Perspectives from the 2nd International Post-Tuberculosis Symposium: mobilising advocacy and research for improved outcomes.

In 2020, it was estimated that there were 155 million survivors of TB alive, all at risk of possible post TB disability. The 2nd International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to increase global awareness and empower TB-affected communities to play an active role in driving the agenda. We aimed to update knowledge on post-TB life and illness, identify research priorities, build research collaborations and highlight the need to embed lung health outcomes in clinical TB trials and programmatic TB care services. The symposium was a multidisciplinary meeting that included clinicians, researchers, TB survivors, funders and policy makers. Ten academic working groups set their own goals and covered the following thematic areas: 1) patient engagement and perspectives; 2) epidemiology and modelling; 3) pathogenesis of post-TB sequelae; 4) post-TB lung disease; 5) cardiovascular and pulmonary vascular complications; 6) neuromuscular & skeletal complications; 7) paediatric complications; 8) economic-social and psychological (ESP) consequences; 9) prevention, treatment and management; 10) advocacy, policy and stakeholder engagement. The working groups provided important updates for their respective fields, highlighted research priorities, and made progress towards the standardisation and alignment of post-TB outcomes and definitions.

En 2020, il est estimé qu'il y a 155 millions de survivants de la TB dans le monde, tous exposés à un risque d'invalidité post-TB. Le deuxième Symposium International Post-Tuberculose (Stellenbosch, Afrique du Sud) a été organisé dans le but de sensibiliser davantage à l'échelle mondiale et de permettre aux communautés touchées par la TB de contribuer activement à la mise en œuvre de l'agenda. De plus, nous avons entrepris de mettre à jour les connaissances sur la vie et les maladies post-TB, de déterminer les domaines de recherche prioritaires, d'établir des partenariats de recherche et de souligner l'importance d'intégrer les résultats sur la santé pulmonaire dans les essais cliniques et les services de soins de la TB. Le symposium était une réunion de travail pluridisciplinaire rassemblant des praticiens, des chercheurs, des personnes ayant survécu à la TB, des donateurs, des décideurs politiques et d'autres acteurs clés. Dix groupes de travail académiques ont établi leurs propres objectifs et ont abordé les sujets thématiques suivants : 1) engagement et perspectives des patients ; 2) épidémiologie et modélisation ; 3) pathogénie des séquelles post-TB ; 4) maladie pulmonaire post-TB (PTLD, pour l'anglais «post-TB lung disease ¼) ; 5) complications cardiovasculaires et vasculaires pulmonaires ; 6) complications neuromusculaires et squelettiques ; 7) complications pédiatriques ; 8) conséquences économiques, sociales et psychologiques (ESP, pour l'anglais «economic-social and psychological¼) ; 9) prévention, traitement et gestion ; 10) plaidoyer, politique et engagement des parties prenantes. Les groupes de travail académiques ont apporté des mises à jour significatives dans leurs domaines respectifs, ont mis en évidence les priorités de recherche et ont avancé vers la normalisation et l'harmonisation des résultats et des définitions de la post-TB.

Impact of post-tuberculosis lung disease on health-related quality of life in patients from two tertiary hospitals in Lagos, Nigeria.

BACKGROUND: Post-tuberculosis (TB) lung disease is a recognised cause of chronic respiratory disease, and its impact on health-related quality of life (HRQoL) has not been extensively described. OBJECTIVES: To describe the clinical profile, spirometry impairment and impact of post-TB lung disease on HRQoL among patients attending two tertiary hospitals in Lagos, Nigeria. METHODS: We conducted a cross-sectional study and obtained data through interviews, chart reviews and physical examination. We measured dyspnoea severity using the Medical Research Council (MRC) scale, HRQoL with the St George's respiratory questionnaire (SGRQ) and performed spirometry. Univariate regression was used to explore the associations between selected variables and HRQoL. RESULTS: A total of 59 participants were recruited and their median (interquartile range (IQR)) age was 45 (36 - 60) years. The most frequent symptom was cough (93.2%; n=55) and sputum production (91.5%; n=54). Less than two-thirds of the participants (62.4%; n=38) had received treatment for TB on more than one occasion, 50.8% (n=30) had moderate to very severe dyspnoea on the MRC scale and 88.7% (n=47/53) had abnormal spirometry with the mixed pattern predominating in 56.6% (n=30) of the participants. The mean (standard deviation (SD)) SGRQ component score for symptoms was 43.89 (18.66), followed by activity (42.50 (22.68)), impact (29.41 (17.82)) and total components (35.78 (17.25)). Dyspnoea, cough, sputum production and weight loss were associated with worsened HRQoL. CONCLUSION: Post-TB lung disease was characterised by a high symptom burden, severe spirometry impairment and poor HRQoL. There is a need for increased recognition and development of guidelines for diagnosis and treatment of post-TB lung disease and for further studies to explore preventive strategies.

Knowledge and practice assessment, and self reported barriers to guideline based asthma management among doctors in Nigeria.

BACKGROUND AND OBJECTIVE: Doctors' knowledge contributes to practice and quality of care rendered to patients. To assess the knowledge and practice assessment and self reported barriers to guideline-based management among doctors. SUBJECTS AND METHODS: This was a cross-sectional study among doctors from various part of the country attending a continuing medical education (CME) program in Lagos, Nigeria. We used a self-administered, pretested, semistructured, validated questionnaire based on the Global Initiative for Asthma (GINA) guideline. RESULTS: Of the 98 participants, 41 (42%) and 18 (18.4%) had good level of asthma knowledge and practice, respectively. There was no relationship between level of knowledge and practice and the level of knowledge was not associated with the practice (X2 = 6.56, P = 0.16). The most reported barriers to good guideline-based practice were the unavailability of diagnostic and treatment facilities (44.3%), poor medication adherence (25.7%), and high cost of asthma medications (18.6%). CONCLUSION: The level of asthma knowledge and practice, respectively, among doctors in Nigeria is low and there is no relationship between level of knowledge and practice. Unavailability of diagnostic and treatment facilities, poor medication adherence, and high cost of medications are important barriers to good practice. There is a need to improve asthma education among doctors in Nigeria. Addressing barriers to good practice is essential for the translation of knowledge into practice.

Smoking cessation on the African continent: Challenges and opportunities.

Tobacco smoking is one of the world's single biggest preventable causes of death. Over 8 million people die each year of a tobacco-related illness - both directly and as a result of second-hand smoke. Combating this epidemic requires commitment from policy makers, healthcare workers and civil society. The WHO has invested extensively in supporting policy frameworks to assist countries to combat tobacco advertising, sales and promotion. Despite these interventions, over 1 billion people actively smoke, of whom >80% live in low- or middle-income countries. Strong policies, high taxation and cigarette pricing dissuade smokers effectively, but the clinician is frequently the individual who is faced with the smoker wishing to quit. Although many African countries have policies regarding tobacco control, very few have programmes to support smokers who wish to quit, and even fewer have active training programmes to equip healthcare practitioners to assist active smokers in breaking their addiction to nicotine. We present a perspective from several countries across the African continent, highlighting the challenges and opportunities to work together to build capacity for smoking cessation services throughout Africa.

Assessment of the knowledge of teachers about asthma and the availability of facilities for asthma care in public secondary schools in Lagos, Nigeria.

BACKGROUND: Asthma is a common chronic illness affecting young people. Asthma management at schools may be influenced by teachers' knowledge of the condition and the availability of treatment facilities. OBJECTIVES: To assess the knowledge of secondary school teachers in Lagos, Nigeria, regarding asthma and to evaluate management options available at schools. METHODS: A descriptive cross-sectional study was conducted. Schools were selected by proportional sampling of the educational districts, followed by stratified single-stage cluster sampling. All consenting teachers in the 54 selected schools were recruited. A self-administered questionnaire was used for data collection. A composite score was calculated, with 32 as the maximum possible. Knowledge was regarded as poor if scores were <16, fair for scores between 16 and 21, and good if scores were ≥22. RESULTS: Results show that 475 (48.1%) of the respondents had poor knowledge, 414 (41.9%) had fair knowledge, and only 99 (10%) had good knowledge. Better knowledge about asthma was associated with personal experience (χ² =16.466; p=0.001) or history of a family member with the condition (χ² =6.412; p=0.04). Of the 54 schools surveyed, only 9 (16%) had a school clinic, while a school nurse was available at only 4 (7.41%) of the schools. None of the schools had access to a nebuliser in case of an asthma emergency. CONCLUSION: Teachers in secondary schools in Lagos have unsatisfactory knowledge about asthma and are not equipped to support affected students during an asthma episode.

A Preliminary Assessment of the Impact of a Continuing Medical Education Program on the Knowledge of Nigerian Pulmonologists Regarding the Management of Chronic Obstructive Pulmonary Disease.

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.

PERIODONTAL SYSTEMIC INTERACTION: PERCEPTION, ATTITUDES AND PRACTICES AMONG MEDICAL DOCTORS IN NIGERIA.

BACKGROUND: Periodontal diseases (PD) impact the outcome of some systemic illnesses. Medical doctors' knowledge and practices regarding this association may influence the effective management of their patients. This has been understudied among Nigerian doctors. AIM: The study aimed to determine the knowledge, attitudes and practices regarding periodontal-systemic disease interactions among medical doctors in Nigeria. METHODOLOGY: This was a descriptive, cross sectional study by design, while the study setting was at the National Postgraduate Medical College of Nigeria (NPMCN), Ijanikin, Lagos. The study participants were senior resident doctors attending compulsory Research Methodology and Management courses organized by the NPMCN in 2014. Self-administered questionnaires were distributed among the participants to obtain information on their socio-demography, PD knowledge, association between PD and systemic illnesses, attitudes to periodontal health and oral hygiene practices questionnaires. Student t test and ANOVA were used to test associations between variables. The level of significance was set at p < 0.05. RESULTS: A total of 236 doctors participated in the study with a mean age of 35.8 (± 4.5) years, males being predominant (62.7%). Few doctors (42.1%) knew dental plaque as the main cause of PD, while 16.5% were aware of gum bleeding as earliest sign. Female doctors displayed better knowledge than males (p= 0.044). Majority were aware of an association between PD and chronic kidney disease (88.6%) and diabetes (86.5%). Knowledge of PD as a risk factor for stroke was 33.1%, poor glycemic control (25.4%), and pre-term low birthweight (14.8%). Most doctors had positive attitudes towards patients' periodontal health, while 33.5% assessed their patients' oral cavity regularly. All the doctors used tooth brush and paste to clean their teeth, while 43.2% cleaned twice daily. Only 16.5% used dental floss frequently and was associated with higher PD knowledge (p<0.001) and higher attitude scores (p=0.005). CONCLUSION: Senior resident doctors in Nigeria have positive attitudes regarding periodontal health. However, poor knowledge of PD and PD as risk factor for some systemic illnesses, coupled with unsatisfactory oral hygiene and dental examination practices are evident among the doctors.

PERIODONTAL SYSTEMIC INTERACTION: PERCEPTION, ATTITUDES AND PRACTICES AMONG MEDICAL DOCTORS IN NIGERIA.

BACKGROUND: Periodontal diseases (PD) impact the outcome of some systemic illnesses. Medical doctors' knowledge and practices regarding this association may influence the effective management of their patients. This has been understudied among Nigerian doctors. AIM AND OBJECTIVES: To determine the knowledge, attitudes and practices regarding periodontal-systemic disease interactions among medical doctors in Nigeria. METHODOLOGY: This was a descriptive, cross sectional study by design, while the study setting was at the National Postgraduate Medical College of Nigeria (NPMCN), Ijanikin, Lagos. The study participants were senior resident doctors attending compulsory Research Methodology and Management courses organized by the NPMCN in 2014. Self-administered questionnaires were distributed among the participants to obtain information on their socio-demography, PD knowledge, association between PD and systemic illnesses, attitudes to periodontal health and oral hygiene practices questionnaires. Student t test and ANOVA were used to test associations between variables. The level of significance was set at p < 0.05. RESULTS: A total of 236 doctors participated in the study with a mean age of 35.8 (± 4.5) years, males being predominant (62.7%). Few doctors (42.1%) knew dental plaque as the main cause of PD, while 16.5% were aware of gum bleeding as earliest sign. Female doctors displayed better knowledge than males (p= 0.044). Majority were aware of an association between PD and chronic kidney disease (88.6%) and diabetes (86.5%). Knowledge of PD as a risk factor for stroke was 33.1%, poor glycemic control (25.4%), and pre-term low birthweight (14.8%). Most doctors had positive attitudes towards patients' periodontal health, while 33.5% assessed their patients' oral cavity regularly. All the doctors used tooth brush and paste to clean their teeth, while 43.2% cleaned twice daily. Only 16.5% used dental floss frequently and was associated with higher PD knowledge (p<0.001) and higher attitude scores (p=0.005). CONCLUSION: Senior resident doctors in Nigeria have positive attitudes regarding periodontal health. However, poor knowledge of periodontal disease, and periodontal disease as risk factor for some systemic illnesses, coupled with unsatisfactory oral hygiene and dental examination practices are evident among the doctors.

A survey of the knowledge of general practitioners, family physicians and pulmonologists in Nigeria regarding the diagnosis and treatment of chronic obstructive pulmonary disease.

BACKGROUND: The level of knowledge of doctors regarding chronic obstructive pulmonary disease (COPD) management impacts on their ability to appropriately diagnose and treat COPD. OBJECTIVES: To assess the level of knowledge of Nigerian doctors regarding COPD management and explore the independent determinants of the level of knowledge. METHODS: A questionnaire was used to assess the knowledge of general practitioners (GPs), family physicians (FPs) and pulmonologists in Nigeria regarding COPD management as recommended by the guidelines. The mean score of pulmonologists was used to set a level of standard for optimal knowledge. RESULTS: 182 doctors (56 GPs, 81 FPs and 45 pulmonologists) participated in the study. Twelve (21.4%) GPs, 46 (56.8%) FPs and 44 (97.8%) pulmonologists were familiar with the Global Initiative on Obstructive Lung Disease (GOLD) Guidelines (p<0.001). 3.6% of GPs, 11.1% of FPs and 33.3% of pulmonologists correctly selected spirometry alone for confirming a diagnosis of COPD. 12.5% of GPs, 8.6% of FPs and 40% of pulmonologists correctly identified inhaled bronchodilators and inhaled corticosteroids as the two best options for treatment of moderate to severe stable COPD (χ(2)=21, p<0.001). The overall level of knowledge was good in 64.4% of pulmonologists, 23.5% of FPs and 14.3% of GPs (χ(2)=34.2, p<0.001). The location of practice (urban versus rural), specialty of the doctors and access to spirometry were independent determinants of level of knowledge. CONCLUSION: The level of knowledge of Nigerian doctors regarding COPD management is sub-optimal. There is a need to develop a systematic COPD education programme to improve their knowledge.

Medical students' knowledge about the management of chronic obstructive pulmonary disease in Nigeria.

SETTING: College of Medicine, University of Lagos, Nigeria. OBJECTIVE: To determine the level of knowledge of medical students regarding the management of chronic obstructive pulmonary disease (COPD). DESIGN: Descriptive cross-sectional survey using a structured questionnaire on risk factors for COPD and some of the diagnostic criteria recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and treatment options. RESULTS: Among 139 questionnaires analysed, the mean total score (maximum 14) was 8.35 ± 2.75. Based on the opinion of pulmonologists in Nigeria who were considered an appropriate standard, 53 students (38.1%) had good (≥70%), 52 (37.4%) had fair (≥50 to <70%) and 28 (20.1%) had poor knowledge (≥30 to <50%) about COPD management; 76 (54.7%) students were familiar with the GOLD guidelines, and 111 (79.9%) knew that spirometry was the means of confirming a diagnosis of COPD. Most students (93.5%) recognised cigarette smoking as a risk factor for COPD; history of tuberculosis (20.1%) was least recognised as a risk factor for COPD. Thirty-nine (28.1%) students were aware that inhaled steroids and inhaled bronchodilators were the correct options for treatment of stable COPD. CONCLUSION: Knowledge about COPD management among medical students in Nigeria is modest, and familiarity with the content of the GOLD guidelines is inadequate for optimal COPD management. More rigorous training would better equip medical students for COPD management in their careers as doctors.

Peak expiratory flow as a surrogate for health related quality of life in chronic obstructive pulmonary disease: a preliminary cross sectional study.

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.

Factors affecting interest in respiratory medicine as a subspecialty of choice: survey of internal medicine residents in Nigeria.

AIMS AND OBJECTIVES: The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. RESULTS: Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. CONCLUSION: The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.

A Synopsis of Asthma Research in Nigeria between 1970 and 2010

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Ventiliatory Function in Nigerians with Type 2 Diabetes

Reduced ventilatory function in type 2 diabetes has been reported in other parts of the world. This study aimed to assess the ventilatory function in Nigerians with type 2 diabetes and its relationship to the duration of symptoms of diabetes, glycaemic control, age, and body mass index (BMI). One hundred and one (101)patients with type 2 diabetes were matched to 104 control subjects with normal glucose tolerance. Historical and clinical data were documented and venous blood sampled for HbA1c in the diabetes group. Peak expiratory flow rate (PEFR), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and the ratio of the FEV1 to the FVC as a percentage (FEV1/FVC%) were measured for both groups. Study subjects and controls were similarly matched. Mean PEFR (L/s), FEV1 (L), and FVC (L) were 5.6±2.24, 2.36±0.74,and 2.94±0.90, respectively, in the diabetes group and 6.31±1.62, 2.58±0.62, and 3.19±0.79, respectively, in the control group (p=0.006, 0.02, and 0.03, respectively).The FEV1/FVC% was 81.90±24.17 in the diabetes group and 81.26±5.99 in controls (p= 0.86). Compared with predicted values for Nigerians, 11 (11%) of diabetes subjects had restrictive lung disease and 6 (6%) had obstructive lung disease while 1 (1%) of controls had restrictive lung disease and 5 (5%) had obstructive lung disease (c2=9.46, p=0.009). In multivariate analysis, age was inversely related to the PEFR (p=0.04). BMI was inversely related to PEFR, FEV1, and FVC (p= 0.01, 0.001, 0.002, respectively). Duration of diabetes was also inversely related to FEV1 (p= 0.02). HbA1c was not significant for any ventilatory index. It was concluded that Nigerians with type 2 diabetes have significantly lower ventilatory function (with a restrictive pattern),compared with matched controls. Symptom duration,age, and BMI are independent determinants of ventilatory function

Eligibility of Nigerians with Type 2 Diabetes Mellitus for Inhaled Insulin

Parenteral delivery of insulin has been shown to reduce acceptance of insulin as a treatment option in type 2 diabetes mellitus (DM) patients.The advent of inhaled insulin is aimed at circumventing this problem; however inhaled insulin is a treatment option only for DM patients with normal lung function.The study set out to evaluate the forced expiratory volume in the first second in Liters (FEV1) of Nigerians with type 2 DM and thus determine the proportion potentially eligible for inhaled insulin.FEV1 was measured in 101 subjects with type 2 DM and 104 age; gender and body mass index matched controls without DM. All subjects were 'never smokers' without any physical condition that could compromise lung function. We then determined the proportion of subjects with FEV1; more than 70of normal; which defines eligibility for inhaled insulin.On the basis of the mean FEV1 in Liters of matched controls in this study being 2.58+ 0.62; the cot off for minimium FEV1 to qualify for inhaled insulin therapy was determined as 1.80 liters (i.e 70of 2.58). A total of 83 (84) of the 101 subjects with type 2 DM had FEV1 1.8 liters indicative of eligibility for inhaled insulin. Male sex; shorter duration of DM; normal body mass index (BMI) and younger age were associated with eligibility.A high proportion of Nigerians with type 2 DM attending tertiary care are eligible for inhaled insulin therapy making it a treatment option. The feasibility of this treatment option in terms of acceptability; affordability; side effect profile and efficacy in blood glucose control in Nigerians is an important research focus