet(3.1).

Orozco-Beltrán, D., et al. (2016). “Management and referral of patients with severe and poorly controlled asthma in primary care.” Family Practice 33(6): 678-683.

Ozair, M. M., et al. (2017). “Development and validation of the Knowledge and Clinical Reasoning of Acute Asthma Management in Emergency Department (K-CRAMED).” Education in Medicine Journal 9(2).

Ozturk, A., et al. (2015). “Association between asthma self-management knowledge and asthma control in the elderly.” Annals of Allergy, Asthma ; Immunology 114(6): 480-484.

Peters, S. P., et al. (2006). “Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment.” Respiratory medicine 100(7): 1139-1151.

Price, D., et al. (2014). “Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey.” NPJ primary care respiratory medicine 24: 14009.

Rabe, K. F., et al. (2007). “Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.” American journal of respiratory and critical care medicine 176(6): 532-555.

Saini, B., et al. (2006). “Development and evaluation of an educational intervention to facilitate community pharmacists to provide specialised asthma care.” International Journal of Pharmacy Practice 14: A39.

Scherer, Y. K. and S. Bruce (2001). “Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma.” Heart ; Lung: The Journal of Acute and Critical Care 30(4): 250-257.

Senna, G., et al. (2017). “The role of the pharmacy in the management of bronchial asthma: A literature-based evaluation.” Annals of Allergy, Asthma ; Immunology 118(2): 161-165.

Shamkuwar, C. A., et al. (2016). “Evaluation of Knowledge, Attitude and Medication Adherence among Asthmatics Outpatients in Tertiary Care Teaching Hospital-A Questionnaire Based Study.” Journal of Young Pharmacists 8(1): 39.

Sullivan, P. W., et al. (2017). “Measuring the cost of poor asthma control and exacerbations.” Journal of Asthma 54(1): 24-31.

Sundbom, F., et al. (2016). “Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics.” Journal of Asthma 53(4): 398-403.

To, T., et al. (2012). “Global asthma prevalence in adults: findings from the cross-sectional world health survey.” BMC public health 12(1): 204.

Upton, M. N., et al. (2000). “Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring.” Bmj 321(7253): 88-92.

Zahran, H. S., et al. (2015). “Assessing asthma control and associated risk factors among persons with current asthma–findings from the child and adult Asthma Call-back Survey.” Journal of Asthma 52(3): 318-326.