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1.  The Saudi initiative for asthma – 2012 update: Guidelines for the diagnosis and management of asthma in adults and children 
Annals of Thoracic Medicine  2012;7(4):175-204.
This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on “difficult-to-treat asthma.” Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient–doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment.
doi:10.4103/1817-1737.102166
PMCID: PMC3506098  PMID: 23189095
Asthma; asthma control test; guidelines; Saudi Arabia
2.  Predicting tobacco use among high school students by using the global youth tobacco survey in Riyadh, Saudi Arabia 
Annals of Thoracic Medicine  2012;7(3):122-129.
OBJECTIVE:
To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia (KSA).
METHODS:
A cross-sectional study was conducted among high school students (grades 10–12) in Riyadh, KSA, between April 24, 2010, and June 16, 2010.
RESULTS:
The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1–2 puffs, was 43.3% overall. This behavior was more common among male students (56.4%) than females (31.3%). The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% (31.3% and 8.9% for males and females, respectively). “Ever smoked” status was associated with male gender (OR = 2.88, confidence interval [CI]: 2.28–3.63), parent smoking (OR = 1.70, CI: 1.25–2.30) or other member of the household smoking (OR = 2.11, CI: 1.59–2.81) who smoked, closest friends who smoked (OR = 8.17, CI: 5.56–12.00), and lack of refusal to sell cigarettes (OR = 5.68, CI: 2.09–15.48).
CONCLUSION:
Several predictors of cigarette smoking among high school students were identified.
doi:10.4103/1817-1737.98843
PMCID: PMC3425042  PMID: 22924068
Adolescents; cigarettes; Saudi Arabia; tobacco
3.  Utilization and responsiveness of the asthma control test (ACT) at the initiation of therapy for patients with asthma: a randomized controlled trial 
Background
The aim of this study was to assess the responsiveness of the asthma control test (ACT) to detect changes at the initiation of therapy and its utilization in the initiation of asthma treatment.
Methods
This study was designed as a randomized clinical trial conducted in a primary care setting. The subjects were asthma patients who had not received controller therapy for at least two months. The patients were randomized into two groups: The Saudi Initiative for Asthma (SINA) group and the Global Initiative for Asthma (GINA) group. Treatment in the SINA group was initiated at step1 when the ACT scores ≥ 20, step 2 when the score between16-19, and step 3 when the score < 16 began at step 3. The GINA group patients were started on step 2 when they had persistent asthma symptoms or step 3 when they had severely uncontrolled disease.
Results
Forty-five patients were analyzed in each group. The improvement in ACT score after treatment initiation was significantly higher when the SINA approach was used (2.9 in the SINA group compared to 1.7 in the GINA group (p = 0.04)). The improvement in FEV1 was 5.8% in the SINA group compared to 3.4% in the GINA group (p = 0.46). The number of patients who achieved asthma control at the follow-up visit and required no treatment adjustment was 33 (73.3%) in the SINA group and 27 (60%) in the GINA group (p = 0.0125).
Conclusion
The ACT was responsive to change at the initiation of asthma treatment and was useful for the initiation of asthma treatment.
Trial Registration number
ISRCTN31998214
doi:10.1186/1471-2466-12-14
PMCID: PMC3359228  PMID: 22449144
Asthma; Asthma control test; Guidelines; Global initiative for asthma; Saudi initiative for asthma; Control
4.  Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire 
BMC Public Health  2012;12:239.
Background
Most of the studies investigating the prevalence of asthma in various countries have focused on children below the age of 15 years or adults above the age of 18 years. There is limited knowledge concerning the prevalence of asthma in 16- to 18-year-old adolescents. Our objective was to study the prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia.
Methods
A cross-sectional study was conducted in secondary (high) schools in the city of Riyadh utilizing the International Study of Asthma and Allergies in Children (ISAAC) questionnaire tool.
Results
Out of 3073 students (1504 boys and 1569 girls), the prevalence of lifetime wheeze, wheeze during the past 12 months and physician-diagnosed asthma was 25.3%, 18.5% and 19.6%, respectively. The prevalence of exercise-induced wheezing and night coughing in the past 12 months was 20.2% and 25.7%, respectively. The prevalence of rhinitis symptoms in students with lifetime wheeze, physician-diagnosed asthma and exercise-induced wheeze was 61.1%, 59.9% and 57.4%, respectively. Rhinitis symptoms were significantly associated with lifetime wheeze (OR = 2.5, p value < 0.001), physician-diagnosed asthma (OR = 2.2, p < 0.001), and exercise-induced wheeze (OR = 1.9, p value < 0.001).
Conclusions
The prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia is high, although it is within range of reported prevalence rates from various parts of the world.
doi:10.1186/1471-2458-12-239
PMCID: PMC3384472  PMID: 22443305
5.  The effect of obesity on spirometry tests among healthy non-smoking adults 
Introduction
The effects of obesity on pulmonary functions have not been addressed previously among Saudi population. We aim to study the effects of obesity on spirometry tests among healthy non-smoking adults.
Methods
A cross sectional study conducted among volunteers healthy non-smoking adults Subjects. We divided the subjects into two groups according to their BMI. The first group consisted of non-obese subjects with BMI of 18 to 24.9 kg/m2 and the second group consisted of obese subjects with BMI of 30 kg/m2 and above. Subjects underwent spirometry tests according to American thoracic society standards with measurement of the following values: the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEF) and forced mid-expiratory flow (FEF25-75).
Results
The total subjects were 294 with a mean age of 32 years. There were 178 males and 116 females subjects. We found no significant differences in FEV1 (p value = 0.686), FVC (p value = 0.733), FEV1/FVC Ratio (p value = 0.197) and FEF25-75 (p value = 0.693) between the obese and non-obese subjects. However, there was significantly difference in PEF between the two groups (p value < 0.020).
Conclusion
Obesity does not have effect on the spirometry tests (except PEF) among health non-smoking adults. We recommend searching for alternative diagnosis in case of findings abnormal spirometry tests results among obese subjects.
doi:10.1186/1471-2466-12-10
PMCID: PMC3337807  PMID: 22436173
obesity; spirometry; Saudi Arabia
7.  Prevalence and characteristics of cigarette smoking among 16 to 18 years old boys and girls in Saudi Arabia 
Annals of Thoracic Medicine  2011;6(3):137-140.
OBJECTIVE:
To study the prevalence and characteristics of cigarette smoking among secondary school students (16- to 18-year-old boys and girls) in Riyadh city, Saudi Arabia.
METHODS:
We applied a standard two-stage, cross-sectional study design. Secondary schools for both boys and girls in Riyadh city were randomly selected using a cluster sampling method. We used the global youth tobacco survey (GYTS) tool to achieve our objectives.
RESULTS:
Among 1272 students (606 boys and 666 girls), the prevalence of those ever smoked cigarettes was 42.8% (55.6% of boys and 31.4% of girls). The prevalence of current smoking was 19.5% (31.2% of boys and 8.9% of girls). Despite the fact that the majority of students think smoking is harmful, most do not wish to stop smoking, and they had not tried to stop in the past year. Cigarette smoking is significantly associated with the male gender, having friends who smoke, and having parents who smoke, but is not significantly associated with the type of school attended.
CONCLUSION:
Smoking prevalence among secondary schools students in Saudi Arabia is high and alarming. There is a need to implement an education program about the risks of smoking and to include parents and friends as healthy models to prevent students from beginning to smoke.
doi:10.4103/1817-1737.82447
PMCID: PMC3131756  PMID: 21760845
Cigarette smoking; prevalence; Saudi Arabia
8.  Reply 
Annals of Saudi Medicine  2011;31(4):434-435.
PMCID: PMC3156528
9.  Prevalence of chronic obstructive pulmonary disease among smokers attending primary healthcare clinics in Saudi Arabia 
Annals of Saudi Medicine  2011;31(2):129-133.
BACKGROUND AND OBJECTIVES:
The prevalence of chronic obstructive pulmonary disease (COPD) in Saudi Arabia is unknown. The aim of this study was to estimate the prevalence of COPD among smokers more than 40 years of age attending primary healthcare clinics in Saudi Arabia.
DESIGN AND SETTING:
A questionnaire was used in a cross-sectional collection of demographic data and other items related to diagnosis of COPD in patients visiting primary healthcare clinics.
METHODS:
Eligible subjects were current or ex-smokers and aged 40 years or above. Spirometry was performed according to American Thoracic Society criteria. Airflow obstruction was classified according to the 2003 update of the World Health Organization and Global Initiative for Chronic Obstructive Lung Disease criteria. COPD was defined as a ratio less than 0.70 of post-bronchodilator-predicted forced expiratory volume in the first second to forced vital capacity (FEV1/FVC <0.70).
RESULTS:
Because of incomplete data or poor performance on spirometry, of 1380 subjects eligible for the study, only 501 subjects were eligible for data analysis. Seventy-one patients had an FEV1/FVC ratio <0.70, comprising 14.2% of the study population, of which 95.8% were males. Current smokers comprised 57 (80.3%) subjects. Of the 71 subjects who fulfilled the criteria for COPD diagnosis, none were found to be in COPD stage I; 40 (56.3%) were in stage II and 31 (43.6%) were in stage III of the disease.
CONCLUSION:
Underdiagnosis of COPD in primary healthcare clinics in Saudi Arabia is common, but its extent is not different from the corresponding data available in the literature for other countries. Use of spirometry as a routine test for all patients older than 40 years of age and with a smoking history can help in early detection and proper diagnosis of COPD, which subsequently will help in implementation of preventive measures.
doi:10.4103/0256-4947.77485
PMCID: PMC3102470  PMID: 21403413

Results 1-9 (9)