RESUMO
BACKGROUND: An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler-specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans. AIMS: This observational study was to assess the inhaler techniques among asthma patients in Nigeria and also to identify the factors related to an inaccurate or poor inhaler use. SUBJECTS AND METHODS: Consenting asthma patients on inhalers, who attended medical out-patients clinic, of two university hospitals in Nigeria were asked to use their inhalers while an inhaler-administration checklist was used to assess each patients inhaler technique. Information on demographics, asthma symptoms history and history of technique education were obtained. Data was analyzed using standard statistical methods. RESULTS: A total of 140 asthma patients participated out of which 75 were females. All the patients used pressurized metered dose inhalers (pMDI) type; 51 of them used dry powder inhalers (DPI) in addition. For pMDI, 22.1% (31/140) completed all required steps while 37.3% (19/51) did so for DPI (P = 0.04). Patients with higher educational qualification (P < 0.01) and those with less frequent asthma symptoms (P < 0.01) are more likely to use the pMDI inhalers more accurately while patients who have been taught previously by a Doctor were more likely to use the DPI better. CONCLUSION: Majority of asthma patients use their inhalers inaccurately. Patient-dependent factors were identified as the cause of incorrect technique of inhaler use. Asthma patients on inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor.
RESUMO
Inadequate attention given to the management of asthma and ways of improving bronchial asthma control could be an important factor for the rising morbidity and mortality from asthma despite major advances in our understanding of the disease process. There is a paucity of data concerning the challenges faced in the management of asthma in Africa. This review was aimed at highlighting the challenges facing asthma management and to discuss various strategies in improving asthma control in Nigeria. Data were sourced from PubMed, Medline, African Journals Online, Google Scholar, SCOPUS, and by reviewing the references of relevant literature. Additional articles were obtained via communications with colleagues and reviewing the Abstract Books of Nigeria Thoracic Society Annual Scientific Conference from 2005 to 2012. The data search was up-to-date as of December 31, 2012. Challenges in asthma management were found during diagnosis, treatment, and follow-up. There are wide variations in diagnostic criteria for bronchial asthma and lack of standard diagnostic equipment leading to under or misdiagnosis. Treatment challenges include poor communication gap between the health-care providers and the patients, a high-cost and unavailability of essential asthma medications. Poor technique uses for medication devices, especially the inhalational drugs and Lack of National/hospital protocol or guidelines for treating asthma. Several challenges affect asthma management in developing countries, which borders on poverty, inadequate resources, weak health systems, and poor infrastructure. Efforts should be made to address these challenges by the Nigerian government, Nigerian Thoracic Society, pharmaceutical industries, and the health-care workers in general.
RESUMO
BACKGROUND: Community acquired pneumonia (CAP) is a major cause of mortality and morbidity in our environment. Recent data on the role of complications on outcome of CAP are not readily available in Nigeria. AIM: This study aims to analyze the influence of complications on the outcome of CAP in a tertiary health center in Eastern Nigeria. SUBJECTS AND METHODS: A prospective observational study was carried out on 80 patients with CAP, who met the inclusion criteria. Data relating to their age, gender, and clinical details; severity assessment using CURB 65 (C- confusion, Serum urea > 7mmol/L, R-respiratory rate > 30, B-systolic BP > 90 and diastolic BP ≤ 60, age > 65 years.) scoring system, laboratory results, complications, and outcome (mortality) were collected. The statistical package used for data analysis is SPSS version 17.0 (Chicago IL USA). Data were presented in tables and charts. Sample means, standard deviation, and Chi-square test were used for statistical significance. Severity was assessed using CURB65 scoring system. Outcome of interest was 30 day mortality. In all P value of 0.05 was regarded as significant. RESULTS: Eighty patients were recruited for the study, 39 males and 41 females; giving male:female ratio of 1:1.05. The mean age range was 56 (18.0) years. A total of 37 patients were managed as out-patients while 43 were managed as in-patients. Complications were observed in 25 patients. Severe hemodynamic changes and pleural effusion 8/25 (32%) were the most common complications observed. Total mortality was 12/80 (15%). Mortality was higher in in-patients than out-patients however, this was not statistically significant. Mortality in those with complications was 6/25 (24%) compared to 6/55 (11%) in those without complications (P = 0.10). CONCLUSION: Mortality rate in patients with CAP though higher in patients with complications numerically were not found to be significantly higher than in those without complications. We posit that other factors like presence of higher severity assessment scores (CURB-65 scores) and co-morbidities may be more important predictors of mortality in CAP patients and should be further studied.
