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The Saudi Initiative for Asthma 2024 (SINA-2024) is the sixth version of asthma guidelines for the diagnosis and management of asthma for adults and children that was developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up-to-date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA Panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5-12 years, and children aged <5 years. SINA guidelines have focused more on personalized approaches reflecting a better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan., Competing Interests: The SINA is fully sponsored by the Saudi Thoracic Society., (Copyright: © 2023 Annals of Thoracic Medicine.)

Background and Objective: In patients with asthma, fractional exhaled nitric oxide (FeNO) is a biomarker for eosinophilic airway inflammation. However, the correlation with the blood eosinophil count, immunoglobulin E (IgE), and spirometric values is not well established. We aimed to investigate the correlation between FeNO, blood eosinophils, IgE, and spirometric values in asthmatic patients., Methods: Data were extracted from the electronic medical records of adult asthmatic patients, and included the FeNO, blood eosinophil count, IgE, and spirometric values. The correlation between the markers was investigated using receiver operating characteristics (ROC) and the area under the curve (AUC)., Results: A total of 135 adult patients (30% male) were analyzed. The mean FeNO was 36 ppb and almost half (48%) had a FeNO > 25 ppb. The mean blood eosinophil count was 377 cells/mm 3 , and 42% had a blood eosinophil count > 300 cells/mm 3 . There was a significant positive correlation between FeNO and the blood eosinophil count (r = 0.42, sensitivity 63%, specificity 77%, AUC 72%, p < 0.0001) as well as with the IgE (r = 0.35, sensitivity 78%, specificity 44%, AUC 68%, p < 0.0007). There was significant negative correlation between FeNO and FEV1% (r = -0.18, sensitivity 35%, specificity 85%, AUC 67%, p = 0.027)., Conclusion: The blood eosinophil count, IgE, and spirometric values were correlated with the severity of the eosinophilic airway inflammation (high FeNO). Asthmatic patients with a higher FeNO level had a higher eosinophil count, higher IgE levels, and lower FEV1 values., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al Ghobain et al.)

The Saudi Initiative for Asthma 2021 (SINA-2021) is the fifth version of asthma guidelines for the diagnosis and management of asthma for adults and children, which is developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5-12 years, and children aged less than 5 years. SINA guidelines have focused more on personalized approaches reflecting better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. Medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan., Competing Interests: The SINA is fully sponsored by the STS., (Copyright: © 2021 Annals of Thoracic Medicine.)

This is the fourth version of the 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 the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is now more aligned for different age groups. The guidelines have focused more on personalized approaches reflecting better understanding of disease heterogeneity with integration of recommendations related to biologic agents, evidence-based updates on treatment, and role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and current situation at national and regional levels. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan., Competing Interests: The SINA is fully sponsored by the STS.

Objectives: To investigate asthma prevalence and to measure asthma symptoms among Saudi adults in Riyadh, Kingdom of Saudi Arabia., Methods: A cross-sectional survey using the European Community Respiratory Health Survey (ECRHS)questionnaire carried out between April and June 2016, among male and female Saudi nationals aged 20-44 years living in Riyadh. Disproportionate cluster sampling method was used. Asthma was defined based on answering "yes" to any of the following: Have you had wheezing when you did not have a cold in the last 12 months? Have you been told by a physician to have asthma? Are you taking medicine for asthma?, Results: A total of 2,405 participants completed the survey. The prevalence of wheezing in the last 12 months when not having a cold was 18.2% with no significant difference between males and females (p=0.107). The prevalence of physician-diagnosed asthma was 11.3% with no significant difference between males and females (p=0.239). The prevalence of taking medicine for asthma was 10.6%. There were no significant differences between asthmatic vs. non-asthmatic in terms of residency area (p=0.07), education level (p=0.11) and smoking tobacco (p=0.06). However, significant differences found between asthmatic and non-asthmatic in relation to nasal allergies (p less than 0.001)., Conclusion: Asthma prevalence is high and much higher than the prevalence reported in most countries using the ECRHS questionnaire.

Background: Misconceptions about medications' safety can lead pregnant women with asthma to stop their medications, resulting in asthma-related neonatal morbidity and mortality. Our aim was to assess the level of pregnancy-related asthma knowledge and education about asthma medications' safety, among women of childbearing age with a history of bronchial asthma., Methods: A cross-sectional survey of convenience sample of outpatient clinic attendees of Pulmonary, Family Medicine and Obstetrics & Gynecology among women of childbearing age with history of asthma at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Participants ( n  = 171) completed a questionnaire to determine levels of education and knowledge, as well as attitudes and practice relating to asthma treatment., Results: Among participants, 77.1% were pregnant at the time of the survey, 77.8% had used asthma medications during current or previous pregnancy, 70.8% of all respondents who ever been pregnant believed in the safety of asthma medications during pregnancy, 49.1% had received education about asthma, and 46.8% had been educated about the safety of asthma medications during pregnancy. Responses indicated that 46.8% had stopped (or expressed the desire to stop) asthma medications during pregnancy, and 48% believed asthma medications would harm them and their babies more than asthma itself, but 92.4% expressed that they would be willing to use asthma medications during pregnancy if their safety was confirmed by a physician. Education level and employment status were both associated with an increased likelihood of having received asthma education ( p values <0.001 and <0.001 respectively), and with awareness of the safety of the medications during pregnancy ( p values <0.001 and <0.003 respectively)., Conclusion: Further efforts is to be taken to develop a program where female asthmatic patients are taught about asthma and its medications' safety during pregnancy., Competing Interests: As this study involved human participants, the study protocol received ethical approval by the Ethical Research Committee (Institutional Review Board) of King Abdullah International Medical Research Center at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. The informed consent taken from the participants.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Streptococcus pneumoniae (pneumococcus) is the leading cause of morbidity and mortality worldwide. Saudi Arabia is a host to millions of pilgrims who travel annually from all over the world for Umrah and the Hajj pilgrimages and are at risk of developing pneumococcal pneumonia or invasive pneumococcal disease (IPD). There is also the risk of transmission of S. pneumoniae including antibiotic resistant strains between pilgrims and their potential global spread upon their return. The country also has unique challenges posed by susceptible population to IPD due to people with hemoglobinopathies, younger age groups with chronic conditions, and growing problem of antibiotic resistance. Since the epidemiology of pneumococcal disease is constantly changing, with an increase in nonvaccine pneumococcal serotypes, vaccination policies on the effectiveness and usefulness of vaccines require regular revision. As part of the Saudi Thoracic Society (STS) commitment to promote the best practices in the field of respiratory diseases, we conducted a review of S. pneumoniae infections and the best evidence base available in the literature. The aim of the present study is to develop the STS pneumococcal vaccination guidelines for healthcare workers in Saudi Arabia. We recommend vaccination against pneumococcal infections for all children <5 years old, adults ≥50 years old, and people ≥6 years old with certain risk factors. These recommendations are based on the presence of a large number of comorbidities in Saudi Arabia population <50 years of age, many of whom have risk factors for contracting pneumococcal infections. A section for pneumococcal vaccination before the Umrah and Hajj pilgrimages is included as well.

This is an updated guideline 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 guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.

The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year) can be classified as either Class I when they have less symptoms (CAT < 10) or Class II when they have more symptoms (CAT ≥ 10). High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD.

Objectives: To derive prediction equations of spirometric values of healthy Saudi adults and to compare the derived equations with equations reported in selected population., Methods: Cross-sectional study of healthy nonsmoking men and women Saudi adults. The measured spirometric values were the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), peak expiratory flow (PEF) and forced mid-expiratory flow (FEF 25%-75%)., Results: A total of 621 spirometric tests were done. The prediction equations were derived using the following formula: Predicted spirometric value = constant + (b1 × age) + (b2 × height (cm)), where b1 and b2 represent the regression coefficients for age and height, respectively. Variable Constant Age (years) Height (cm) Variable Constant Age (years) Height (cm) Males (n = 292) Females (n = 175) FVC -2.933 -0.018 0.046 FVC -3.470 -0.016 0.045 FEV1 -1.886 -0.019 0.036 FEV1 -2.482 -0.018 0.036 FEV1 /FVC (%) 98.41 -0.095 -0.068 FEV1 /FVC (%) 100.67 -0.142 -0.072 PEF 17.274 -1.243 3.471 PEF -226.648 -0.499 4.076 FEF25%-75% 0.100 -0.024 0.027 FEF25%-75% -1.337 -0.021 0.031 The means of the measured FVC and FEV1 were significantly lower than the predicted values derived by the American equations of -7.2% and -4.6% among males, respectively (P value < 0.00001), and -4.7%, and -5.26% among females, respectively (P value < 0.00001)., Conclusion: The reference spirometric values derived in our study were significantly lower than the predicted values derived by the American equations., (© 2013 John Wiley & Sons Ltd.)

Objective: The present study was designed to estimate the prevalence of rhinitis symptoms among secondary school students in Saudi Arabia, Methods: A cross-sectional study was conducted among children from secondary schools in the city of Riyadh. The study utilised the International Study of Asthma and Allergies in Children (ISAAC) questionnaire., Results: Among the 3073 students (1504 boys and 1569 girls), the prevalence of life-time rhinitis, rhinitis in the past 12 months, and hay fever were 43.8%, 38.6% and 21.3%, respectively. There was a significant difference between boys and girls in the prevalence of life-time rhinitis (41% versus 46.5%, p = 0.02) and the prevalence of rhinitis in the past 12 months (35.1% versus 41.9%, p = 0.001). There was no significant difference between boys and girls in the prevalence of hay fever (22.5% versus 20.2%, p = 0.144). The prevalence of asthma symptoms among students with life-time rhinitis and hay fever were 35.4% and 39.9%, respectively. Asthma symptoms were strongly linked with life-time rhinitis (Odds Ratio [OR] = 2.5, p < 0.001) and hay fever (OR = 2.4, p value < 0.001)., Conclusions: The prevalence of rhinitis symptoms is high among 16 to 18 years old adolescents in Saudi Arabia, and symptoms are more common in girls compared to boys. Rhinitis symptoms are also associated with a high frequency of asthma symptoms.

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.

Objective: To assess the health-related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD) in 4 Gulf Council Cooperation (GCC) countries., Methods: We conducted a cross-sectional survey between December 2011 and March 2012 in the following countries: Kingdom of Saudi Arabia (Riyadh, Dammam, and Jeddah), Kuwait, Bahrain, and the United Arab Emirates. The HRQL was measured using the COPD Assessment Test (CAT) and the Chronic Respiratory Disease Questionnaire-Self-Administered Standardized questionnaire (CRQ-SAS)., Results: We recruited 120 patients from 6 centers in 4 countries. Their average forced expiratory volume (FEV)1 was 49.3% ( +/- 13.4) of predicted, and the ratio of FEV1 to forced vital capacity was 0.58 ( +/- 0.11). The average COPD Assessment Test (CAT) score was 20.4 +/- 7.6; CAT scores were highest for Riyadh (24.1 +/- 7.7) and lowest for Kuwait (18.5 +/- 9.2), with no significant difference between the centers. For the CRQ-SAS, the dyspnea domain score was 4.6 +/- 1.6, the fatigue domain score was 4.3 +/- 1.3, the emotional domain was 4.6 +/- 1.2, and the mastery domain was 4.8 +/- 1.4. The correlation coefficients of the association between the CAT score and the 4 domains of the CRQ-SAS for all of the centers combined was statistically significant., Conclusion: The CAT and CRQ-SAS revealed that the patients with COPD experienced a moderate to severe impact from the disease, and a considerably compromised quality of life in the GCC countries.

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.

Objective: To assess Saudi patients' preferences regarding Saudi physicians' attire, and its influence on patients' level of trust and confidence in their physician., Methods: A cross-sectional survey was conducted from May to June 2011 among patients waiting to be seen by their physicians from the outpatient medical clinics of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Patients were asked multiple questions, which included their choice of preference regarding the attire of male and female physicians. Additionally, patients were asked questions related to their preferences regarding their physician's gender, and the influence of physician's appearance on patient confidence., Results: A total of 399 patients were interviewed (231 males, 168 females). The mean age was 37 years. Most of the patients (62%) preferred physicians` formal outfit, which was is defined as; tie, shirt, and trousers. Only 9.7% of the patients preferred national Saudi attire (thoab and shemagh). Most patients (73%) preferred long skirts to be worn by female doctors. Up to 85% of patients preferred the white coat to be worn by physicians. Approximately 50% of the patients expressed no preference regarding the gender of their physicians. Confidence in the physician's competence and experience was not significantly associated with the physician's attire or gender (p=0.238)., Conclusion: Most patients prefer physicians to wear formal attire, however, the gender of the treating physician was not shown to be of particular importance. In addition, the level of trust in a physician is not related to his/her external appearance.

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.

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.

Objective: To produce a conceptually equivalent Arabic version of the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), and to assess its reliability., Methods: A prospective observational study was carried out from June 2010 to September 2010 at King Abdulaziz Medical City and King Khalid University Hospital, Riyadh, Saudi Arabia. We conducted this study in 2 phases. Phase 1: the translation of the CAT from English to Arabic, through forward and backward translation, as well as pilot testing. Phase 2: assessment of the test-retest reliability of the CAT for 45 patients with COPD who received optimal care by their pulmonologist., Results: This study was conducted on 45 participants. The CAT mean total (+/- SD) score at the test session was 10.7+/-5.8, and 9.2+/-4.5 at the re-test session. The interclass correlation of the total score was 0.9 (p=0.000076). The strongest correlation was for the item of confidence in leaving home with a value of 0.92 (p=0.000082), whereas the weakest was for the item related to sleep with a value of 0.53 (p=0.007)., Conclusion: The Arabic version of the CAT was found to be easy to administer, reliable, and had a strong interclass correlation reflecting stability over time and across the items.

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.