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Study evaluates extent of asthma in Sub-Saharan African adolescents; highlights need for diagnosis, treatment and management; and Asthma control in children overestimated by parents, physicians and assessment tools. Inhalation February 2025 35 BACK PAGE Study evaluates extent of asthma in Sub-Saharan African adolescents; highlights need for diagnosis, treatment and management "Rapid urbanization and popu- lation growth are contributing to increased incidence of asthma in Sub-Saharan Africa. e disease is now the second most common cause of chronic respiratory deaths in the overall population," accord- ing to a study published in e Lancet Child & Adolescent Health. However, "a large proportion of adolescents with symptoms of severe asthma are not receiving formal diagnoses and appropriate subsequent therapy." To assess asthma prevalence and severity among adolescents, a team led by researchers from Queen Mary University of Lon- don conducted the ACACIA (Achieving Control of Asthma in Children in Africa) Study, a two-part, multi-country, school- based, cross- sectional study, ini- tially enrolling more than 27,000 students. e authors indicated the study is the first of its kind to accurately assess asthma prev- alence and severity in undiag- nosed adolescents in Sub-Saharan Africa." e study was reported by Pharmacy Times and Eureka Alert. Study part 1 findings: Asthma undiagnosed Study participants were recruited from 149 schools in urban areas of 6 Sub-Saharan countries including Ghana, Malawi, Nigeria, South Africa, Uganda and Zimbabwe between November 1, 2018 and November 1, 2021. To screen participants for asthma symptoms, investigators admin- istered the International Study of Asthma and Allergies in Children (ISAAC) Questionnaire from Jan- uary 20, 2019 to November 11, 2021. Data were obtained from 27,272 participants. Among them, 54.7% (n = 14,918) were female, the mean age was 13 years (with an interquartile (IQR) range of 12-13 years) and 98.3% were of Black African ethnicity (n = 26,821). In part 1 of the study, 3,236 (11.9%) adolescents reported having wheeze in the past 12 months and 644 of those adoles- cents (19.9%) had a formal clini- cal diagnosis of asthma. Based on ISAAC criteria, 66.3% (n = 2,146) of the 3,236 adolescents reported severe asthma symptoms and 77.9% of the 2,146 (n = 1,672) had no diagnosis of asthma by a health care professional. Prevalence of adolescents with asthma symptoms ranged from 4.2% in Blantyre, Malawi to 23.8% in Durban, South Africa. Study part 2 findings: Asthma untreated In the second part of the study, adolescents who were symptom- atic in the first part of the study were invited to complete a detailed survey about their asthma severity, treatment and exposure to envi- ronmental risk factors. Between July 16, 2019, and November 26, 2021, the second questionnaire was administered to 1,654 adoles- cents who enrolled. Among those, 57.9% of participants (n = 959) were female and the mean age was 13 years (IQR 12-14). In addition, one or more diagnos- tic tests for asthma were adminis- tered to 93.5% (n = 1,546) of the participants. Positive results were classified as: • Forced expiratory volume in 1 second (FEV 1 ) predicted under 80% • FEV 1 under lower "normal" limits or • FEV 1 divided by forced vital capacity under the lower limits of normal, among other factors. One or more positive results were found for 48.8% (n = 374) of 766 undiagnosed adolescents who had severe symptoms and for 42.4% (n = 176) of 415 of undiagnosed