Association between health literacy, inhaler technique and disease control in obstructive airway disease

OBJECTIVE: The association of health literacy with compliance, inhaler technique and disease control with respect to both asthma and chronic obstructive pulmonary disease (COPD) patients is poorly addressed. We examined the association between health literacy, inhaler technique and disease control in patients suffering from obstructive lung disease in Trinidad. DESIGN AND METHODS: The method was a cross-sectional study which employed 781 patients from Chest Clinics in Trinidad (Arima Health Facility, Eric Williams Medical Sciences Complex, Port of Spain and San Fernando General Hospitals). Out-patients were interviewed on a pilot tested questionnaire for information on compliance and disease control. Morisky 8- item Medication Adherence Questionnaire, Asthma Control Test (ACT), and COPD Assessment Test (CAT) were used to assess compliance, asthma and COPD control respectively. Health literacy was assessed using Rapid Estimate of Adult Literacy in Medicine – short form (REALM- SF), and inhaler technique was observed on dummies.

Health burden of co-morbid asthma and allergic rhinitis in West Indian children

Background: Co-morbid allergic rhinitis (AR) and asthma has not been studied in Caribbean countries where there is a high prevalence of childhood asthma. Methods: Using the International Primary Care Airways Group (IPAG) guidelines to determine AR, care-givers of 393 (response rate=100%) children attending asthma clinics in selected public sector health facilities in Trinidad, West Indies, were interviewed. Results: Children (393) were between 2–17 years and included 239 (60.8%) boys and 154 (39.2%) girls. As many as 53.9% of children sampled (95% CI 45.9–55.8) suffered from AR. Children exposed to household smoking were nearly twice as likely to have AR (p<0.0041, OR=1.9, CI 1.22–2.88). Significantly (p<0.01) more asthmatics with AR (154, 58.6%) visited Accident and Emergency (A&E) in the past 12 months. The odds of visiting A&E at least once in the past 12 months for asthmatics with AR were 1.75 (95% CI 1.15–2.68). The average frequency of A&E visits was higher in children who also suffered from AR (1.75 vs 1.36, p<0.04). Age was negatively correlated (-0.21, p<0.005) with exacerbation frequency for asthmatics without AR suggesting A&E visits are independent of age in co-morbid disease. More children with AR (>60%) suffer day and night symptoms (p<0.001), and miss school (59.8%) (p<0.03) at least once a week (p<0.002) than asthmatics without AR (OR=1.5, 95% CI=1.03–2.30). Conclusions: AR is prevalent in 53.9% of Trinidadian children with asthma. The burden of co-morbid disease in asthmatic children is associated with increased likelihood of asthma-related A&E visits, day and night symptoms and absence from school