Original Article

Associated Factors and Disability Burden among

Adolescent and Adult Nigerians with Bronchial Asthma
Ogunkoya John Omotola1*, Imishue Onome Tobore2, Sodeinde John Kolawole3, Oluwole Afolasade Olasimbo4,
Ladele Akindele Emmanuel5, Okwudishu Oluyemisi Temitope6, Bamidele Emmanuel Fikayo 3, Osinake Abiodun
Olufemi3

Abstract
Background: Bronchial asthma is a global health issue affecting the socio-economic, financial, psycho-social, and
emotional well-being of individual patients. It is a major non-communicable disease that affects children,
adolescents, and adults. Bronchial asthma has been linked with a high burden of physical limitation and functional
disability.
Aim/objective: This study was conducted to determine the prevalence of disability and its predictors in
adolescents and adult patients treated for bronchial asthma.
Method: This is a facility-based cross-sectional study involving 106 randomly selected patients, and randomly
selected asthmatic patients attending the General Out-Patient Department and Respiratory Clinics were recruited
for this study. A structured questionnaire was used to collect the socio-demographic characteristics and the level of
disability, which was assessed with WHODAS 2.0 short-form having a five-point ordinal scale, ranging from 1 to
5. Data was analyzed with SPSS version 16. Frequency, mean, and standard deviation were used to summarize the
data. Associations between variables were assessed by using the chi-squared (χ2) test and Student’s t-test.
Associations between the independent effects of variables were assessed by using Poisson regression analysis. The
level of statistical significance was set at a p-value of 0.05.
Results: This study included 32 (30.2%) males and 74 (69.8%) female participants with a mean age of 35.82±0.56
years. More than half of both male (n=19, 59.3%) and female (n=49, 66.2%) participants reported no disability,
while only 1 male and 5 females reported severe disability. The differences were not statistically significant
(p>0.05). The mean disability in this study was 2.1, suggesting low disability based on the International
Classification of Functioning, Disability, and Health severity range. However, age (CI=0.998-1.003), BMI
(CI=0,994-1.013), and duration of disability (CI=1.001-1.002) were the significant predictors of disability.
Conclusion: This study showed that individuals with asthma have a low burden of disability. Age, BMI, and
duration of disability were the most important predictors of disability burden. The finding of a low asthma
prevalence of disability in asthma emphasizes the need to incorporate disability assessment into asthma
management. [Ethiop. J. Health Dev. 2024; 38(2): 00-00]
Keywords: Bronchial asthma, burden, disability, predictors, quality of life.

Introduction and this likely ranks among the highest in sub-Saharan

Bronchial asthma has become a global health issue Africa (3). In addition to this, demographic,
affecting the socio-economic, financial, psycho-social, epidemiological, and environmental changes in Nigeria
and emotional well-being of individual patients(1). in the past 20-40 years have resulted in an increased
Asthma is a major non-communicable disease affecting burden of asthma, leading to rising morbidity and
both children and adults, and it is the commonest mortality of bronchial asthma in recent decades across
chronic disease among children (1). It is often all ages and races (4). This increased burden is noted in
underdiagnosed and under-treated, particularly in low- varying proportions and rates across diverse
and middle-income countries (1). It is increasing in geographical areas in the world (5). Most asthma
prevalence, affecting an estimated 300 million people deaths are largely preventable and occur in individuals
worldwide in 2021 and leading to 455, 000 deaths who are 45 years and older. These deaths are
(2). It affects 1-18% of the population in different associated with delayed access to emergency care,
countries of the world. In North America, asthma is especially during exacerbations ,insufficient long-term
present in 10% of the population (2). In a recent care, and scarcity of medications (6).
review, the prevalence of physician-diagnosed asthma, Asthma is defined as a heterogeneous disease
clinical asthma, and wheezing in Nigeria was 2.5%, characterized by chronic airway inflammation, and it
6.4%, and 9.0% respectively (3). presents with a history of respiratory symptoms such as
chest tightness, shortness of breath, ,wheezing, and
The number of individuals diagnosed clinically as coughing, all of which vary over time and in intensity
asthma patients in Nigeria is approximately 13 million, (7). Asthma is diagnosed based on characteristic
1
Division of Respiratory Medicine and Allergy, Department of Medicine, Babcock University Teaching Hospital, Ilishan
Remo, Ogun State, Nigeria.
2
Psychiatry Unit, Department of Medicine, Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria.
3
Department of Community Medicine, Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria.
4
Division of Cardiology, Department of Medicine, Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria.
5
Family Medicine Department, Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria.
6
Division of Endocrinology and Metabolism, Department of Medicine, Babcock University Teaching Hospital, Ilishan Remo,
Ogun State, Nigeria.
*Corresponding author email- omotee4real@yahoo.com
2 Ethiop. J. Health Dev.
symptom patterns and evidence of airflow limitation Moreover, in 2019, the global age-standardized
best demonstrated by bronchodilator reversibility disability-adjusted life-years (DALY) rate was 273.6,
testing (7,8). The mainstay of asthma treatment is the with asthma patients being more likely to develop
use of inhaled controller medications, which contain disability than those without asthma(4). Factors that are
anti-inflammatory agents, usually inhaled associated with an increasing burden of disability
corticosteroids, to reduce exercitations and reliever among people with asthma include increased Body
medications (short-acting bronchodilators) to relieve Mass Index (BMI), Low socio-economic index,
acute symptoms and effect bronchodilation during occupational ashmagens, and smoking (4,6). In Nigeria
exacerbations (8). and Africa in general, there is a paucity of studies on
the global disability burden in individuals on treatment
Some studies have linked asthma to a high burden of for asthma (7). There is, therefore need for such a study
physical limitations and functional disability, with that will help not only in estimating the burden of
people with frequent acute asthma attacks being at disability but will also highlight the magnitude and
higher risk of disability (4,6). Others have linked the severity of the problem and help to develop consensual
burden of the disease with low Disease Adjusted Life efforts to reduce the societal burden of disability and
Year (DALY) and high economic burden on patients, improve the health outcomes for individuals being
particularly in developing countries where the managed for asthma. The study aimed to determine the
healthcare system is poorly organized and funded. The prevalence of disability and its predictors among
direct health-care costs of managing bronchial asthma adolescents and adults being managed for asthma.
are substantial and vary from country to country
depending on the burn of the disease, type of health
system, demographic status and the level of Methods
organization of the health system of each country. Study design and setting
Several studies have been published evaluating the This was a cross-sectional study of asthma patients
economic burden of asthma on society and individuals, attending the out-patient department c of a private
as well as evaluating the Disease Adjusted Life Year university teaching hospital in southwest Nigeria.
(DALY) and the Quality of Life (QoL) of adult patients The teaching hospital is a 150-bed hospital that serve
with bronchial asthma (9). A 2018 study showed that the people of Ogun State, with referrals from other
among patients with treated asthma in the USA, the southwestern states of Lagos, Oyo, Osun, and Ekiti. It
cost of medications was enormous and constitutes the provides health services to about 2-3 million Nigerians
largest portion of the total cost of treatment (10). For living in Ogun State and its environs (14). This study
the year 2013, with an asthma prevalence of 4.9%, the was conducted between February 1 and August 31,
estimated total medical cost of asthma in the United 2022.
States was 57.9 USD billion. In Europe, the direct costs
vary from less than 500 USD per individual per year in Study population: One hundred and six randomly
Russia to over 2,000 USD in the United Kingdom (10). selected adolescents and adults diagnosed with asthma
A Nigeria study revealed that the burden of asthma who were 15 years and older attending the General
among Nigerian adults is very high despite advanced Out-patient Clinic (GOC) and Respiratory Clinics were
knowledge of the pathophysiology of asthma and included in this study.
improved treatment modalities. The study showed
significant impairment in daily activities which Sampling technique/subject selection: From a sample
included sports (84%), Job/career (60%), Physical frame of approximately 400 diagnosed asthmatic
activity (55%), Social activity (54%), Household patients, a simple random technique was used to select
chores (61%), Disturbed sleep (53%), Daytime study participants who fulfilled the inclusion criteria.
symptoms (51%), and Hospitalization (50%). (11) Hence, a total of 106 patients attending the GOC and
Another study done among children and adolescents in the Respiratory clinic were considered for this study.
Nigeria revealed that childhood asthma was
responsible for 23.6-34.24 YLLs per 1000 population, Inclusion criteria
0.01-1.28 YLDs per 1000 population, and 24.23-34.41 The patient must be above the age of 15 years and
DALY per 1000 population. Minimal difference in attending the General Out-patient Clinic (GOC) and
DALYs was observed across clinical categories and Respiratory Clinic of the hospital.
was consistently higher among older children The diagnosis of asthma must be confirmed by
(adolescents) aged 12-17 years. (12). spirometry.

Quality of Life (QoL) is a tool being employed to Exclusion criteria

quantify the effect of the disease on the patients’ daily Patients who were too ill and unable to respond to the
life and well-being in a standardized manner. This questions.
concept, also referred to as health-related quality of Patients with significant comorbidity such as heart
life, is actually a representation of patients’ judgment failure, myocardial infarction, chronic kidney diseases,
of the effect of their disease status and its treatment on malignancies, etc.
their lifestyle. A nationwide study done in Portugal
showed a marked effect of asthma on patients, with Data collection and disability assessment tool
women reporting poorer QoL than men in all the A structured questionnaire was used to collect
questionnaire’s subscales, and surprisingly, smokers information on socio-demographic parameters with
presented better QoL than non-smokers. (13) self-reported asthma duration (in years) obtained from

Ethiop. J. Health Dev. 2024; 38(2)

 Bronchial asthma, burden, disability, predictors, quality of life 3
the participants. The dependent variable was the disability. The level of statistical significance was set at
disability scores and classes, while the independent a p-value of <0.05.
variables were the age and gender of the patient, the
BMI, occupational status, and duration of disability. Ethical declaration
The World Health Organization Disability Assessment The study was approved by the Babcock University
Schedule (WHODAS 2.0) short form with a five-point Health Research Ethics Committee and Health,
ordinal scale ranging from 1 (none) to 5 (extreme or Planning, Research and Statistics Review Board of the
cannot do it) was used to assess the level of disability Ogun State Ministry of Health in Abeokuta, Ogun
in this study. This standard Disability Assessment tool State, Nigeria (approval number HPRS/381/322). This
Schedule 2.0 provides a common metric for the impact study was conducted in accordance with the principles
of any health condition in terms of functioning. It is of the Declaration of Helsinki. Written informed
useful in the assessment of both physical and mental consent was obtained from each participant.
disability burdens of all health conditions irrespective Results
of etiology [9]. Due to the fact that it was an item- Socio-demographic characteristics of study
based analysis, each item was dichotomized as no participants: A total of 0ne hundred six participants
disability (1 = none) and the presence of disability: 2–5 attending the GOC and Respiratory Clinic of Babcock
(mild to extreme). The items were re-coded from 0 University Teaching Hospital (BUTH), Ilishan- Remo,
(none) to 4 (extreme or cannot do it) for both simple Ogun State, Nigeria, were involved in this study, which
sum and item-response theory (IRT) summary score included 32 (30.2%) males, and 74 (69.8%) females.
analysis. A summary score (outcome) of 45 was the The mean age of participants was 35.82±0.56 years.
cut-off point for overall disability. Simple sum norm The majority of participants (n=69, 65.1%) had been
values of 0, 1–4, 5–9, and 10–48 were used to classify diagnosed with asthma for less than 10 years. Only 19
survivors into no disability, mild, moderate, and severe participants (17.9%) were obese, majority of study
disabilities, respectively. participants were overweight (n=42, 39.6%). (Table 3)

Statistical analysis The burden of disability among study participants:

All data collected were analyzed using Statistical Table 1 shows the prevalence of disability by each item
Package for Social Sciences (SPSS) version 16 [SPSS, of the WHODAS scale. The prevalence of disability
Chicago, IL]. Continuous and categorical variables was high in 8 items among male participants and all 12
were presented as frequency, mean, and standard items among female participants but low or moderate
deviation. Significant statistical differences were in 4 items among male participants, ranging between
assessed with the chi-squared (χ2) test for categorical 02 and 07. However, when the summary cut-off (45)
variables and the Student’s t-test or F-test for was used, only 7 male (21.9%) and 21 female (28.4%)
continuous variables. Associations between variables participants with asthma reported significant disability.
or predictive factors for disability were analyzed with There was no significant statistical difference in the
Poisson regression analysis or predictive factors of prevalence of disability between male and female
participants. (p=0.065). (Table 1)

Table 1 shows the gender differences in the prevalence of disability by items.

Items Male Female p-values
N (%) N (%)
1 How much difficulty did you have in standing for long periods, such as 3(9.3) 11(14.9) 0.047
30 min?
2 How much difficulty did you have in taking care of your household 11(34.4) 38(51.4) 0.042
responsibilities?
3 How much difficulty did you have in learning a new task, for example, 1(3.1) 3(4.1) 0.271
learning how to get to a new place?
4 How much of a problem did you have joining in community activities? 9(2.8) 21(28.4) 0.112
5 How much have you been emotionally affected by your health 06(18.8) 37(50.0) 0.034
problems?
6 How much difficulty did you have in concentrating on doing something 07(21.9) 23(31.8) 0.294
for 10 min?
7 How much difficulty did you have in walking a long distance, such as a 13(40.1) 49(66.2) 0.534
kilometer [or equivalent]?
8 How much difficulty did you have in washing your whole body? 02(6.3) 13(17.6) 0.057
9 How much difficulty did you have in getting dressed? 02(6.3) 16(21.6) 0.072
10 How much difficulty did you have in dealing with people you do not 03(9.4) 21(28.4) 0.077
know?
11 How much difficulty did you have in maintaining a friendship? 7(21.9) 25(33.8) 0.055
12 How much difficulty did you have in your day-to-day work? 11(34.4) 31(41.9) 0.102
The summary score for all items 07(21.9) 21(28.4) 0.065

Table 2 shows the severity of disability among patients at BUTH. More than half of both male [n=19, 59.3%]
with asthma attending the GOC and Respiratory Clinic and female (n=49, 66.2%) participants reported no

Ethiop. J. Health Dev. 2024; 38(2)

4 Ethiop. J. Health Dev.
disability, while only 1 male and 5 females reported were not statistically significant [p>0.05].
severe disability. Adjusted for gender, the differences

Table 2 shows the severity of disability by gender among study participants

Severity of disability Male Female p-values
N (%) N (%)
No disability 19(59.3) 49(66.2) 0.125
Mild disability 7(21.9) 9(12.2) 0.067
Moderate disability 5(15.6) 11(14.9) 0.455
Severe Disability 1(3.2) 5(6.7) 0.321
Total 32(100) 74(100)

Factors affecting the burden of disability among Furthermore, there was no gender difference in the
study participants pattern of disability among the study participants
Table 3 shows the pattern of disability by socio- (Table 3). Table 4 shows the severity of disability in
demographic and clinical characteristics. Majority of the patients with asthma. Poisson regression analysis
study participants were overweight (n=42, 39.6%), showed socio-demographic variables of age
while only 19(17.9%) participants were obese, with no (IRR=0.998-1.003), weight (IRR=0.994-1.013), and
significant statistical difference (p=0.67). The disability duration of disability (IRR=1.001-1.002) among
in this study was 2.1, suggesting low disability based asthmatic participants as significant predictors of
on the International Classification of Functioning, disability. This study showed that one one-year
Disability, and Health severity range. This was noticed increase in age and duration of disability and a unit
to have decreased with decreased duration of disability, increase in body weight were associated with 0.1%,
though not statistically significant [p=0.68]. 0.1%, and 0.3% increase in disability, respectively.

Table 3 Pattern of disability by socio-demographic and clinical factors

Variables N (%) WHODAS Summary score (IRT)
Both Male Female
Mean± SD Mean± SD Mean± SD p-value
Age (years)
15-24 37(34.9) 3.7±19.1 5.7±21.1 2.4±16.6 0.69
25-34 21(19.8) 3.3±19.1 1.4±19.0 5.6±19.3 0.77
35-44 19(17.9) 1.0±18.7 2.0±18.9 0.9±18.7 0.56
45-54 8(7.5) 2.1±18.6 1.7±19.1 3.3±16.8 0.35
55-64 10(9.4) 2.9±18.7 4.3±10.8 1.1±20.3 0.56
≥65 11(10.5) 1.8±20.1 0.8±19.6 2.4±18.4 0.66
P=0.74*
Gender
Male 32(30.2) 2.6±16.7 1.9±17.9 3.0±20.2 0.54
Female 74(69.8) 2.7±19.3 1.4±18.5 3.3±20.5 0.98
P=0.86*
BMI (kg/m2)
Underweight 6(5.7) 3.5±23.6 5.8±23.1 2.9±20.0 0.62
Normal weight 39(36.8) 2.7±18.4 2.3±16.7 3.8±19.4 0.54
Overweight 42(39.6) 8.5±29.5 8.7±29.4 9.2±41.2 0.98
Obese 19(17.9) 8.0±18.4 7.2±07.2 8.6±29.1 0.49
P=067*
Religion
Christianity 77(72.7) 3.8±18.3 3.6±23.1 4.2±19.4 0.89
Islam 25(23.5) 2.2±12.6 2.3±21.7 1.9±21.1 0.35
Others 4(3.8) 1.6 ±16.7 1.4±16.4 1.7±16.5 0.75
P=0.84*
Occupation
Artisan 19(17.9) 5.9±18.7 5.0±19.3 7.8±23.1 0.54
Trading 27(25.5) 2.1±19.1 2.3±16.7 2.0±18.9 0.52
Professional 34(32.1) 2.7±29.4 3.0±18.7 2.2±41.2 0.22
Students 24(22.6) 2.4±19.0 2.0±18.4 2.3±21.2 0.96
Unemployed 2(1.9) 2.8±20.9 2.0±18.8 4.1±23.6 0.62
P=0.57*
Duration of disability
≤ 10 years 69(65.1) 2.2±19.0 2.6±23.4 1.6±18.8 0.62
>10 years 37(34.9) 3.3±19.4 2.9±20.0 3.6±16.1 0.74
P=0.68*

Ethiop. J. Health Dev. 2024; 38(2)

 Bronchial asthma, burden, disability, predictors, quality of life 5
Total 106 2.1±17.3 2.7±29.5 1.4±16.7 0.78
*p-values (f-test), p-values (t-test)

Table 4 shows the Poisson Regression Analysis of Disability and Predicting Factors
Variables B SEB IRR 95%CI(IRR) p-value
Intercept 2.565 0.311 15.040 7.093-21.889 0.0001
Gender
Male (Reference)
Female -0.037 0.045 0.962 0.905-1.060 0.54
Age 0.001 0.001 1.001 0.998-1.003 0.0001
BMI 0.003 0.006 1.003 0.994-1.013 0.0001
Occupation 0.003 0.004 1.003 0.996-1.010 0.43
Duration of disability 0.001 0.001 1.001 1.001-1.002 0.0001

Discussion reduce global disability in the management of asthma

The findings from this study showed that patients with from the time of diagnosis and/ or at the onset of
asthma in Nigeria have a mild to moderate burden of treatment (19, 20). This is imperative, especially in
global disability. This was shown to affect, to a great developing countries where disability from asthma is
extent, the domains of mobility and life activity. This is higher compared to the developed world or is on the
similar to findings in previous studies with different increase partly due to poor economic status, non-
measures of disability (15, 16). However, unlike this availability, and/or scarcity of controller medications
study, which shows a low prevalence of disability in (19).
young patients (15-24 years), some of these studies
also reported a higher prevalence of disability among Our study showed low disability in people with asthma
asthma patients, especially in the elderly and those based on ICF severity. Other studies that used generic
aged 5-15 years (17,18). This shows that the younger measures of disability, the WHODAS 2.0, particularly
the study subject, the lower the disability. in black Africans, are not available for comparison.
However, the low disability score of 2.1 in our study is
The low prevalence of disability in this study may be much lower than the moderate to severe disability
attributed to the fact that the majority of study subjects scores of 44 and 22 reported in stroke survivors (21)
are young, are students and likely from economically and type- 2 diabetes mellitus (T2DM0 (22) respectively
well families. This study also showed that only 7 males in Nigeria, using the same assessment tool. This
and 21 females (1:3) had asthma disability, which was strongly suggests that asthma is associated with less
not statistically significant. The failure to establish disability burden compared to T2DM patients and
differences in disability prevalence between males and stroke survivors. Similar to this study, disability in
females in this study may be attributed to the small T2DM and stroke patients increases with an increase in
sample size used for this study, and the result may not aged (21,22), but unlike in this study, disability was
be fully comparable to findings in other large significantly higher among females with T2DM
population studies. compared to their males counterparts (22). This may
suggest that asthma patients are more compliant with
The Global Initiative for Asthma (GINA) defines medications compared to stroke survivors or T2DM
asthma as a heterogeneous disease, usually patients or that the anti-inflammatory agents used in
characterized by chronic airway inflammation. It is the management of asthma promote treatment control
defined by the history of respiratory symptoms such as and minimize adverse clinical outcomes (20).
wheezing, shortness of breath, chest tightness, and
cough that vary over time and intensity, together with Our findings also showed that there is no gender
expiratory airflow limitation (7). It is generally and difference in disease burden among asthma patients,
scientifically accepted that asthma is a chronic implying that disability attributed to asthma cannot be
inflammatory disease of the airways which, if left predicted by the gender of individual patients. This is
untreated, especially with the use of inhalational similar to the findings of a study done in Jinan, China
steroid-based controller medication, may lead to (23). The findings from our study showed that age,
uncontrolled inflammation which causes irreversible body weight, and duration of disability are significant
damage to the airway (airway remodeling), resulting in predictors of disability among people with asthma.
persistent airflow limitation, decreased mobility, poor This supports the multifactorial nature of the disease as
activity tolerance, and increased disability in asthma supported by multiple phenotypes explaining the
patients (19). Although GINA documented and pathophysiology of the disease (21). These factors
established a relationship between asthma and obesity, significantly impacted functionig and may
it failed to evaluate, exploit, or discuss the likely effect consequently affect the quality of life of this group of
of asthma and its risk factors on day to day activities of (4,6). This has been found to be in agreement with
the patients and the effect of asthma on DALYs of studies done in other parts of the world (24,25). This
asthma patients. This study also showed an association study suggests an association between the duration of
between obesity and disability in asthma patients. It is disability and the burden of disability. A month
very important, therefore, to evaluate the quality of life increase in disability duration has estimated 1.001
of patients with asthma and put in place measures to times more disabilities reported in agreement with a

Ethiop. J. Health Dev. 2024; 38(2)

6 Ethiop. J. Health Dev.
similar study which observed an association between 4. Musa BM and Aliyu MD. Asthma prevalence
the duration of disability and functional disability(22). in Nigerian adolescents and adults: systematic
review and meta-anaylsis. African Journal of
Study Limitation Respiratory Med. 2014 Sep; 10(1):1-6
The small sample size of this study makes it 5. Global asthma prevalence in adults: findings
challenging to claim complete comparability of the from the cross-sectional world health survey.
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sample size employed is a significant limitation of the Bateman ED, Cruz AA, Boulet LP. BMC
study design, which may restrict the generalizability of Public Health. 2012. 19; 12: 204.
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Sullman MJM, Nejadghaderi SA, Taghizadieh
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This study showed that individuals with asthma exhibit Mansournia MA, Collins GS, Kaufman JS.
a mild degree and low burden of disability predicted by Prevalence, Deaths, and Disability-Adjusted
socio-demographic characteristics such as age, body Life-Years Due to Asthma and Its Attributable
weight, and duration of the disability. The burden of Risk Factors in 204 Countries and Territories,
disability is, however, comparable to findings in other 1990-2019. Chest. 2022 Feb;161(2):318-329.
parts of the world. There are very few studies on the https://doi.org/10.1016/j.chest.2021.09.042.
burden of asthma in Nigeria and Africa in general; 7. Global Strategy for Asthma Management and
therefore, more studies are needed in Sub-Saharan Prevention. Global Initiative for Asthma
Africa to fill this vacuum. (GINA): Updated 2022.
https://www.ginasthma.org. Assessed June,
Recommendation 2022.
The authors are advocates for a multi-center study with 8. Louis R, Satia I, Ojanguren I, Schleich F,
a larger sample size, which will evaluate other risk Bonini M, Tonia T et al. European respiratory
factors that were not part of this study, to be carried out Society Guidelines for the Diagnosis of
in not too distant future in order to have a fuller picture Asthma in Adults. Eur Respir j 2022; in press
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social status of patients. 9. Boudewijn J.H. Dierick, Thys van der Molen,
Bertine M. J. Flokstra-de Blok, Antonella
Declarations Muraro, Maarten J. Postma, Janwillem W.H.
Acknowledgment: None Kocks & Job F.M. van Boven (2020) Burden
and socioeconomics of asthma, allergic
Funding: The authors received no funding for this rhinitis, atopic dermatitis and food allergy,
study. Expert Review of Pharmacoeconomics &
Outcomes Research, 20:5, 437-453. DOI:
Conflict of interest: The authors have no conflict of 10.1080/14737167.2020.1819793.
interest to declare. 10. Nurmagambetov T, Kuwahara R, Garbe P.
The Economic Burden of Asthma in the
Author’s declarations: Ogunkoya J.O, Imishue O. T, United States, 2008-2013. Ann Am Thorac
Sodeinde K.J, Oluwole A.O, Ladele A.E, Okwudishu Soc. 2018 Mar;15(3):348-356. doi:
o.T, bamidele E.F, and Osinaike A.O participated in 10.1513/AnnalsATS.201703-259OC.
the conception and design of the study, literature 11. Oni AO, Erhabor GE, Egbagbe EE. The
review, data analysis and interpretation, drafting of the prevalence, management and burden of
manuscript, and review of the draft manuscript for asthma - a Nigerian study. Iran J Allergy
sound intellectual content. All the authors approved the Asthma Immunol. 2010 Mar;9(1):35-41
final version of the manuscript. 12. Ughasoro MD, Eze JN, Oguonu T,
Onwujekwe EO. Burden of childhood and
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