Five-year Audit of Spirometry at the Lasuth; Ikeja; South-West Nigeria

Spirometry is a non-invasive tool of importance in respiratory medicine. There is an enormous burden ofpulmonary disease worldwide, including in Nigeria.This retrospective study was done to determine the utilisation of spirometry services in the Lagos StateUniversity Teaching Hospital (LASUTH). It determined the sources of referral, indications, and pattern of pulmonary abnormalities.This is a retrospective study. An audit was done on the data collected at the Pulmonary Function Laboratory of the LASUTH between September 2006 and October 2011. Spirometry was done using the Gold Standard Vitalograph spirometer. The demographic characteristics of the patients who had spirometry as well as FEV1, (forced expiratory volume in 1 second)FVC (forced vital capacity), and their predicted values were noted.A total of 849 patients had spirometry done over the 5-year period. Slightly more than half were male patients. The mean age of the patient was 50±19 years. There was a steady increase in the number of spirometry tests performed from 2006 reaching a peak in 2009. Thereafter, a sharp decline was seen in 2010 with a steady rise in the first 10 months of 2011.The most common indication for spirometry was in the evaluation and assessment of asthma in 487 patients (57%). Most of the referrals for spirometry were from the medical department of the hospital representing 532 (63%) patients; 202 (24%) of the request were from the general out-patient department by family physicians, while 115 (13%) came from the surgical department. The outcome of the ventilatory abnormalities showed that 372 (44%) had normal ventilatory indices, 206 (24%) had obstructive patterns,169 (20%) had mixed type, while restrictive patterns were seen in 102 (12%).We concluded that although spirometry is frequently used in our clinical practice, this can be improved upon

Prevalence of gastroesophageal reflux disease among patients with bronchial asthma.

Bronchial asthma (BA) is a chronic inflammatory condition of the airways characterised by bronchial hyper-responsiveness and narrowing of the airways, which is reversible either spontaneously or with treatment. It affects about 300 million people worldwide including 10% of the Nigerian population.1 Gastroesophageal reflux disease (GERD) however is a chronic gastrointestinal condition characterised by abnormal exposure of the mucosa of the lower oesophagus to acid due to dysfunction of the lower oesophageal sphincter. About 10-30% of adult population in the Western world are affected.2 GERD can aggravate asthma in several ways; and these include vagally mediated reflex triggered by acid in oesophagus as well as micro aspiration of gastric acid resulting in bronchoconstriction.3 Also some asthma drugs cause lower esophageal sphincter relaxation making acid escape easy. Hyperinflation of the chest in asthma with flattening of the diaphragm is thought to contribute to weakness of the crura muscles and dysfunction of the lower esophageal sphincter and amplification of the thoraco-abdominal pressure gradient during an attack helps to promote GERD.4 Reflux symptoms are reported in up to 77% of asthmatics while 32-82% of asthmatics have abnormal pH studies. Silent reflux may be as common as symptomatic reflux with reports suggesting that 25-50% asthmatics have no reflux symptoms but abnormal pH studies5. On the other hand, GERD has been known to have extra-oesophageal manifestation including hoarseness of voice, cough and wheezing.6 Endoscopic studies equally could be normal in up to 50% (non-erosive GERD). 7 There appears to be a diagnostic dilemma, which is further intrigued by cases of silent GERD. 24-hour oesophageal pH measurement and sometimes manometry has remained the cornerstone of GERD diagnosis, however, this is often not widely available in daily practice because of their cost and invasive nature. Hence, guidelines for their use8 have been published. Symptom analysis however has been documented as a practical and inexpensive method of diagnosing GERD, but this obviously may not detect cases of silent GERD or with atypical symptoms. A number of validated questionnaires including QUEST, REQUESTTM and FSSG9 exist with differing sensitivity and predictability. Reports of relationship between BA and GERD exist in Western literature with sometimes conflicting findings to improper definition of BA and/or GERD.10-12 There is limited information about this association among asthma sufferers in Nigeria. We aim to study this relationship among our patients to bridge the existing gap with objectives as: to determine the frequency of symptomatic GERD among previously diagnosed asthmatics attending an Asthma clinic by means of a validated questionnaire (frequency scale for symptoms of GERD (FSSG or Fscale) 9 as well as 24 hour nasopharyngeal DX PH detector, to compare GERD prevalence between the asthmatics and a control population matched for age and sex and to document the upper gastrointestinal tract endoscopic findings in the subgroup of subjects found to have GERD.