Asthma management and adherence to GINA guidelines in Maghreb countries and Madagascar

Introduction. - During asthma, the knowledge and adherence to guidelines is an essential step in improving patient management. However, several studies have shown that there is a considerable gap between these recommendations and current practice. Aim. - To determine the level of knowledge and adequacy of the Global Initiative for Asthma (GINA) guidelines in patients followed for asthma in the Maghreb countries and Madagascar. Methods. - A multicentric cross-sectional study conducted from 151 September to 30 November 2018 in the Maghreb countries (Tunisia, Algeria and Morocco) and Madagascar. Patients over 15 years old diagnosed with asthma for at least 12 months were included. Data of included patients and participating physicians were collected. Results. - During the inclusion period, 26 physicians participated in the study and 485 patients (211 men, 274 women, mean age : 42.08 +/- 16.4 years) were included. According to the participating physicians, the asthma treatment was not considered consistent with GINA guidelines in 1 patient out of 4, mainly due to unavailability of treatments. The latter scenario was particularly frequent among Tunisian patients and those followed in the public hospital sector (p < 10(-3)). In addition, only 49.4% of physicians had ranked their patients at the correct therapeutic level according to the GINA guidelines. This finding was more frequently observed among non-pneumologist doctors practicing in the private sector (p < 10(-3)). Conclusion. - Our results underscore the need for greater efforts in the Maghreb countries and Madagascar to improve treatment availability and to provide continuing medical education and training in order to improve adherence to guidelines and quality of care for asthmatic patients. (C) 2019 Published by Elsevier Masson SAS.