Ademola E. Fawibe

Assessment of the Level of Asthma Control among Adult Patients in Two Tertiary Care Centers in Nigeria

Background. According to the Global Initiative for Asthma (GINA) guidelines, the goal of asthma management is to achieve clinical control. Uncontrolled asthma places a significant social and economic burden on patients. Objective. The two aims of this study were to (1) assess the level of asthma control (according to the GINA definition of “control”) among adult patients attending two tertiary care centers in Nigeria and (2) to determine the predictors associated with uncontrolled asthma. Methods. This cross-sectional study was carried out from June 2009 to December 2010. The participants were all 18 years old or older with physician-diagnosed asthma. First, the participants completed an interviewer-administered questionnaire, which included items that collected their socio-demographic information and clinical data. Second, anthropometric indices were measured and spirometry was conducted to determine each participant’s lung function. Finally, the researcher team members assessed each participant’s inhaler device technique. The outcome measures were (1) uncontrolled asthma, (2) partly controlled asthma, and (3) controlled asthma. Results. One hundred and twenty-four asthma patients participated in the study. Of these, 69.3% had uncontrolled asthma, 22.6% had partly controlled asthma, and 8.1% had controlled asthma. Multivariate analysis showed that uncontrolled asthma was strongly associated with asthma severity based on clinical features, the incorrect use of an inhaler device, the use of oral corticosteroids, an abnormal pulmonary function test, the presence of comorbidity, and the lack of adherence to inhaled corticosteroids (ICSs). The results also revealed that increasing age and a lack of tertiary education were weakly associated with asthma control. In this study, gender, marriage, smoking status, occupation, socioeconomic status, income, and the duration of the asthma were not associated with asthma control. Conclusion. A significant proportion of the sampled patients had uncontrolled asthma. To reduce this number, health care providers must reinforce the education of each asthma patient and promote the regular assessment of asthma control at every clinic visit, identify those with poor control, and institute the appropriate therapy needed to achieve clinical control.

Secondhand smoke exposure among nonsmoking adults in two Nigerian cities

BACKGROUND Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. MATERIALS AND METHODS We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure, awareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. RESULTS Of the 585 nonsmoking adults that completed the study, 38.8% had regular exposure to SHS; mostly, in public places (24.4%). More men were exposed at public places when compared with women (27.0% vs. 19.5%). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95% confidence interval (CI), 3.08-9.42]; and in men, it was lack of home smoking restriction (PR ratio-6.35; 95% CI, 4.51-8.93). Among men, SHS exposure at any location was associated with lack of secondary school education, residing in slum apartment (house with many households), living with a smoking family member (non-spouse), lack of home smoking restriction, and alcohol intake. Among women, SHS exposure at any location was associated with having a smoking spouse, residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r = +0.45; P = <0.01), lack of secondary school education (r = -0.10; P = 0.04), residing in slum apartment (r = -0.12; P = 0.03) and being a widow/widower (r = +0.24; P < 0.01). Only 17.4% of the employees reported availability of outdoor smoking area at their workplaces. CONCLUSION Our results show that prevalence of SHS exposure was the highest in public places. These findings underscore the need for enactment of comprehensive smoke-free legislation and implementation of educational strategies to reduce SHS exposure in homes.

Drug prescription pattern for asthma among nigerian doctors in general practice: A cross-sectional survey

BACKGROUND: A wide range of medications are now available for the treatment of asthma and selection of the optimal treatment combination of agents is essential. OBJECTIVES: This study was designed to evaluate a self-reported drug prescribing pattern for asthma among Nigerian doctors in general practice. METHODS: It was a cross-sectional survey conducted among general practitioners in six states of Nigeria. RESULTS: For acute severe asthma, 75.9% of the doctors prescribed intravenous methylxanthines, which was combined with oral or inhaled short-acting β2 agonists (SABA) by 56.3% of them. Systemic steroids were prescribed mainly via the intravenous route by 58.8% of them. Aberrant drugs such as antibiotics, antihistamines, and mucolytics were prescribed by 25.6% of them. For long-term, follow-up treatment of asthma, oral steroids, and oral SABA were commonly prescribed, while inhaled corticosteroids (ICS) and ICS/LABA (long acting beta agonists) were infrequently prescribed. Aberrant drugs such as analgesics, antimalaria, and antihistamines were prescribed by 22.8% of them. About 48% of the doctors had never attended any form of update training on asthma management, whereas, only 16.3% attended update training on asthma within the last year preceding this study. Awareness of international guidelines on asthma treatment was poor among them with only 16.4% being able to mention any correct guideline on asthma management. CONCLUSION: The poor anti-asthma prescribing behavior among these doctors is associated with a low level of participation at update training on asthma management and poor awareness of asthma guidelines. The Nigerian Medical Association and the Nigerian Thoracic Society should urgently address these problems.

Awareness of the Warning Signs, Risk Factors, and Treatment for Tuberculosis among Urban Nigerians

Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (r + 0.12), higher family income (r + 0.10), higher level of education (r + 0.10), and belonging to Christian faith (r + 0.11). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB.

An audit of spirometry at the University of Ilorin Teaching Hospital, Ilorin, Nigeria (2002-2009)

BACKGROUND Spirometry is a noninvasive and cost-effective physiologic test that greatly complements other investigative procedures in evaluation of respiratory conditions. This study was aimed at auditing the spirometry performed at the University of Ilorin Teaching Hospital (UITH) Ilorin, Nigeria, and highlighting some of the challenges associated with the procedure. METHODS We reviewed and analyzed the record of spirometry performed at the cardiopulmonary unit of the hospital from June 2002 to December 2009. RESULTS A total of 119 patients had spirometry tests from 2002 to 2009 and their age ranged from 15 to 85 years with a mean of 47.6 +/- 14.8 years. There were 69 (58%) males and the male:female ratio was 1.4:1. More than half (65%) of the tests were in patients <50 years old. The rate of spirometry performed annually increased from 12 (10.1%) in 2002 to 31 (26.1%) in year 2009. Evaluation of bronchial asthma was the most common indication for spirometry (43 patients; 36.1%). Majority of the requests (84 patients; 70.6%) were from adult respiratory physicians. The identified challenges were lack of awareness of the range of diseases that could be investigated by spirometry, lack of skills in interpreting the results, lack of time and delays in replacing exhausted consumables and faulty components of spirometer. CONCLUSION Gradually, the trend of spirometry request is increasing in UITH; however, a wider acceptability could be achieved for this test by raising the level of awareness and improving the skills of all doctors on the usefulness and interpretation of spirometry.

Unmet needs in asthma treatment in a resource-limited setting: findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception and treatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians and patients in Nigeria, with the goal of identifying barriers to optimal management. Methods To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians. Results Majority (66.7%) of the patients reported their asthma as moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to educational issues (31.4% vs.18.7%) and its contents: individual management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0%) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines. Conclusion This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria.

General practitioner reported follow–up visits among asthma patients in North Central Nigeria

BACKGROUND Despite the benefits of regular follow-up in the long-term care of asthma, no previous study has reported on it among asthma patients in Nigeria. OBJECTIVE This survey was designed to evaluate GP-reported follow-up visits among asthma patients in North Central Nigeria. METHODS It was a cross-sectional survey conducted among GPs in three North Central states of Nigeria. RESULTS Overall, 48.3% of the GPs reported that their patients usually come for follow-up visits. About 63.6%, 40.0%, and 55.3% of the GPs in Kwara, Kogi, and Niger states, respectively, reported that their patients came for follow-up visits in the month prior to this study. Less than two-third of GPs in both private (55.1%) and public (56.8%) hospitals reportedly attended to patients on follow-up visits. About 46.5%, 37.5%, and 52.0% of the GPs who attended to patients <1 week, 1-2 weeks and >2 weeks prior to the study reported that their patients came for follow-up visits. There was significant difference (P = 0.04) in the reported follow-up visits by GPs who attended to ≥10 asthma patients compared to others. None of the nine GPs who reportedly treated ≥ 10 patients in the preceding month of the study attended to any patient on follow-up visits. CONCLUSION The GP-reported rates of follow-up visits in patients that are accessing asthma care from GPs practicing in the North Central part of Nigeria are low. Further studies to identify barriers to follow-up visits and how to correct them are therefore recommended.

Reference equations for spirometric indices from a sample of the general adult population in Nigeria

BackgroundThe increasing importance of pulmonary function testing in diagnosing and managing lung diseases and assessing improvement has necessitated the need for locally derived reference equations from a sample of the general Nigerian population.MethodsIt was a cross sectional study in which we used linear regression models to obtain equations for reference values and lower limits of normal for spirometric indices in adult Nigerians from a sample of the general population aged 18–65 years (males) and 18–63 years (females).ResultsSeven hundred and twenty participants made up of 358 males and 362 females who satisfactorily completed the spirometric measurements using the ATS/ERS reproducibility and acceptability criteria were included in the analysis. The most important predictive variables were height and age. The values of the spirometic indices increase with increasing stature but decrease with increasing age in both sexes. The sex difference in all the indices is also apparent as all the indices, except FEV1/FVC, are higher in men than in women.Our values are higher than values obtained from previous studies in Nigeria (except FEV1/FVC) but the differences were not statistically significant. This suggests that although the values are increasing, the increase is yet to be significantly different from values obtained using the past equations. The implication of this is that there is need for periodic study to derive new equations so as to recognise when there is significant difference.There was no significant difference between values from our equations and those obtained from study among Ethiopians. Compared to report from Iran, our FVC and FEV1values (in males and females) as well as PEFR (in females) are significantly lower. Our values are also lower than values from Poland. We also observed disparities between our values and those of Afro Americans from the GLI study.ConclusionsOur findings show that it is important to always interpret ventilatory function tests in any individual by comparing it with reference values obtained from a well-defined population of healthy subjects of the same ethnic origin in similar geographic location.

Cardiac autonomic dysfunction in sickle cell anaemia and its correlation with QT parameters

Background: Abnormalities of QT parameters together with cardiac autonomic neuropathy (CAN) confer significant risks of cardiac morbidity and mortality in patients with diabetes mellitus. We questioned whether or not CAN influences occurrence of QT interval prolongation and dispersion in patients with sickle cell anaemia (SCA). Materials and Methods: Forty stable adult sickle cell patients with 44 healthy haemoglobin AA controls were studied. Baseline electrocardiograms were obtained and cardiovascular autonomic function tests were performed using standard protocols. Results: Mean corrected QT (QTc) in sickle cell patients was significantly higher (P = 0.001) than the mean of controls. Similarly, mean QT dispersion (QTcd) was higher (P = 0.001) in the former than in the latter. Mean QTc in patients with CAN was longer than patients with normal autonomic function (461 ± 26 ms versus 411 ± 23 ms), P = 0.001 (OR of 17.1, CI 3.48–83.71). Similarly, QTcd was higher (P = 0.001) in patients with CAN than those with normal cardiac autonomic function. Positive correlations were found between CAN with QTc and QTcd (r = 0.604, P = 0.001, r = 0.523, P = 0.001, respectively). Conclusion: CAN is a risk factor for abnormalities of QT parameters in SCA and both may be harbinger for cardiac death.

Advanced sickle cell associated interstitial lung disease presenting with cor pulmonale in a Nigerian

Previous studies have reported abnormal pulmonary function and pulmonary hypertension among Nigerians with sickle cell disease, but there is no report of interstitial lung disease among them. We report a Nigerian sickle cell patient who presented with computed tomography proven interstitial lung disease complicated by pulmonary hypertension and cor pulmonale.