Introduction Asthma is a chronic inflammatory disease that usually begins at early stages of life. The recurrent attacks of breathlessness and wheezing are characteristics of asthma and the severity of the signs varies from one person to another. The long term inflammation of the airway passages causes Asthma and that long term inflammation is caused by hypersensitivity of the nerve endings in the airways which can cause goblet cell hyperplasia, epithelial fragility, enlarged submucosal mucus glands, wall thickening and an increase airway smooth muscle mass (1) . During an attack, the airway passages lining become swollen which causes an obstruction in the airways and reversible narrowing, that is an evidence of chest tightness, wheezing, shortness of breath and coughing (2). Asthma is an episodic disease, with acute exacerbations interspersed with symptom-free periods. Typically, most attacks are short-lived, lasting from minutes to hours, and clinically the patient seems to recover completely after an attack. However, there can be a phase in which the patients experience some degree of daily airway obstruction. This phase can be mild, with or without superimposed severe episodes, or can be much more serious, with severe obstruction persisting for days or weeks; the latter condition is known as “acute severe asthma”. In unusual circumstances, acute episodes can cause death .(3) Asthma exacerbations are characteristically worse at night and can progress to severe airflow obstruction, shortness of breath, and respiratory distress and insufficiency. Rarely, severe sequel such as hypoxic seizures, respiratory failure, and death can occur . (4) From that perspective, it becomes important to evaluate quality of life in patients with chronic diseases such as asthma, because they can impair quality of life in its various biopsychosocial domains and can affect the daily lives of the affected population.(5,6) In addition, children and adolescents deserve special attention, because asthma affects not only the individuals with the disease, but also their caregivers, thereby altering the family routine and the quality of life of all involved.(7-9) The acceptance of individual bodies to the medications used for asthma treatment is good, however, sometimes the body resists and the patient might show some inconsistent results. During exercises and seasonal changes, the symptoms of asthma are more prevalent (10). There are many factors that affect asthma control such as psychosocial factors, severity of asthma, sociodemographic characteristics, exposure to infectious agents (ie. Viruses), adherence to treatment and indoor and outdoor allergens or pollutants (11-15). Asthma may be classified to atopic , nonatopic , or a combination . Atopic asthma begins in childhood and is linked to triggers that initiate wheezing. It may arise after exposure and response to a specific allergen, such as dust mites, grass or tree pollen, pet dander, smoke, or certain drugs or foods. On exposure to a trigger, excessive release of IgE occurs, which initiates B-lymphocyte activation. Nonatopic asthma doesn’t in-volve an IgE response. It may have fewer obvious triggers and usually occurs in adults, possibly secondary to a viral infection.(16) The findings during the physical examination of an asthmatic patient are: Paradoxical thoracoabdominal movement occurs • Wheezing may be absent • Severe hypoxemia may manifest as bradycardia • Pulsus paradoxus may disappear: This finding suggests respiratory muscle fatigue (17) Asthma diagnostic either by clinical presentation (wheezing , cough , shortness of breath ,and chest pain ) , family history of some allergies or asthma . and there are various test to diagnose the asthma like: Pulmonary function test, and Peak expiratory flow measurement . With asthma patient , the ratio of forced expiratory volume in 1 second to forced vital capacity typically declined . (16) The burden of asthma varies hugely around the globe. Data from phase three of the International Study of Asthma and Allergies in Childhood (ISAAC) showed the prevalence of asthma (measured as symptom prevalence of wheeze in the past 12 months) to vary from 3.5% (Indonesia) to 34.8% (Costa Rica) in 6- to 7-year-olds, and from 3% (Albania) to 32.3% (Isle of Man) in 13- to 14-yearolds (18). The Prevalence of asthma in the Middle Eastern children aged 13-14 years was 7.57% (95% Cl: 6.38- 8.75). The minimum prevalence rate of asthma (0.7%) was observed in Isfahan in Iran (19), and the highest 22.3% was reported from Bagdad in Iraq .(20) In Saudi Arabia, there are more than 2 million complaining of asthma attacks even before they are diagnosed of having asthma. This makes asthma to be considered as one of the common chronic diseases. The percentage of Saudi children that are diagnosed with asthma is about 8-14% and there are about 19.6% of the adolescent age (16-18 years old) that are diagnosed with asthma .(23) The prognosis of asthma for individuals who have asthma during childhood have significantly lower forced expiratory volume in 1 second (FEV1), higher airway reactivity, and more persistent bronchospastic symptoms than those with infection-associated wheezing.(24) The reason behind hospital admission and ER presentation is the poor asthma control (25). Even though that asthma is an alarming public health problem in the Kingdom, there are few studies that have been exploring this issue. Anyway, there are some studies that suggest that the patient should be well educated and instructed on asthma attacks and how to react when he/she faces mild attacks at home. This will significantly decrease the asthma symptoms (26). Based on the clinical data, the high number of deaths and morbidity of asthmatic patients is related to some factors: • Poor diagnosis: failure on analyzing the triggers of asthma and failure to adopt the measures to avoid exposure to the triggers of the disease. • Understanding the chronic nature of the disease by the patient and failure to follow up with the treatment. • Patients don’t follow the treatment because of their unawareness of the risks and benefits associated with the therapy. • Ignoring the severity of asthma by the patients because they cannot assess it. (27) Poor asthma control places a heavy burden on patients and their families, as it manifests in increased rates of hospitalizations and emergency room and other urgent care visits, in addition to activity limitations, night-time awakenings, and lost time from work and school.(28) Asthma diagnosis and therapy have developed significantly compared to the past, however, a large number of Saudis with asthma are yet poorly controlled. Appropriate pharmacological treatment and avoidance measures can control asthma in most patients. (29). Recently, several investigators developed patient-based tools that quantify clinical asthma control, such as Asthma Control Test TM (ACT), Asthma Control Questionnaire (ACQ), and Asthma Therapy Assessment Questionnaire (ATAQ) (30-32). Asthma Control Scoring System (ACSS) (33) is a tool for quantifying the asthma control that assesses clinical, physiological, and inflammatory parameters and provides a total percentage score as an average of the three component scores. Furthermore, many studies indicate that the level of asthma control is often overestimated by both patients and physicians suggesting that asthma treatment guidelines alone are not enough to ensure the proper assessment of asthma control (34, 35). There are limited numbers of studies available regarding the association between adherence with treatment and control of asthma. This study will be conducted in Eastern Region, where no such type of data available to highlight this main area for increasing number of uncontrolled asthmatic patients. Hence, this study will provide data which will be helpful in making policies for controlling asthma in Dammam, Eastern Region.
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