Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria

Objective: To describe the clinical characteristics and identifiable risk factors for Chronic Obstructive Pulmonary Disease (COPD) in a real-world clinical setting. Design: Cross-sectional study among patients with COPD. Setting: The Respiratory clinic of the Lagos University Teaching Hospital. Participants: Consecutive patients with spirometry confirmed COPD on follow-up for ≥3 months. There were 79 participants. Intervention: None Main outcome measure: COPD risk factors, disease severity, comorbidities, and the severity of airflow limitation. Results: The mean age of the participants was 63.3± 12.4 years, and 47 (59.5) were male. There was a high symptom burden (73.4% had COPD assessment test (CAT) score >10), 33 (41.8%) and 4 (5.1%) had GOLD 3 and GOLD 4 airflow limitation, respectively. Risk factors were identified for 96.2% of the participants: history of asthma in 37 (46.8%), tobacco smoking 22 (27.8%), occupational exposure 15 (19%), biomass exposure 5 (6.6%), post-tuberculosis 3 (3.8%), old age (3.8%), and prematurity 1 (1.3%). Fifty-nine (74.7%) had Asthma COPD Overlap (ACO). There were no significant associations between the risk factors and disease severity. Participants with ACO had lower lung function and a high frequency of allergic rhinitis. Conclusion: Asthma was the most commonly identifiable risk factor for COPD, underscoring asthma risk reduction and management optimisation as priorities toward COPD burden mitigation. Future studies need to validate these findings and identify the predominant COPD phenotypes in our setting.

Factors influencing adherence to asthma control measures among patients in Mama Lucy Kibaki Hospital, Nairobi Kenya

BACKGROUND :Asthma is an obstructive respiratory disease characterized by wheezing, chest tightness, cough and shortness of breath that is evidenced by expiratory airflow limitation. Patient awareness of asthma control measures is key in ensuring compliance with asthmatic drugs. The main aim of the study was to assess determinants of adherence to asthma control measures among adult asthmatic clients attending chest clinics in Mama Lucy Kibaki Hospital. MATERIALS AND METHOD We employed a descriptive cross-sectional study design involving asthmatic patients interviewed at Mama Lucy Kibaki Hospital in Nairobi, Kenya. The study participants had to have been diagnosed with asthma for at least three months preceding the study, attend the chest clinic and consent to participate in the study. We pretested the study tools at Mbagathi county hospital on 11 asthmatic patients. A systematic random sampling method was used to select 110 study participants and data was collected using a modified questionnaire and lung function test between March to June 2018. Quantitative data was analyzed using SPSS 22.0. The Chi-square test was used to establish the association between independent variables and asthma adherence control measures at a 95% confidence interval. RESULTS Our findings report a response rate of 89% (98). The majority (58.2%) of participants were females. On average 57.1% had good adherence to asthma control measures. Control of asthma was poor, with well-controlled being 27.5%, moderately controlled at 53.1% and poorly controlled at 19.4%, respectively P (0.003). Respondents with adequate knowledge were 56.1% and positive attitude with 71.2%. There was a significant association between adherence to asthma control measures and participants' attitude (P-value=0.000), knowledge (P-value=0.000), level of education (P-value=0.000), level of asthma control (P-value=0.003). Environmental factors were cleaning carpets/curtains (P-value=0.001), type of fuel (P-value=0.003), and use of carpet (Pvalue=0.014). CONCLUSION Adherence to asthma control measures was suboptimal resulting in a generally poor asthma control. Adequate knowledge was associated with a positive attitude. Adherence was strongly associated with attitude, knowledge, education and asthma control.

Profil épidémio-clinique, fonctionnel et de sensibilisation aux allergènes chez les asthmatiques suivis en consultation en milieu Africain à Libreville, Gabon / Epidemiological-clinical, functional profile and sensitization to allergens in asthmatics followed in consultation in an African environment in Libreville, Gabon

Introduction : La prévalence de l'asthme au niveau national est inconnue. L'objectif était de déterminer la prévalence hospitalière de l'asthme et la sensibilisation aux pneumallergènes standards.Patients et Méthodes : Il s'agit d'une étude transversale, rétrospective qui a consisté en l'analyse descriptive de 164 dossiers de patients asthmatiques reçus pour consultation au CHU de Libreville sur une période d'activité de 36 mois. La mesure du VEMS pré et post-bronchodilatateur ainsi que les prick-tests ont été réalisés. Les extraits standardisés suivants étaient testés : Dermatophagoïdes pteronyssinus et farinae, les phanères (chien et chat), les plantes vertes (Cynodon dactylon) et les moisissures (Alternaria sp). Résultats : Des 2798 patients reçus en consultation de pneumologie, 164 l'étaient pour un asthme soit une fréquence 5,8%. Parmi les 164 patients asthmatiques 59,8%(n=98) étaient des femmes avec un sex-ratio à 0,67. La moyenne d'âge de la population d'étude était de 31±18,1 ans, des extrêmes de 5 et 81 ans. Plus de la moitié des patients résidait en milieu urbain (59,7%), et était sans revenu (50,7%). L'asthme était associé à la rhinite allergique dans 72,6%. Seuls 45 patients avaient réalisé les prick tests parmi lesquels la sensibilisation aux acariens (n=37/45 ; 82,2%) était fréquente et dominée par Dermatophagoïdes pteronyssinus (n=32/37 ; 86,5%). La sensibilisation à Blomia tropicalis était de 73,0% (n=27/37). La sensibilisation aux phanères d'animaux (chiens et chats) était observée chez 9 patients (n=9/45 ; 20,0%). Aucune sensibilisation à l'Alténaria sp n'a été relevée. Le déficit ventilatoire obstructif proximal et distal a été observé dans 45,8% des cas (n=60/131).Conclusion : La prévalence de l'asthme est relativement élevé dans notre contexte d'exercice. Le taux sensibilisation révélé est le témoin d'une forte pression allergénique exercée par l'environnement domestique

Introduction: The national prevalence of asthma is unknown. The objective was to determine the hospital prevalence of asthma and sensitization to standard airborne allergens. Patients and Methods: This is a cross-sectional, retrospective study which consisted of the descriptive analysis of 164 records of asthmatic patients received for consultation at the University Hospital of Libreville over a period of activity of 36 months. Measurement of pre- and post-bronchodilator FEV1 as well as prick-tests were performed. The following standardized extracts were tested: Dermatophagoides pteronyssinus and farinae, skin appendages (dog and cat), green plants (Cynodon dactylon) and molds (Alternaria sp).Results: Of the 2798 patients seen in a pulmonology consultation, 164 were for asthma, i.e. a frequency of 5.8%. Among the 164 asthmatic patients 59.8% (n=98) were women with a sex ratio of 0.67. The average age of the study population was 31 ± 18.1 years, extremes of 5 and 81 years. More than half of the patients lived in urban areas (59.7%), and had no income (50.7%). Asthma was associated with allergic rhinitis in 72.6%. Only 45 patients had performed prick tests,among which sensitization to house dust mites (n=37/45; 82.2%) was frequent and dominated by Dermatophagoides pteronyssinus (n=32/37; 86.5%). Sensitization to Blomia tropicalis was 73.0% (n=27/37). Sensitization to animal dander (dogs and cats) was observed in 9 patients (n=9/45; 20.0%). No sensitization to Altenaria sp was noted. Proximal and distal obstructive ventilatory deficit was observed in 46.5% of cases (n=60/130).Conclusion: The prevalence of asthma is relatively high in our exercise context. The sensitization rate revealed is the witness of a strong allergenic pressure exerted by the domestic environment.

Prevalence of chronic respiratory disease in urban and rural Uganda

Objective To determine the prevalence of chronic respiratory diseases in urban and rural Uganda and to identify risk factors for these diseases. Methods The according to standard guidelines and completed questionnaires on respiratory symptoms, functional status and demographic characteristics.The presence of four chronic respiratory conditions was monitored: chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis and a restrictive spirometry pattern. Findings In total, 1502 participants (average age: 46.9 years) had acceptable, reproducible spirometry results: 837 (56%) in rural Nakaseke and 665 (44%) in urban Kampala. Overall, 46.5% (698/1502) were male. The age-adjusted prevalence of any chronic respiratory condition was 20.2%. The age-adjusted prevalence of COPD was significantly greater in rural than urban participants (6.1 versus 1.5%, respectively; P<0.001), whereas asthma was significantly more prevalent in urban participants: 9.7% versus 4.4% in rural participants (P<0.001). The age-adjusted prevalence of chronic bronchitis was similar in rural and urban participants (3.5 versus 2.2%, respectively; P=0.62), as was that of a restrictive spirometry pattern (10.9 versus 9.4%; P=0.82). For COPD, the population attributable risk was 51.5% for rural residence, 19.5% for tobacco smoking, 16.0% for a body mass index <18.5 kg/m2 and 13.0% for a history of treatment for pulmonary tuberculosis.Conclusion The prevalence of chronic respiratory disease was high in both rural and urban Uganda. Place of residence was the most important risk factor for COPD and asthma

Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler

Background: Research globally has shown that metered dose inhaler (MDI) technique is poor, with patient education and regular demonstration critical in maintaining correct use of inhalers. Patient information containing pictorial aids improves understanding of medicine usage; however, manufacturer leaflets illustrating MDI use may not be easily understood by low-literacy asthma patients. Aim: To develop and evaluate the outcome of a tailored, simplified leaflet on correct MDI technique in asthma patients with limited literacy skills. Setting: A rural primary health care clinic in the Eastern Cape, South Africa. Methods: Pictograms illustrating MDI steps were designed to ensure cultural relevance. The design process of the leaflet was iterative and consultative involving a range of health care professionals as well as patients. Fifty-five rural asthma patients were recruited for the pre-post design educational intervention study. Metered dose inhaler technique was assessed using a checklist, and patients were then educated using the study leaflet. The principal researcher then demonstrated correct MDI technique. This process was repeated at follow-up 4 weeks later. Results: The number of correct steps increased significantly post intervention from 4.6 ± 2.2 at baseline to 7.9 ± 2.7 at follow-up (p < 0.05). Statistically significant improvement of correct technique was established for 10 of the 12 steps. Patients liked the pictograms and preferred the study leaflet over the manufacturer leaflet. Conclusion: The tailored, simple, illustrated study leaflet accompanied by a demonstration of MDI technique significantly increased correct MDI technique in low-literacy patients. Patients approved of the illustrated, simple text leaflet, and noted its usefulness in helping them improve their MDI technique

Current concepts in Asthma control: Is it achievable?

Asthma control is the central focus of Global Initiative for Asthma (GINA) guidelines, which is defined as the extent to which the various manifestations of asthma observed in the patient are reduced or removed by treatment. It is determined by the interaction between the patient's genetic background, underlying disease processes, the treatment that they are tak-ing, environment and psychological factors.The long-term goals of asthma management are to achieve good symptom control, and to minimise future risk of exacer-bations, fixed airflow limitation and side-effects of treatment. The patient's own goals regarding their asthma and its treat-ment should also be identified.Several factors have been identified which contribute to failure in achieving asthma control despite adequate drug therapy. To assist in assessing asthma control, several validated questionnaires have been developed.Despite the goal of asthma management is attaining optimal control; majority of asthmatics are not well controlled. Global surveys of asthma care have suggested only 5% of asthmatics meet the goals of asthma management as set out in guidelines.Global multi centre research should be conducted especially in developing countries on asthma control to assess the impact and adequacy of asthma care in all the regions of the wor

Assessment of asthma control in pulmonary consultation in Ouagadougou, Burkina Faso

Background: Despite the recommendations now in force for the management of asthma, evidence suggests that many asthmatic patients still have their disease uncontrolled. Objective: to assess asthma control and to identify the fac-tors associated with uncontrolled disease among the patients received for consultation in the department of Pneumology in Ouagadougou, Burkina Faso.Patients and methods: We conducted a cross-sectional study from 02/01/2015 to 01/31/2016 in the department of Pneu-mology of Yalgado Ouedraogo University Hospital in Oua-gadougou. All asthma patients seen during this time frame participated in this study. The 2014 GINA criteria were used to assess the asthma control status.Results: One hundred and two asthmatic patients were in-cluded (76 women and 26 men) with a mean age of 38.7 ± 18.6 years. Asthma was found to be well controlled in 26.5% of cases, partially controlled in 34.3% of cases and uncontrolled in 39.2% of cases. The following factors were found to be associated with an uncontrolled asthma: age >36 years (p = 0.002), low level of education (p = 0.04), allergic rhinitis (p = 0.01), overweight (p = 0.03), duration of asthma ≥ 10 years (p = 0.04), therapeutic non-compliance (p = 0.00).Conclusion: Asthma was insufficiently controlled in our study. A tremendous emphasis must be put on not only on the therapeutic education of asthma patients, but also on a better management of comorbiditie

Management of paediatric asthma

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Profil de sensibilisation aux allergènes des asthmatiques adultes à Kinshasa, RDC : Etude transversale par prick-tests

Contexte. Environ 80% des asthmatiques sont atopiques. La sensibilisation aux allergènes communs présente certaines variabilités environnementales et géographiques. Objectif. Déterminer le profil de sensibilisation aux allergènes communs des asthmatiques adultes de la ville de Kinshasa. Méthodes. De juin 2017 à février 2018, 216 asthmatiques de 18 ans et plus, des 2 sexes, ont été consécutivement recrutés aux Cliniques Universitaires de Kinshasa et dans certaines paroisses et églises de réveil de la ville de Kinshasa. A l'aide d'un questionnaire validé, les variables sociodémographiques ont été précisées. Le prick-test a été réalisé avec cinq extraits commerciaux standardisés de phanères de chien et chat, l'acarien de poussière de maison (Blomia tropicalis, Bt), les moisissures (Alternaria alternata), et le jaune d'œuf. Résultats. L'âge moyen de la population était de 45,23 (ET=17,56) ans, 74% de sexe féminin, 47 % non sensibilisés et 53% sensibilisés à au moins un allergène. Vingt-cinq pourcent étaient monosensibilisées et 27% plurisensibilisées. Le profil de sensibilisation était Blomia tropicalis (72%), phanères de chat (46%), phanères de chien (34%), Alternaria alternata (13%) et jaune d'œuf (11%). Conclusion. Une plurisensibilisation aux allergènes communs chez les asthmatiques dans notre milieu est présente dont le profil dominé par les acariens et les phanères de chats. Des enquêtes futures incluant un plus grand nombre de sujets et recourant à des batteries de tests plus élargies s'imposent en vue d'une définition d'options diagnostiques et thérapeutiques dans notre contexte

The effects of treatment in patients with childhood asthma on the elastic properties of the aorta

Introduction: The study aimed to investigate the effects of treatment in patients with childhood asthma on the elastic properties of the aorta and cardiovascular risk.Methods: The study was performed in 66 paediatric patients diagnosed with bronchial asthma (BA). All patients were administered the ß2 agonist, salbutamol, for seven days, followed by one month of montelukast and six months of inhaled steroid treatment. All patients underwent conventional transthoracic echocardiographic imaging before and after treatment. Aortic elasticity parameters were considered to be the markers of aortic function.Results: Aortic elasticity parameters, including aortic strain (15.2 ± 4.8 and 18.8 ± 9.5%, p = 0.043), aortic distensibility (7.26 ± 4.71 and 9.53±3.50 cm2/dyn, p = 0.010) and aortic stiffness index (3.2 ± 0.6 and 2.8 ± 0.5, p = 0.045 showed significant post-treatment improvement when compared to pre-treatment values. Tricuspid annular plane systolic excursion (TAPSE) was also observed to improve after treatment (1.81 ± 0.38 and 1.98 ± 0.43, p = 0.049). Conclusion: The study demonstrated that when provided at appropriate doses, medications used in BA may result in an improvement in aortic stiffness

Respiratory comorbidity in South African children with atopic dermatitis

Background. Atopic dermatitis (AD) is an early and important step in the propagation of the allergic march, enhancing food and respiratory allergies via epicutaneous sensitisation to allergens.Objectives. To determine the prevalence and patterns of aeroallergen sensitisation, asthma and allergic rhinitis in South African (SA) children with AD. Methods. This was a prospective, observational study in a paediatric university hospital in Cape Town, SA. Children with moderate to severe AD, aged 6 months - 10 years, were recruited randomly and investigated for food sensitisation and allergy. They were assessed for sensitisation to aeroallergens by the immuno solid-phase allergen chip test. House-dust mite DerP and DerF, dust mite Eur m, Timothy grass, Bermuda grass, tree pollen, mould (Alternaria), cat and dog sensitisation patterns were analysed. Symptoms of asthma and allergic rhinitis were elicited using a questionnaire modified from the International Study of Asthma and Allergies in Childhood study questions.Results. One hundred participants (59 black Africans and 41 of mixed ethnicity) were enrolled (median age 42 months). Of the participants, 39% had symptoms of asthma and 53% symptoms of allergic rhinitis; 89% tested positive to at least one aeroallergen, most commonly house-dust mite DerP or DerF (81%), dust mite Eur m (51%), Timothy grass (36%) and cat (35%). Asthma, allergic rhinitis and aeroallergen sensitisation all increased with increasing age, while food allergy decreased with age. Food allergy was not an independent risk factor for respiratory allergies. Children were sensitised to indoor allergens (house-dust mite, pets) from an early age, while pollen allergies increased with age. Conclusions. In this cohort of SA children with moderate to severe AD, comorbidity with respiratory allergies was high. The prevalence of respiratory allergies increased with age while food allergy decreased with age, in keeping with the pattern of the allergic march. Seasonal allergies increased with age, while house-dust mite and pet allergy peaked in younger children, in keeping with early exposure via a defective skin barrier. Early and effective restoration of the skin barrier in AD may be a target for reducing aeroallergen-related diseases

Profil épidémiologique des pathologies respiratoires chez l'enfant à l'Hôpital d'Enfants de Rabat, Maroc

Introduction: les pathologies respiratoires représentent un motif fréquent d'hospitalisation en pédiatrie. L'objectif de cette étude était d'évaluer le profil épidémiologique des pathologies respiratoires chez l'enfant à l'hôpital d'enfants de Rabat, Maroc.Méthodes: il s'agit d'une étude observationnelle transversale qui a concerné tous les cas d'enfants âgés de 3 mois à 15 ans hospitalisés pour une pathologie respiratoire au service de pneumoallergologie et infectiologie pédiatriques de l'hôpital d'enfants de Rabat sur une période d'une année, du 1 janvier 2014 au 31 décembre 2014.Résultats: sur 3537 patients hospitalisés, 2493 (70,5%) l'ont été pour une pathologie respiratoire. Les hospitalisations pour exacerbation d'asthme (p < 0,001), bronchiolite aigüe (p < 0,001) et dyspnée laryngée (p = 0,004) étaient plus fréquentes chez le garçon alors que les hospitalisations pour pneumopathie aigüe (p = 0,005), pour inhalation de corps étranger (p = 0,007) et pour coqueluche (p = 0,020) étaient plus fréquentes chez la fille. Les hospitalisations pour pneumopathie aigüe (p < 0,001), exacerbation de séquelles graves de virose (p < 0,001) et pour coqueluche (p < 0,001) étaient plus fréquentes chez le nourrisson. Les hospitalisations pour pneumopathie aigüe (p < 0,001) et pour coqueluche (p = 0,015) étaient plus fréquentes en période automnohivernale.Conclusion: les motifs d'hospitalisation étaient dominés par les exacerbations d'asthme et la bronchiolite aigüe, lesquelles étaient plus fréquentes chez le garçon. Les infections respiratoires, représentées par les pneumopathies aigües et la coqueluche, étaient plus fréquentes en période automnohivernale et touchaient plus le nourrisson

Planned Health Care Non-Attendance and Asthma Control among Asthma Patients in Real Life Setting in an African Country: a Prospective Cohort Study

BACKGROUND: Compliance with scheduled medical visit is an indirect indicator of the adherence to treatment.The aim of this study was to determine the incidence of non-compliance with scheduled medical visits and investigate the predictors and relationship with disease control among patient with asthma in the sub-Saharan African setting. METHODS: We conducted a prospective study between January 2012 and August 2013. All patients with asthma receiving care at the Yaounde Jamot Hospital and CEDIMER medical practice were included. Planned medical visit occurred at month one; three; six and twelve following baseline evaluation. Regression models were employed to investigate the predictors of non-compliance. RESULTS: 186 patients [121 (65.1%) being female] were included. Their median age (25th-75th percentiles) was 35.5 (20.0-52.3) years. A total of 67 (36%) failed to attend at least one of the scheduled visits. The proportion of patients who failed to comply with scheduled visits was 48.4%; 68.8%; 73.5% and 79.5% at month one; three; six and twelve respectively. The accompanying rates of unacceptable asthma control were 17.2%; 24.4% and 20.8% respectively at three; six and twelve months of follow-up. Inadequate asthma control at baseline was the main predictor of non-compliance with medical visits; with adjusted odds ratio ranging from 2.00 to 4.67. Furthermore; non-sensitisation to non-pollinic aeroallergens was associated with 2.79 (95%CI 1.58-6.07) risk of non-compliance at one month of follow-up. CONCLUSION: Targeting education of patients with poorly controlled disease at baseline can potentially improve adherence to medical visit and anti-asthmatic treatments and outcomes of care

Assessment of Quality of Life among Children with Bronchial Asthma and their Caregivers at the National Hospital Abuja; Nigeria

Background: The global disease burden associated with bronchial asthma has continued to increase particularly among children. Asthma-related quality of life is a health related assessment of disease impact on patient and care givers.Aim: To determine the perceived quality of life (QOL) among children with bronchial asthma and their caregivers as well as the related factors.Subjects and methods: This was a prospective study of children diagnosed with bronchial asthma and the caregivers attending the Respiratory Clinic of the National hospital Abuja; Nigeria. Using the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) information from the various domains was obtained. The PAQLQ 23 questions assessed the child physical domain (5); emotional (8) and social behaviors (10); and the PACQLQ 13 questions assessed the caregivers' activity limitation domain (4) and emotional function (9).Mean QOL scores from each domain and overall scores were calculated based on a seven-point scale. A QOL score of 7 was reported as best with no impairment; score one as least and severest impairment; score 4 as mid point in the range from 2-6 of moderate degree impairment. Other information on the demographic biodata and clinical information from child and caregivers was also obtained.Results: Forty-three children and 43 caregivers each were enrolled; from August to December 2014. Patients were aged 7-15years; 25(58.1%) males; 18(41.9%) females; while caregiver's were males 23(53.5%); females 20(46.5%); age range 21- 48years. 25(58.1%) caregivers were of middle- lower socio-economic status; 20(46.5%) children had persistent asthma; 22(51.2%) well controlled; 21(48.8%) partly controlled. Medication use were; none; 17 (39.5%); long acting beta2 agonist/ inhaled corticosteroids (LABA/ ICS); 13(30.2%); antihistamine; 8 (18.6%); leukotriene receptor antagonist (LTRA);5(11.6%). Overall mean QOL was 4.89(4.54- 5.24;95% CI) for the children and 4.6 (3.91- 4.82; 95% CI) for caregivers; correlation (R) 0.438 p=0.003. Multiple regression showed that females gender had significant impairment in mean QOL scores in the activity domain (p= 0.022); and those with poor control and severe asthma also had significant impairment in mean QOL (p 0.05).Conclusion: Asthma impacted QOL of both the asthmatic children and caregivers with female gender in the activity domain; severe and not well controlled disease as independent predictors of quality of life

Auditing chronic disease care: Does it make a difference?

Background: An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa's Western Cape Province participated in the audit process. Aim: To determine whether clinical audits improve chronic disease care in health districts over time. Setting: Western Cape Province, South Africa. Methods: Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 ('2012 old') to districts that started auditing recently ('2012 new'). Results: The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest; and the overall provincial average seemed worse in 2012 compared to 2011. However; there was an improvement in the '2012 old' districts compared to the '2012 new' districts for both the facility audit and the folder review; including for eight clinical indicators; with '2012 new' districts being less likely to record clinical processes (OR 0.25; 95% CI 0.21-0.31). Conclusion: These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes

Advances in the treatment of severe asthma

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Asthma Control in Cities of Developing Countries: Results of a Five-City Survey

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The Asthma Control Test and its Relationship with Lung Function Parameters

The Asthma Control Test (ACT) is a validated, simple,and inexpensive instrument to assess control among patients with bronchial asthma. However, its relationship with lung function parameters is yet to be demonstrated among Nigerian asthma patients. Our study aimed at assessing asthma control using ACT scores and determining its relationship with lung function parameters among persons with asthma in a university respiratory clinic.The cross-sectional study included 65 patients with bronchial asthma who underwent routine check-ups in respiratory clinics at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria between October 2009 and January 2011. The ACT was administered to assess for asthma control. Lung function testing was done using the guidelines of the American Thoracic Society (ATS).The mean pre-bronchodilator FEV1 (forced expiratory volume in 1 second) was 1.97±0.87L and mean ACT score was 18.2+4.28; 24 (37%) of the study subjects had well-controlled asthma. The ACT scores were weakly correlated with percentage of predicted,FEV1(r=0.220, p=<0.078) and PEF (peak expiratoryflow), (r=0.168,p=0.18).In this study, most of the patients had poor asthma control and lung function parameters correlated poorly with ACT scores. It is important that the ACT complements other physiological measures of assessing asthma control in our environment

Knowledge; Awareness; and Practice of the Use of Peak Flow Meters by Physicians in the Management of Asthma in Children

The peak flow meter (PFM) is a useful device in asthma monitoring and in determining the severity of symptoms. Against the background of reported under utilisation of PFMs in the management of asthma and prescription for home use; and the paucity of such data in developing countries; this study was carried out to assess the knowledge; awareness; and practice of physicians on the use of PFMs in the management of children with asthma. The work was a prospective cross-sectional study involving 67 doctors working in the paediatric departments of two government hospitals in Lagos State; Nigeria. The number of doctors varied as not all responded to all the questions. The figures therefore correspond with the number of doctors that responded to the particular issue/question addressed. The survey was conducted with a self-administered structure questionnaire. Information obtained included the availability of PFMs in consulting rooms; knowledge of their use; benefits; frequency of prescription; and constraints in prescribing PFMs for the home management of asthma. Only 13 (20.0) of the doctors (n=65) used the peak expiratory flow rate (PEFR) regularly in the diagnosis of asthma. The designation of the respondents and the years of experience in the management of asthma were significantly related to the frequency of prescription of the PFM (p=0.007; p=0.003 respectively).Non-availability was the highest constraint to PFM use (75.0); followed by the cost of the PFM (51.7). This study revealed that the physicians' knowledge about the PFM was suboptimal. The meters were rarely used in diagnosis nor prescribed for home management by physicians attending to asthmatic children at the two referral hospitals. The cost and availability of the PFM should be addressed by the hospital management