Effect of Chronic Obstructive Pulmonary Disease Severity on Inspiratory Flow Rates via Inhaler Devices.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that affects millions of people worldwide and inhalation therapy is central to the symptomatic management of the disease. Therefore, knowledge of the minimum Peak inspiratory flow (PIF) requirements for specific inhalers especially dry powder inhalers (DPI's) is necessary when prescribing inhalation therapy. The purpose of this study is to assess the effect of COPD severity on PIF in patients with COPD. METHODOLOGY: A total of 150 subjects (75 patients with stable COPD, and 75 apparently healthy subjects) participated in the study. PIF was assessed using the In-check Inhaler Assessment Kit (manufactured by Clement Clarke International Ltd, Harlow, UK). Lung function was assessed by spirometry with subjects divided into four groups based on the severity of their airway obstruction using the GOLD criteria. The Modified Medical Research Council (MMRC) dyspnea scale was used to assess dyspnea severity. Exercise capacity was assessed using the 6-minute walk test. Statistical analysis was performed with SPSS 23.0 software. In all the statistical tests, a p value of <0.05 was considered significant. RESULTS: The mean age for the COPD patient and control population are 72.48 ± 8.01 and 70.69 ± 5.82 respectively. The control group had higher PIF than COPD group; however, only the clickhler and pMDI had statistically significant difference between the mean PIF of the patients compared with the control group. Generally, there was an observed trend of a decrease in mean PIF as the COPD stage progresses with a statistically significant difference observed for Easibreathe (F= 3.52, p= 0.019) and pressurized Metered dose inhaler (pMDI) (F= 4.26, p= 0.008). There was a significant positive correlation between FEV1%, FVC, Exercise capacity (6-minute walk distance) and PIF for Clickhaler, Autohaler, Easybreathe and pMDI. For pMDI, there was a statistically significant difference between means of PIF across the MMRC dyspnea scale with PIF decreasing with increasing severity of dyspnea (F= 2.85, p= 0.033). CONCLUSION: COPD patients have slightly lower PIF than controls. Poor exercise tolerance and lower spirometric pulmonary function parameters may contribute to low PIF.

INTRODUCTION: La bronchopneumopathie chronique obstructive (BPCO) est un trouble respiratoire chronique qui touche des millions de personnes dans le monde et la thérapie par inhalation est essentielle à la gestion symptomatique de la maladie. Par conséquent, il est nécessaire de connaître les exigences minimales en matière de débit inspiratoire de pointe (DIP) pour certains inhalateurs, en particulier les inhalateurs de poudre sèche (IPS), lors de la prescription d'un traitement par inhalation. L'objectif de cette étude est d'évaluer l'effet de la gravité de la BPCO sur le débit de pointe inspiratoire chez les patients atteints de BPCO. MÉTHODOLOGIES: Un total de 150 sujets (75 patients atteints de BPCO stable et 75 sujets apparemment sains) ont participé à l'étude. Le PIF a été évalué à l'aide du kit d'évaluation In-check Inhaler (fabriqué par Clement Clarke International Ltd, Harlow, UK). La fonction pulmonaire a été évaluée par spirométrie, les sujets étant répartis en quatre groupes en fonction de la gravité de l'obstruction des voies respiratoires selon les critères GOLD. L'échelle de dyspnée modifiée du Medical Research Council (MMRC) a été utilisée pour évaluer la sévérité de la dyspnée. La capacité d'exercice a été évaluée à l'aide du test de marche de 6 minutes. L'analyse statistique a été réalisée avec le logiciel SPSS 23.0. Dans tous les tests statistiques, une valeur p de <0,05 a été considérée comme significative. RÉSULTATS: L'âge moyen des patients atteints de BPCO et de la population de contrôle est respectivement de 72,48 ± 8,01 et 70,69 ± 5,82. Le groupe de contrôle avait un PIF plus élevé que le groupe BPCO; cependant, seuls le clickhler et le pMDI présentaient une différence statistiquement significative entre le PIF moyen des patients et celui du groupe de contrôle. D'une manière générale, on a observé une tendance à la diminution du FRP moyen au fur et à mesure de l'évolution de la BPCO, avec une différence statistiquement significative pour l'Easibreathe (F= 3,52, p= 0,019) et l'aérosol-doseur pressurisé (pMDI) (F= 4,26, p= 0,008). Il existe une corrélation positive significative entre le VEMS, la CVF, la capacité d'exercice (distance de marche de 6 minutes) et le PIF pour Clickhaler, Autohaler, Easybreathe et pMDI. Pour le pMDI, il y avait une différence statistiquement significative entre les moyennes de PIF sur l'échelle de dyspnée du MMRC, le PIF diminuant avec l'augmentation de la sévérité de la dyspnée (F= 2,85, p= 0,033). CONCLUSION: Les patients atteints de BPCO ont un PIF légèrement inférieur à celui des témoins. Une mauvaise tolérance à l'exercice et des paramètres spirométriques de la fonction pulmonaire plus faibles peuvent contribuer à la faiblesse du PIF. Mots clés: Maladie pulmonaire obstructive chronique, Inhalateurs de poudre sèche, Débit inspiratoire de pointe, Aérosol-doseur pressurisé.

Serum Uric Acid Predicts Antihypertensive Medication Adherence in Nigeria: A Hospital Based Study.

BACKGROUND: Hypertension is a major risk factor for cardiovascular morbidity and mortality. Optimum adherence to medication is still a perplexing matter for hypertensive patients in Nigeria and serum markers use as predictor for medication adherence has not been conclusive. AIM: To define the level of antihypertensive medication adherence, its possible correlation with serum uric acid (SUA) levels and other predictors of antihypertensive medication adherence among Nigerian patients. METHODS: Patients were recruited from the University Teaching Hospital Cardiology Clinic. Blood was drawn for SUA levels. Validated 8-item MMAS-8 was administered to hypertensives to measure adherence, and correlations analysed between SUA levels and the MMAS-8 score, with SPSS-23. SUA is defined as elevated in men with concentrations of =430µmols/l, normal range 200-430µmols/l, and =360µmol/l in women, normal range140-360µmol/l. Linear regression analysis of the predictors of antihypertensive medication adherence was done. A statistical p value of <0.05 was considered significant. RESULTS: The total number and mean age of the cases were 271 and 60.8±12.3years respectively. MMAS-8 revealed that about half of the hypertensives (131 cases, 48.3%) had low adherence (MMAS-8 score 4), 81 cases (29.5%) had medium adherence (MMAS-8 score 2) while 59 cases (22.1%) showed high adherence (MMAS-8 score 0). Bivariate Correlation between SUA levels in hypertensives and antihypertensive medication adherence was of moderate degree and significant (r=0.396, p<0.001) suggesting that SUA levels increased with increasing non-adherence to antihypertensive medications. This correlation remained significant after adjusting for singular confounding variables like age (r=0.371 fair relationship, p=<0.001), DM (r=0.382 fair relationship, p<0.001); blood pressure (BP) duration and class r=0.356, 0.306, fair relationship p<0.001 respectively). The correlation between SUA levels and adherence to antihypertensive medications was weakened (r=0.209, p<0.001) after adjusting for combined confounding variables. Linear regression revealed that SUA levels is a predictor of antihypertensive medication adherence. CONCLUSION: Antihypertensive medication adherence was unsatisfactory, elevated SUA levels correlated with low antihypertensive adherence, and this correlation was influenced by several singular and combined confounding variables in our patient population. Hence SUA levels can be a predictor and a marker of antihypertensive medication adherence.

Comparing Asthma Control Test with Global Initiative for Asthma Defined Control in Nigerian Adult Asthmatics: A Prospective Cross-sectional study.

BACKGROUND: Assessment of control is central to asthma management. The Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) defined control are commonly used measures of asthma control. This study examined the agreement between the ACT and GINA defined control and determined the best cut-off point of ACT to predict GINA level of control. METHODS: It was a cross-sectional study of 82 consecutive [72% females, age 44 (IQR) 29-60 years] asthmatic patients in a tertiary teaching hospital. We compared ACT with GINA defined control using Cohen's kappa and receiver operating characteristics curve was computed to determine sensitivity and specificity. RESULTS: There was fair to moderate level of agreement between ACT and GINA defined control (kappa 0.34 to 0.46). To detect GINA-defined controlled asthma, the ACT cut-off point of =20 had a sensitivity of 81%, specificity of 74%, a positive predictive value of 52% and negative predictive value of 92%, with an area under the receiver operating characteristics curve(AUC) value of 0.82 [95% confidence interval (CI): 0.72-0.90]. ACT scores of = 19 predicted GINA-defined uncontrolled asthma with sensitivity of 87%, specificity of 51%, positive predictive value of 41%, negative predictive value of 91% with AUC values of 0.75 (95% CI: 0.75-0.84). CONCLUSION: In Nigerian asthmatics, ACT scores of =20 and =19 are useful for identifying patients with controlled and uncontrolled asthma respectively, as defined by GINA 2014 criteria. However, the former is more predictive than the latter.

Impact of Sleep Quality on the Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Impaired sleep is reportedly common in chronic obstructive pulmonary disease (COPD) and the impact of quality of sleep on health-related quality of life (HRQL) has been documented. Although factors affecting HRQL have been investigated in various studies, the impact of sleep quality on HRQL has not been previously investigated among patients with COPD in Nigeria. The purpose of this study was to determine the contribution of sleep quality as a factor affecting HRQL. We hypothesized that sleep quality is a determinant of HRQL. METHODOLOGY: Sixty patients with COPD were evaluated. HRQL was assessed using COPD Assessment Test (CAT). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Lung function was assessed by spirometry, severity of dyspnea by the Modified Medical Research Council (MMRC) scale, and functional exercise capacity by the Six-Minute Walk Test (6MWT). In all the statistical tests, a p value of <0.05 was considered significant. RESULTS: The mean age of the study population was 70±8years. Forty-nine patients (81.7%) had poor quality of sleep (PSQI > 5). The mean CAT score of the study population was 19.40±7.5. Bivariate correlation shows that HRQL reduces with worsening sleep quality (r=0.705, p=<0.001). HRQL was also associated with COPD severity (P = 0.001), severity of dyspnea, exercise capacity and frequency of exacerbation (P = <0.001). Multiple regression analysis showed that quality of sleep was the best independent predictor of HRQL in our patients (p= <0.001). CONCLUSION: Results from this study suggest that health status is generally poor in patients with COPD and quality of sleep is a significant determinant of their HRQL.