Atorvastatin improves sputum conversion and chest X-ray severity score.

BACKGROUND: We report the results of a phase IIB study investigating the safety and effectiveness of atorvastatin use with standard anti-TB drugs.METHODS: In this multicentre, open-labelled study, we recruited treatment-naÏve patients with uncomplicated pulmonary TB aged at least 18 years. Participants were randomly assigned to standard-of-care or standard-of-care plus oral dose of atorvastatin (40 mg) daily for 2 months. Primary end points were safety measured by the number of participants with severe adverse events and effectiveness measured by the number of participants with negative sputum culture. Secondary endpoint was chest X-ray (CXR) severity score.RESULTS: Of the 185 participants screened, 150 were enrolled and equally assigned to the standard-of-care and atorvastatin groups. Adverse event severity was similar in the two groups. There was increased frequency of muscle pain in the trial group (12/75, 16% vs. 4/75, 5%). For efficacy analysis, respectively 64 (97%) and 57 (85.1%) patients in the trial and control groups had culture-negative results (P = 0.02) and experienced a reduction in CXR severity score of respectively 37% and 22%, with a mean difference of 1.4-4.9%.CONCLUSION: Atorvastatin is safe and associated with improved microbiological and radiological outcomes in TB.

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.

Determinants of Suboptimal Peak Inspiratory Flow Rates among Patients with Chronic Obstructive Pulmonary Disease in Southwest, Nigeria.

BACKGROUND: Inhalational therapy is the cornerstone in the management of chronic obstructive pulmonary disease (COPD) patients. Patients' peak inspiratory flow impacts effective dry powder inhaler (DPI) delivery and management outcome. OBJECTIVE: This study assessed peak inspiratory flow rates (PIFR) and determined the factors associated with suboptimal inspiratory flow rates among COPD patients. METHODS: A descriptive cross-sectional study was conducted among 60 participants (30 stable COPD patients and 30 age-and-sex matched controls). Socio-demographic characteristics was obtained and spirometry was done for all participants. PIFR assessment was done using the In-Check Dial Meter and was categorized as suboptimal (< 60L/min) or optimal (≥ 60L/min). P values less than 0.05 were taken as statistically significant. RESULTS: Mean age of the COPD patients and healthy controls were both 67.8 ± 10.3 years, with 53.3% being females. Post-bronchodilation FEV 1/FVC% for COPD patients was 54.15 ± 11.27%. The mean PIFR among COPD patients was significantly lower than that of healthy controls, in all DPIs simulated, especially for Clickhaler (46.2±13.4 vs 60.5±11.4L/min, p<0.001). A significant proportion of COPD patients had suboptimal PIFR, in the simulated resistances against Clickhaler and Turbuhaler (70% vs 80%; p<0.001). Older age, shorter height and low BMI were associated with suboptimal PIFR among COPD patients. However, independent predictors of suboptimal PIFR were BMI, PEFR, FEV1% and FVC%. CONCLUSION: Suboptimal PIFR was found in a significant number of COPD patients when compared with healthy respondents. Routine assessment using In-Check Dial meter should be done to determine the suitability of dry powder inhalers for patients with COPD.

CONTEXTE: Le traitement par inhalation est la pierre angulaire de la prise en charge des patients atteints de bronchopneumopathie chronique obstructive (BPCO). Le débit inspiratoire de pointe des patients a une incidence sur l'efficacité de l'inhalateur de poudre sèche et sur les résultats de la prise en charge. OBJECTIF DE L'ÉTUDE: Cette étude a évalué les débits inspiratoires de pointe et déterminé les facteurs associés aux débits inspiratoires sousoptimaux chez les patients atteints de BPCO. MÉTHODES: Une étude transversale descriptive a été menée auprès de 60 participants (30 patients atteints de BPCO stable et 30 témoins appariés selon l'âge et le sexe). Les caractéristiques socio-démographiques ont été recueillies et une spirométrie a été effectuée pour tous les participants. L'évaluation du PIFR a été réalisée à l'aide du Dial Meter In-Check et a été catégorisée comme suboptimale (< 60L/min) ou optimale (≥ 60L/min). Les valeurs P inférieures à 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: L'âge moyen des patients atteints de BPCO et des témoins sains était de 67,8 ± 10,3 ans, avec 53,3 % de femmes. Le pourcentage de VEMS/FVC après bronchodilatation chez les patients atteints de BPCO était de 54,15 ± 11,27 %. Le PIFR moyen des patients atteints de BPCO était significativement plus faible que celui des témoins sains, pour tous les DPI simulés, en particulier pour le Clickhaler (46,2±13,4 vs 60,5±11,4L/min, p<0,001). Une proportion significative de patients atteints de BPCO avait un PIFR sous-optimal, dans les résistances simulées contre Clickhaler et Turbuhaler (70% vs 80% ; p<0.001). L'âge avancé, la petite taille et un faible IMC étaient associés à une PIFR sous-optimale chez les patients atteints de BPCO. Cependant, les prédicteurs indépendants du PIFR suboptimal étaient l'IMC, le DEP, le VEMS et la CVF. CONCLUSION: Un nombre significatif de patients atteints de BPCO présente un PIFR sous-optimal par rapport aux personnes interrogées en bonne santé. Une évaluation de routine à l'aide de l'appareil de mesure In-Check Dial devrait être effectuée pour déterminer si les inhalateurs de poudre sèche conviennent aux patients atteints de BPCO. Mots clés: Inhalateur de poudre sèche, Débit inspiratoire maximal, Fonction pulmonaire.

Perceived Stress and Coping Strategies among Adults with Asthma in Ile-Ife, Nigeria.

BACKGROUND AND OBJECTIVES: Asthma is one of the common chronic diseases globally. There is paucity of data on perceived stress among patients with asthma in Nigeria. This study aimed to determine the extent of perceived stress and its association with coping strategies among adults with asthma. METHODS: This is a cross-sectional descriptive study in which 100 adults with asthma were consecutively recruited from the Respiratory Clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. They completed a questionnaire containing demographic details, Perceived Stress Scale(PSS), Brief Coping Orientation to Problems Experienced (Brief-COPE) Scale and Asthma Specific Coping Scale(ASCS). RESULTS: Most of the respondents were female (56%, n = 56) with mean age of 38.8 (±16.5), and FEV1% predicted was 78.9%±24.5. Sixty-three (63%) participants had high levels of perceived stress. Patients with asthma who had high perceived stress were significantly younger than those with low perceived stress (χ2 = 2.66; p=0.01). The mean scores of coping strategies for asthma patients with high stress level was generally higher compared with those with low stress level, and was significantly higher in the adaptive coping strategy (t=-3.36; p=0.01) and its subscales. For asthma specific coping scale, there was significant difference between those with high perceived stress and low perceived stress in the positive appraisal (t=-2.95, p=0.004) and ignoring asthma (t=-2.09, p=0.040) subscales. CONCLUSION: The level of perceived stress is high among Nigerian patients with asthma. This study showed that the more stressed they are, the more they are likely to use coping strategies.

CONTEXTE ET OBJECTIFS: L'asthme est l'un des maladies chroniques courantes dans le monde. Il y a peu de données sur stress perçu chez les patients asthmatiques au Nigeria. Ceci étude visant à déterminer l'étendue du stress perçu et son association avec des stratégies d'adaptation chez les adultes asthmatiques. MÉTHODES: Il s'agit d'une étude descriptive transversale dans laquelle100 adultes asthmatiques ont été recrutés consécutivement parmi les clinique respiratoire de l'Université Obafemi Awolowo Enseignement Complexe hospitalier, Ile-Ife, Nigéria. Ils ont complété un questionnaire contenant des détails démographiques, Stress perçu Échelle (PSS), Brève orientation d'adaptation aux problèmes rencontrés(Brief-COPE) Échelle et échelle d'adaptation spécifique à l'asthme (ASCS). RÉSULTATS: La plupart des répondants étaient des femmes (56 %, n = 56)avec un âge moyen de 38,8 ans (±16,5 ans) et un VEMS 1 % prédit était78,9 %±24,5. Soixante-trois (63 %) participants avaient des niveaux élevés destress perçu. Patients asthmatiques qui avaient une perception élevée le stress était significativement plus jeune que celui des personnes ayant une faible perceptioncontrainte (χ2 = 2,66; p = 0,01). Les scores moyens des stratégies d'adaptation pour les patients asthmatiques avec un niveau de stress élevé était généralement plus élevé par rapport à ceux ayant un faible niveau de stress, et était significativement plus élevé dans la stratégie d'adaptation adaptative (t =-3,36; p = 0,01) et sessous-échelles. Pour l'échelle d'adaptation spécifique à l'asthme, il y avait une différence entre ceux qui ont un stress perçu élevé et un stress faiblele stress perçu dans l'évaluation positive (t=-2,95, p=0,004) et ignorer les sous-échelles de l'asthme (t = -2,09, p = 0,040). CONCLUSION: Le niveau de stress perçu est élevé chez patients nigérians souffrant d'asthme. Cette étude a montré que leplus ils sont stressés, plus ils sont susceptibles d'utiliser l'adaptation stratégies. Mots-clés: Stress perçu, Stratégie d'adaptation, Asthme, Adaptatif adaptation.

Clinical Profile and Outcome of COVID-19 Cases Admitted at a Tertiary Health Facility In South-West Nigeria.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is anemerging disease with a global spread that has affected millions of lives. In Nigeria, the third wave of the outbreak is being experienced with many patients requiring hospitalization. Being a novel disease, we characterized the clinical profile and outcomes of patients admitted into our isolation centre. METHODS: A case series of 65 COVID-19 patients admitted at theIsolation Centre of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from June 2020 to March 2021 is presented. Information on demographic characteristics, medical history, symptoms, treatment and outcomes was obtained. Data were analysed using SPSS version 25. RESULTS: Most (47; 72.3%) patients were less than 65 years old and 39 (60.0%) were males. The commonest symptoms were cough (42; 64.6%), breathlessness (41; 63.1%), fever (40; 61.5%), muscle aches (40; 61.5%), and anosmia (16; 24.6%). Hypertension (41; 63.1%) and diabetes (18; 27.7%) were the most predominant comorbidities. Forty-three patients (66.2%) had supplemental oxygen therapy. The majority (44; 70%) of patients were admitted for 10 days or less and 58 (89.3%) patients were discharged home. However, 6 deaths (9.2%) were recorded among patients with advanced comorbidities and severe sepsis with all deaths occuring within 5 days of admission. CONCLUSION: There was a male predominance among patients admitted at the Isolation Centre and all mortalities occurred within five days of admission. Early detection, prompt management of cases with hypoxaemia and optimal treatment of comorbidities are recommended for good outcomes in COVID-19 patients.

CONTEXTE: La maladie de la coronavirus 2019 (COVID-19) est une maladie émergente dont la propagation mondiale a affecté des millions de vies. Au Nigéria, la troisième vague de l'épidémie est en train de se produire avec de nombreux patients nécessitant une hospitalisation. S'agissant d'une nouvelle maladie, nous avons caractérisé le profil clinique et les résultats des patients admis dans notre centre d'isolement. MÉTHODES: Une série de cas de 65 patients atteints de COVID-19 au Centre d'isolement de l'Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, de juin 2020 à mars 2021 est présentée. Des informations sur les caractéristiques démographiques, les antécédents médicaux, symptômes, le traitement et les résultats ont été obtenus. Les données ont été à l'aide de SPSS version 25. RÉSULTATS: La plupart des patients (47 ; 72,3 %) étaient âgés de moins de 65 ans et 39 (60,0 %) étaient des hommes. Les symptômes les plus fréquents étaient la toux (42 ; 64,6%), l'essoufflement (41 ; 63,1%), la fièvre (40 ; 61,5%), les douleurs musculaires (40; 61,5%) et l'anosmie (16 ; 24,6 %). L'hypertension artérielle (41; 63,1%) et le diabète (18 ; 27,7%) étaient les comorbidités les plus prédominantes. Quarante-trois patients (66,2 %) avaient une oxygénothérapie complémentaire. La majorité (44 ; 70%) des patients ont été admis pour 10 jours ou moins et 58 (89,3%) ont été renvoyés chez eux. Cependant, 6 décès (9,2 %) ont été enregistrés parmi les patients présentant des comorbidités avancées et une septicémie grave, tous les décès étant survenus dans les 5 jours suivant l'admission. CONCLUSION: Il y avait une prédominance masculine parmi les patients admis au centre d'isolement et tous les décès sont survenus dans les cinq jours cinq jours après l'admission. La détection précoce, la prise en charge rapide des cas l'hypoxémie et le traitement optimal des comorbidités sont recommandées recommandés pour obtenir de bons résultats chez les patients atteints de COVID-19. Mots clés: COVID-19, Profil clinique, Résultat, Gestion des cas, Centre d'isolement.

Impact of Sleep Quality on Asthma Control amongst Asthmatics at Federal Medical Centre, Owo, Ondo State.

BACKGROUND: Poor sleep quality is reportedly common among asthmatic patients, however, there is little or no data among Nigerian asthmatics. The purpose of this study was to determine the contribution of sleep quality to Asthma control OBJECTIVE-To determine the impact of sleep quality on asthma control amongst asthma patients at Federal Medical Centre, Owo, Ondo State. METHODS-This was a cross sectional study evaluating 100 clinically stable asthmatic patients at the outpatient department at Federal Medical Center, Owo. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Daytime sleepiness was assessed using the Epworth sleepiness scale (ESS). Asthma control was assessed by Asthma Control Test (ACT) score. Peak Expiratory Flow variability (PEF) was used to determine average daily variability in lung expiratory flow and this was used to monitor asthma control and severity over a period of two weeks. Additionally, lung function was assessed by spirometry. RESULTS: The mean age of the study population was 45.2 ± 17. 5years. Sixty patients (60%) had poor quality of sleep (PSQI > 5), while fifty-three patients (53%) had excessive daytime sleepiness (ESS>9). Increasing global PSQI score (poor sleep quality) was associated with decreasing ACT score (poor asthma control) with (r=-0.63; p <0.001). Multiple regression analysis showed that quality of sleep was the independent predictor of asthma control in our patients (p= <0.001). CONCLUSION: Results from this study suggest that quality of sleep is a significant determinant of asthma control in asthmatic patients. Therefore, efforts should be made to screen patients with asthma for sleep impairment.

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.

Relationships between respiratory parameters, exercise capacity and psychosocial factors in people with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects respiratory functioning and psychosocial factors. However, little is known about perceived ability of people with COPD to engage in a regular exercise program. This study assessed respiratory parameters, exercise capacity, psychosocial factors and their relations in people with COPD. METHODS: This cross-sectional study involved patients with COPD recruited from a Nigerian university teaching hospital. Respiratory parameters including forced expiratory volume in 1sec (FEV1) and forced vital capacity (FVC) were assessed by using a spirometer and FEV1/FVC ratio was calculated. Participants were sitting upright in a comfortable chair and wearing a nose clip for measurements. The procedure was performed in accordance with the American Thoracic Society criteria. Exercise capacity was assessed by the 6-min walk test (6MWT). Gait speed was assessed by the distance covered in 6min. Perceived exercise self-efficacy (PESE) and rating of perceived exertion (RPE) were assessed by exercise self-efficacy and Borg scales, respectively. Data were analysed using descriptive and inferential statistics. Alpha level was set at P<0.05. RESULTS: The mean age of the 125 participants was 62.0±7.1years (60% male). The mean values for FEV1, FVC and FEV1/FVC were 1.8±0.6L, 2.4±0.5L and 58.0±8.8%, respectively, and the mean 6MWT and PESE values were 291.1±41.6m 63.1±11.2%. Exercise capacity was correlated with mean values for the respiratory parameters FEV1 (r=0.29; P=0.035), FVC (r=0.32; P=0.045) and FEV1/FVC ratio (r=0.37; P=0.007), and both exercise capacity and PESE were correlated with gait speed (r=0.96, P=0.001 and r=0.57; P=0.042) and RPE (r=0.42, P=0.050 and r=-0.44; P=0.032), but PESE was not correlated with respiratory parameter values (P>0.05). CONCLUSION: Participants with COPD demonstrated reduced respiratory parameter values and low exercise capacity but moderate PESE. We found significant correlations between exercise capacity and respiratory parameter values, but PESE was correlated with only gait speed and RPE. The study has implications for respiratory health promotion and exercise adherence.

Determinants of health related quality of life in a sample of patients with chronic obstructive pulmonary disease in Nigeria using the St. George's respiratory questionnaire.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a multi-systemic and progressive disease. However the determinants of its impact on health related quality of life are not well-studied or understood in Nigeria. OBJECTIVES: To assess the determinants of health related quality of life in COPD. METHODS: Patients with stable COPD were recruited consecutively from the outpatient clinics of a university hospital. Health Related Quality of Life (HRQL) was assessed using the St. George's Respiratory Questionnaire (SGRQ) and the Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) were measured by a vitalograph spirometer. RESULTS: Fifty patients were recruited for this study (male = 60%). The mean (SD) age was 69 (9) years. The overall mean (SD) SGRQ scores was 45.9 (26.5), 50.6 (29.2), 29.7 (19.9), 38.8 (22.0) for the symptom, activity, impact and total scores respectively. After adjusting for age, sex and smoking, self-reported breathlessness independently predicted on average 25.2, 36.8, 13.65 and 22.9 points increase in SGRQ symptom, activity, impact and total scores respectively. Self-reported weight loss predicted 12.2 points increase in the impact subscale. CONCLUSIONS: Self-reported breathlessness and weight loss are independent predictors of low HRQL score in COPD.

Exercise-induced asthma in adult Nigerian asthma patients: a comparison of step test, free running, and bicycle ergometer

Exercise is not only a very common precipitant of acute asthmatic episodes but also a potent non-pharmacological test for diagnosis of asthma. Different exercise protocols have been used; however a simple exercise test would be valuable and helpful for detecting exerciseinduced asthma (EIA). The main goal of this study was to compare the exercise-inducing capacity of free running; step test; and cycle ergometer. Forty-eight asthma patients performed and completed the exercise tests reaching at least 80-85of the predicted maximal heat rate. The peak expiratory flow (PEF) values and heart rate (HR) were used to monitor pulmonary function post-exercise and the intensity of the exercise respectively. The PEF values were measured at baseline; immediately after the exercise then at 5-minute intervals up to 30 minutes. Subjects who reached the percentage fall in PEF 15were considered positive for EIA. Free running was found to be the most asthmagenic exercise followed by the step test and cycle ergometer: 36 subjects (75) for free running versus 27 subjects (56) for step test; versus 24 subjects (50) for cycle ergometer. There is a strong and significant correlation between the percentage fall in PEF of cycle ergometer and step test (r=0.61; p0.001). Free running produced the most positive result. However; the step test is a safe; simple; portable; and readily available instrument which compares well with laboratory-based cycle ergometer. We conclude that the step-test is an inexpensive and responsive exercise protocol for assessing and evaluating asthmatics in low-income countries

Prevalence of asthma symptoms among university students 15 to 35 years of age in Obafemi Awolowo University, Ile-Ife, Osun State.

INTRODUCTION: Asthma continues to cause increasing morbidity and mortality among young adults in the developing world. There is scarcity of data on the prevalence of asthma among young Nigerian adults. METHODS: We studied the prevalence of asthma among students (15-35 years of age) of the Obafemi Awolowo University using a standardized questionnaire. One thousand self-administered questionnaires were distributed; 903 were retrieved and analyzed (469 males, 434 females). Symptoms indicative of asthma were cough, chest tightness at rest and on exposure to irritants, and the presence of nocturnal symptoms. Students with three or more symptoms or who had a diagnosis of asthma were considered probable asthmatics and those with one or two symptoms as suspected asthmatics. Students in any of these two categories were defined as symptomatic respondents. RESULTS: The 12-month prevalence of wheeze, night waking with cough, and chest tightness in the morning was 9.0% (n = 81) 9.4% (n = 85) and 8.0% (n = 72), respectively. One hundred and twenty-seven respondents (14.1%) comprising 49 males (10.4%) and 78 females (17.9%) had probable asthma. The remaining symptomatic respondents consisting of 20 males (4.3%) and 16 females (3.9%) had suspected asthma. Of these, only 32.5% (53/163) had been previously diagnosed and 22.1% were on occasional inhaled bronchodilator treatment. CONCLUSION: These results indicate a relatively high prevalence of asthma among the students. A greater proportion of them had not been diagnosed and were not receiving proper treatment.