title: Guidance on the diagnosis and management of asthma among adults in resource limited settings.
abstract: BACKGROUND
  Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings.
  
  
  METHODS
  Review of international asthma guidelines and other published studies on diagnosis and management of asthma.
  
  
  RESULTS
  We establish that clinical diagnosis of asthma can be made if recurrent respiratory symptoms especially current wheeze or wheeze in the last 12 months are present. Presence of a trigger, other allergic diseases, personal or family history of asthma; clinical improvement and increase in the peak flow and forced expiratory volume in one second of ≥12% after salbutamol administration increases the likelihood of asthma. At diagnosis severity grading, patient education, removal or reduction of trigger should be done. Follow up 2-6 weeks and assessment of control during therapy is essential. Therapy should be adjusted up or down depending on control levels. Patients should be instructed to increase the frequency of their bronchodilators and/or steroids therapy when they start to experience worsening symptoms.
  
  
  CONCLUSIONS
  Good quality asthma care can be achieved in resource limited settings by use of clinical data and simple tests.
authors.affiliation: Pulmonology unit, Department of Medicine, Makerere University College of Health sciences/Mulago Hospital; Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Kirenga
authors.affiliation: Department of Internal Medicine, Yale School of Medicine.
authors.forename: Jeremy I
authors.initials: JI
authors.lastname: Schwartz
authors.affiliation: Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Corina
authors.initials: C
authors.lastname: de Jong
authors.affiliation: Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: Pulmonology unit, Department of Medicine, Makerere University College of Health sciences/Mulago Hospital.
authors.forename: Martin
authors.initials: M
authors.lastname: Okot-Nwang
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D003937:Diagnosis, Differential; D019468:Disease Management; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D010366:Peak Expiratory Flow Rate
chemical_list: D018927:Anti-Asthmatic Agents
keywords: Asthma; diagnosis; management and resource limited settings; treatment