Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria

Objective: To describe the clinical characteristics and identifiable risk factors for Chronic Obstructive Pulmonary Disease (COPD) in a real-world clinical setting. Design: Cross-sectional study among patients with COPD. Setting: The Respiratory clinic of the Lagos University Teaching Hospital. Participants: Consecutive patients with spirometry confirmed COPD on follow-up for ≥3 months. There were 79 participants. Intervention: None Main outcome measure: COPD risk factors, disease severity, comorbidities, and the severity of airflow limitation. Results: The mean age of the participants was 63.3± 12.4 years, and 47 (59.5) were male. There was a high symptom burden (73.4% had COPD assessment test (CAT) score >10), 33 (41.8%) and 4 (5.1%) had GOLD 3 and GOLD 4 airflow limitation, respectively. Risk factors were identified for 96.2% of the participants: history of asthma in 37 (46.8%), tobacco smoking 22 (27.8%), occupational exposure 15 (19%), biomass exposure 5 (6.6%), post-tuberculosis 3 (3.8%), old age (3.8%), and prematurity 1 (1.3%). Fifty-nine (74.7%) had Asthma COPD Overlap (ACO). There were no significant associations between the risk factors and disease severity. Participants with ACO had lower lung function and a high frequency of allergic rhinitis. Conclusion: Asthma was the most commonly identifiable risk factor for COPD, underscoring asthma risk reduction and management optimisation as priorities toward COPD burden mitigation. Future studies need to validate these findings and identify the predominant COPD phenotypes in our setting.

Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria.

Objective: To describe the clinical characteristics and identifiable risk factors for Chronic Obstructive Pulmonary Disease (COPD) in a real-world clinical setting. Design: Cross-sectional study among patients with COPD. Setting: The Respiratory clinic of the Lagos University Teaching Hospital. Participants: Consecutive patients with spirometry confirmed COPD on follow-up for ≥3 months. There were 79 participants. Intervention: None. Main outcome measure: COPD risk factors, disease severity, comorbidities, and the severity of airflow limitation. Results: The mean age of the participants was 63.3± 12.4 years, and 47 (59.5) were male. There was a high symptom burden (73.4% had COPD assessment test (CAT) score >10), 33 (41.8%) and 4 (5.1%) had GOLD 3 and GOLD 4 airflow limitation, respectively. Risk factors were identified for 96.2% of the participants: history of asthma in 37 (46.8%), tobacco smoking 22 (27.8%), occupational exposure 15 (19%), biomass exposure 5 (6.6%), post-tuberculosis 3 (3.8%), old age (3.8%), and prematurity 1 (1.3%). Fifty-nine (74.7%) had Asthma COPD Overlap (ACO). There were no significant associations between the risk factors and disease severity. Participants with ACO had lower lung function and a high frequency of allergic rhinitis. Conclusion: Asthma was the most commonly identifiable risk factor for COPD, underscoring asthma risk reduction and management optimisation as priorities toward COPD burden mitigation. Future studies need to validate these findings and identify the predominant COPD phenotypes in our setting. Funding: None declared.

The feasibility and effect of a nurse-led, patient-centered asthma education program in a Nigerian context.

RATIONALE, AIMS AND OBJECTIVES: Insufficient asthma education is an unmet need in Nigeria. We aimed to assess the feasibility of a nurse-led asthma education program and its effect on asthma knowledge and outcomes in Lagos, Nigeria. METHODS: Using a quasi-experimental study design, we recruited participants ≥12 years with physician diagnosed asthma. We assessed asthma knowledge, asthma control, medication adherence, health related quality of life and inhaler technique and also measured lung function. A trained nurse delivered asthma education sessions during the regular clinic visits and demonstrated correct inhaler technique. All assessments were repeated at 3-month. Data was analyzed with descriptive and inferential statistics. A p-value of <0.05 was considered significant for all associations. RESULTS: Of the 80 participants at baseline, 42 (52.5%) completed the follow-up assessment and were included in the outcome analysis. Their ages ranged from 12 to 75 years, 35 (83.3%) were ≥18 years old and 30 (71.4%) were females. There was significant improvement in knowledge score immediately post intervention (15.48 ± 3.05 versus 18.33 ± 2.21, p < 0.001) and at 3 months (17.52 ± 2.63, p < 0.001). Those with uncontrolled asthma (Asthma Control Test score ≤19) had a meaningful (3.8-point) change in ACT score at follow-up. The improvement in the mean score on the Morisky Medication Adherence Scale was significant (p = 0.03), but a change of 0.48 was not considered meaningful. There was significant (p < 0.001) and meaningful (1.08) improvement in Mini Asthma Quality of Life score at 3 months. Pre-bronchodilator FEV1% predicted and scores on the inhaler technique check list for the Diskus and pressurized meter dose inhaler did not significantly change at follow-up (p = 0.38, 0.26 and 0.80 respectively). CONCLUSION: It is practicable for nurses to deliver effective asthma education during regular clinic visits in our practice setting. This training could meaningfully improve asthma control and health related quality of life.

Smoking habits, awareness of risks, and attitude towards tobacco control policies among medical students in Lagos, Nigeria.

BACKGROUND: This study aimed to assess the prevalence of cigarette smoking among medical students, and to determine their level of knowledge regarding risk associated with cigarette smoking and their attitude and behavior towards tobacco control strategies and policies. MATERIALS AND METHODS: A stratified random sampling approach was used to select participants. A modified version of the the Global Health Professional Students Survey questionnaire was self-administered. Descriptive statistics were applied and comparisons were done using chi-square test. Multivariate logistic regression was used to obtain the significant determinants of smoking. A P < 0.05 was considered significant. RESULTS: A total of 250 students participated in the study with a response rate of 89.2%. The mean age (years) was 21.4 ± 3. Rate of ever smoking and current smoking was 9.6 and 1.2%, respectively. Age > 21, having a smoking father, and use of alcohol were significantly associated with ever smoking. Knowledge of smoking as a risk for emphysema was 72.8%, coronary artery disease 82.8%, stroke 68.8%, and low birth weight 76.4%. There were 103 (41.2%) students aware of antidepressant usage in smoking cessation. One hundred and ninety-five (78%) offered smoking cessation advice if a smoker had no smoking-related disease and did not seek their opinion about smoking, 68.8% affirmed to having adequate knowledge on smoking cessation, and 56.8% had received formal training on smoking cessation techniques. The ban on cigarette smoking in enclosed public places was supported by 92.4%. CONCLUSIONS: The prevalence of current cigarette smoking among medical students in Lagos is relatively low. Gaps exist in the level of knowledge of the students regarding risks of cigarette smoking, tobacco cessation strategies, and in their attitude and behavior towards offering tobacco cessation advice. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

The Prevalence of Self-Reported Smoking and Validation with Urinary Cotinine Among Commercial Drivers in Major Parks in Lagos, Nigeria.

The validity of self-reported smoking is questionable because smokers are inclined to deny smoking. We aimed to determine the prevalence of self-reported smoking among intra-city commercial drivers in Lagos, and assess its validity based on urinary cotinine assessment. This study was conducted at three major motor parks in Lagos, Nigeria. Information on smoking status and habits was obtained from 500 consecutive male drivers using a structured questionnaire during a face-to-face interview. Eighty-one self-reported smokers and non-smokers were selected by systematic random sampling for urinary cotinine assessment using cotinine strips. The prevalence of self-reported smoking was compared to the prevalence of smoking based on urinary cotinine and the specificity and positive predictive values of self-reported smoking was determined. Prevalence of self-reported current smoking was 32% and 17.9% of non-smokers were passive smokers. Among 81 drivers in whom urinary cotinine assessment was performed, the prevalence of smoking based on self-report was 34 (42%) compared to 41 (50.6%) when based on urinary cotinine, (X2=38.56, P<0.001). The rate of misclassification among self-reported non-smokers as smokers was 21.3% and misclassification rate for self-reported smokers as non-smokers was 8.8%. The sensitivity of self-reported smoking in accurately classifying smoking status was 91.2% and the specificity was 78.7%. The prevalence of self-reported cigarette smoking among commercial drivers in Lagos is high and a significant proportion of self-reported non-smokers are passive smokers. Self-reported smoking status obtained during face-to-face interview appears unreliable in obtaining accurate smoking data in our locality.

High-risk of obstructive sleep apnea and excessive daytime sleepiness among commercial intra-city drivers in Lagos metropolis.

BACKGROUND: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. AIM: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra-city commercial drivers. SETTING AND DESIGN: A descriptive cross-sectional study in three major motor parks in Lagos metropolis. MATERIALS AND METHODS: Demographic, anthropometric and historical data was obtained. The risk of OSA and EDS was assessed using the STOP BANG questionnaire and the Epworth Sleepiness Scale, respectively. STATISTICAL ANALYSIS: The relationship between the OSA risk, EDS risk and past road traffic accident (RTA) was explored using the Pearson's chi square. Independent determinants of OSA risk, EDS risk and past RTA, respectively, were assessed by multiple logistic regression models. RESULT: Five hundred male commercial drivers (mean age (years) ±SD = 42.36 ± 11.17 and mean BMI (kg/m(2)) ±SD = 25.68 ± 3.79) were recruited. OSA risk was high in 244 (48.8%) drivers and 72 (14.4%) had EDS. There was a positive relationship between OSA risk and the risk of EDS (Pearson's X(2) = 28.2, P < 0.001). Sixty-one (12.2%) drivers had a past history of RTA but there was no significant relationship between a past RTA and either OSA risk (X(2) = 2.05, P = 0.15) or EDS risk (X(2) = 2.7, P = 0.1), respectively. Abdominal adiposity, regular alcohol use and EDS were independent determinants of OSA risk while the use of cannabis and OSA risk were independent determinants of EDS. No independent risk factor for past RTA was identified. CONCLUSION: A significant proportion of commercial drivers in Lagos metropolis are at high risk of OSA and EDS.