ABSTRACT
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.
Subject(s)
Dyspnea/etiology , Health Status , Pulmonary Disease, Chronic Obstructive/complications , Quality of Life , Sleep Wake Disorders/etiology , Sleep/physiology , Aged , Dyspnea/psychology , Exercise Tolerance , Female , Humans , Male , Middle Aged , Nigeria , Pulmonary Disease, Chronic Obstructive/psychology , Severity of Illness Index , Sleep Wake Disorders/physiopathology , Sleep Wake Disorders/psychology , Surveys and QuestionnairesABSTRACT
BACKGROUND: The knowledge ofPulmonologists in Nigeria regarding the management of chronic obstructive pulmonary disease (COPD) is modest and needs to be improved. Continuing Medical education programs have the potential to improve the knowledge of doctors. OBJECTIVES: To determine the impact of attendance at a COPDtraining on the level of knowledge of pulmonologists in Nigeria. METHODS: A Cross-sectional study conducted during the Nigerian Thoracic Society (NTS) annual conference held at Ile-Ife, Nigeria in November 2013. The participants included residents in respiratory medicine and qualified pulmonologists. The study instruments were pre-test and post-test questionnaires which comprised of the same set of questions. The pre-test was administered and retrieved before the start of the COPD symposium and the post-test immediately afterwards. The scores on the pre-test were compared with the scores on the post-test. RESULTS: There were 54pre-test and 46 post-test questionnaires. The maximum obtainable score was 25. The mean score±standard deviation on the pre-test was 13±6 and 17±5 on post-test (t=-3.9, p<0.001) translating to an improvement in knowledge from 52% to 68%. Assessment of airflow limitation using spirometry in the initial evaluation for COPD was correctly selected by 57.4% on pre-test and 65.2% on post-test (p=0.42). The knowledge of tuberculosis and environmental pollution were the least recognized risk factors for COPD and mood/anxiety disorder was the least recognized comorbid condition. CONCLUSION: The level of knowledge of pulmonologists in Nigeria about COPD is modest and participation at a CME program improved their knowledge.
ABSTRACT
BACKGROUND: Health Related Quality of Life (HRQL) measures can capture the non-respiratory effects of Chronic Obstructive Pulmonary Disease (COPD). However the relationship with Peak Expiratory Flow (PEF) is not well understood. AIM: To determine the relationship of PEF and quality of life measurements in patients with COPD. SETTINGS AND DESIGN: A cross section of consecutive patients in a university clinic. METHODS: Stable patients with COPD defined by the Global Initiative on chronic Obstructive Lung Disease (GOLD) criteria, were recruited into the study. Spirometry was done using American Thoracic Society's standards and reference equations from African American norms of the US population. Quality of life was measured with the St George's Respiratory Questionnaire (SGRQ). RESULTS: Out of 50 patients recruited for the study, 48 provided complete data with acceptable spirometry and PEF data. The mean (SD) age and body mass index was 68.4 (8.9) years and 21.4 (4.6) kg/m(2) respectively and 96% of the patients were in moderate-severe stages of COPD using the GOLD criteria. Percent predicted PEF correlated with percent predicted FEV1; r= 0.559 p<0.001 and also showed a significant, though moderate correlation between PEF readings and SGRQ scores especially in the activity (r= -0.455 p< 0.01) and total scores (r=-0.415 p<0.01) for pre bronchodilator (BD) percent predicted PEF. In regression analysis, PEF was associated with SGRQ (-0.11 95% CI -0.19, -0.03) after adjusting for age, sex, height, smoking and disease severity. CONCLUSIONS: PEF correlates with SGRQ scores and may be a useful surrogate for HRQL in patients with COPD.
Subject(s)
Peak Expiratory Flow Rate , Pulmonary Disease, Chronic Obstructive/physiopathology , Quality of Life , Aged , Cross-Sectional Studies , Female , Humans , Male , Pulmonary Disease, Chronic Obstructive/diagnosisABSTRACT
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.
Subject(s)
Health Status , Pulmonary Disease, Chronic Obstructive/psychology , Quality of Life , Surveys and Questionnaires , Aged , Female , Forced Expiratory Volume , Humans , Male , Middle Aged , Nigeria , Vital Capacity , Weight LossABSTRACT
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
