Patient and healthcare provider perceptions of inhaled medicines for asthma care in The Gambia, West Africa

Introduction: Asthma affects 1 in 15 adults globally with the highest asthma related mortality found in low- and middle- income countries. The Global Initiative for Asthma (GINA) recommends as-needed combination low-dose inhaled corticosteroid-formoterol as a first step in asthma management, while recognising the importance of access to inhalers, concordance, and inhaler technique. We explored patients’ and providers’ perceptions and lived experiences of inhaled medicines for asthma care in The Gambia, in line with GINA recommendations. Methods: This study was conducted at three health facilities in The Gambia. Participants included patients presenting with an acute exacerbation of asthma and health care providers working within these facilities. Semi-structured interviews were conducted between August and November 2022, by trained Gambian social scientists, in English, Wolof or Mandinka. Interviews were recorded and transcribed in English. Thematic analysis was conducted using NVivo software, v14. Results: A total of 20 patients, (12 females) and 15 health care providers (5 nurses, 5 pharmacists and 5 doctors, 10 of which were male), were interviewed. Patients and providers perceived there to be a lack of emphasis on asthma care in the Gambian health system; this was informed by participants reporting negativity relating to; limited availability of diagnostics (e.g. spirometry and misdiagnosis), the lack of inhaled medicines (specifically corticosteroids which were associated with high treatment costs), inadequate training (e.g. on inhaler use and its benefits over oral preparations) and low sensitisation and awareness among community members. These all contributed to low prioritisation of inhaler use for asthma care. Discussion: Lived experiences and views of patients with asthma and their health care providers in The Gambia highlight sub-optimal use of inhalers limiting implementation of GINA recommendations. Prioritisation and sustained efforts to promote access to inhalers and enhance community-based asthma education are key priorities for improving outcomes for asthma in The Gambia.