Evaluation of Inhaler Techniques among Asthma Patients Seen in Nigeria: An Observational Cross Sectional Study

Background: An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler-specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans. Aims: This observational study was to assess the inhaler techniques among asthma patients in Nigeria and also to identify the factors related to an inaccurate or poor inhaler use. Subjects and Methods: Consenting asthma patients on inhalers; who attended medical out-patients clinic; of two university hospitals in Nigeria were asked to use their inhalers while an inhaler-administration checklist was used to assess each patients inhaler technique. Information on demographics; asthma symptoms history and history of technique education were obtained. Data was analyzed using standard statistical methods. Results: A total of 140 asthma patients participated out of which 75 were females. All the patients used pressurized metered dose inhalers (pMDI) type; 51 of them used dry powder inhalers (DPI) in addition. For pMDI; 22.1 (31/140) completed all required steps while 37.3 (19/51) did so for DPI (P = 0.04). Patients with higher educational qualification (P 0.01) and those with less frequent asthma symptoms (P 0.01) are more likely to use the pMDI inhalers more accurately while patients who have been taught previously by a Doctor were more likely to use the DPI better. Conclusion: Majority of asthma patients use their inhalers inaccurately. Patient-dependent factors were identified as the cause of incorrect technique of inhaler use. Asthma patients on inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor

Home Management of Acute Respiratory Infections in a Nigerian District

Globally; over 2 million children die annually from acute respiratory infections (ARIs) especially pneumonia. ARI symptoms (cough and difficult/fast breathing) frequently overlap with those of malaria. In Nigeria; children with these pneumonia symptoms are frequently overlooked by the home management strategy that seeks to treat all childhood fevers as malaria. The aim of the study was to determine the prevalence of overlap of fever and ARI symptoms; the timeliness of care-seeking and the type of care sought for ARI with or without fever at community level. From a district; 420 households with 420 children aged over 5 years who had been sick with cough within 2 weeks of the survey were selected through systematic random sampling and their carer interviewed about the child's illness. Of the 413 children who had been sick with cough; 21reported overlapping symptoms of fever; cough and difficult/fast breathing (DFB). Of these; 27received antimalarials alone. Sixty percent of children with ARI received antibiotics and 59received care within 24 hours of symptom recognition. Carers of infants and children with DFB were more likely to seek care within 24 hours of symptom recognition (both p 0.001). Most (45) of the antibiotics used were obtained from patent medicine dealers. It was concluded that a large percentage of children have malaria and pneumonia symptom overlap; and a significant proportion of these cases are mismanaged as malaria in the community. The role of patent medicine dealers in recognising and appropriately treating ARI should be explored