Asthma Management in Lebanon: Pollution, Pollen & Inhaler Technique

Lebanon's air quality has deteriorated post-2019 with the surge in neighbourhood diesel generators. Asthma patients feel it directly. A structured plan, not just a reliever inhaler, is the modern standard.

Modern foundations (GINA-aligned)

• Even mild asthma now uses an inhaled corticosteroid (ICS) — typically in a combined ICS-formoterol inhaler, taken both as maintenance and as needed.
• Short-acting beta-agonist (SABA) alone is no longer recommended.
• Step up by adding a long-acting muscarinic antagonist (LAMA) or biologic therapy for severe cases.

Inhaler technique matters

Up to 70% of patients use their inhaler incorrectly. Ask the pulmonologist or pharmacist to watch you use it at every visit. A spacer for MDIs dramatically improves drug delivery, especially in children.

Triggers to address

• Generator-day air — close windows during peak generator hours, use an air purifier with HEPA in the bedroom.
• Cigarette and hookah smoke — strongest avoidable trigger.
• Allergens — see an allergist about immunotherapy if sensitized to dust mite, cypress, olive.
• Viral infections — annual flu shot and updated COVID booster.
• Cold dry air, exercise — pre-medicate as instructed.

Severe asthma

If you are using oral steroids more than twice a year or hospitalized for asthma, biologic therapies (omalizumab, mepolizumab, benralizumab, dupilumab) are now available in Lebanon. They are partially covered by MoPH and some insurers for documented severe phenotypes.

Action plan

A written personalized asthma action plan (green/yellow/red zones) shortens exacerbations. Ask your pulmonologist for one and review it twice a year.