A randomised controlled trial of an enhanced asthma care package vs standard outpatient care on asthma control in Malawian children. - Trial PACTR201807211617031

Timeline & Enrollment

Summary

- The type of research studyThis is a pilot randomised controlled trial of standard vs enhanced asthma care, involving children attending outpatient follow-up at Queen Elizabeth Central Hospital (QECH), Blantyre.- BackgroundAsthma is the most common chronic medical condition in childhood and is an emerging problem in Africa. Chronic inflammation of the airways leads to typical symptoms of wheeze, cough and breathlessness which cause considerable morbidity if untreated. Malawi Standard Treatment Guidelines (2015) for asthma include inhaled short acting β2-agonist (SABA) and corticosteroid (ICS), although reliable supply and affordability is an issue. In an overburdened and understaffed clinical setting, key aspects of treatment; medication adjustment in response to disease control, and education of patients and their families, are often overlooked. Treatment guidelines, extrapolated from high-income settings, may not be appropriate in low-income countries (LIC) where different environmental exposures may drive the inflammatory process. Asthma is a heterogenous condition, with different airway inflammatory patterns (phenotypes), requiring alternative treatment approaches. However, the nature of airway inflammation in asthmatic children from LIC has not been described, and it is unclear whether good control of asthma symptoms can be achieved in children in Malawi, using inhaled corticosteroids. - The objectivesThis study will address the following questions;Can asthma control be improved through an enhanced care package, as compared to standard care in the paediatric clinic at QECH?What factors explain poor asthma control in included children? To what extent are indicators of eosinophilic airway inflammation associated with asthma control at baseline, and response to treatment?

ICD-10 Classifications