Asthma Prevalence and Management in Low-Resource Pediatric Settings: Identifying Gaps in Diagnosis and Treatment

Alaa Ahmed¹, Shahd Abu Al-Rub², Abdulwahhab M. Al-Shaikhli³, Hajer Elkhalifa⁴*

Abstract

 

Asthma is one of the most common chronic diseases in childhood and a major cause of morbidity worldwide. In low- and middle-income countries (LMICs), its diagnosis and management remain particularly challenging due to limited diagnostic tools, poor access to essential medicines, and caregiver knowledge gaps.

Objectives:
To systematically review the prevalence, diagnostic barriers, management practices, and interventions for pediatric asthma in LMICs and underserved populations.

Methods:
This review followed PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies published between 2005 and 2025. Eligible studies included children aged 0–18 years and reported on prevalence, diagnosis, treatment, caregiver perceptions, or interventions. Two reviewers independently screened and extracted data. Study quality was appraised using JBI, AMSTAR-2, CASP, or RoB-2 tools as appropriate. Findings were synthesized narratively due to heterogeneity.

Results:
Twenty-five studies met inclusion criteria. Reported prevalence varied from 2% to 20%, with pooled estimates in India at 7.9% and underdiagnosis rates as high as 68% in Georgia. Diagnostic barriers included poor access to spirometry (available in <20% of facilities) and frequent misdiagnosis as pneumonia. Management gaps were characterized by low inhaled corticosteroid (ICS) use (<30%), reliance on oral medications, and poor adherence. Caregiver misconceptions, stigma, and limited health literacy further compromised outcomes. Interventions such as caregiver education, school-based programs, and spirometry training improved asthma control but were small in scale and lacked long-term evaluation.

Conclusion:
Pediatric asthma in LMICs remains under-recognized and suboptimally managed. Strengthening health systems, improving access to affordable ICS, and scaling culturally adapted educational interventions are essential. Future priorities include implementation science and large-scale pragmatic trials to close persistent care gaps.