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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/., Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised., Supported by Wellcome Trust grant 085790/Z/08/Z for the BOLD (Burden of Obstructive Lung Disease) Study. The initial BOLD programprogramme was funded in part by unrestricted educational grants to the Operations CenterCentre in Portland, Oregon from Altana, Aventis, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck, Novartis, Pfizer, Schering-Plough, Sepracor, and the University of Kentucky (Lexington, KY). A full list of local funders can be found at https://www.boldstudy.org.

Objectives: Oxygen is among the commonly used drugs in acute emergencies. Prescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health-care providers on various aspects of oxygen therapy. The purpose of this study was to assess the knowledge and practice of oxygen therapy among doctors and nurses working in Ondo State, South-West Nigeria and see how it compares with standard practice with a view to improving the quality care in this regard. Materials and Methods: A descriptive cross-sectional study was employed. The data were collected electronically using the Monkey survey application from consenting doctors and nurses through a self-administered validated and structured questionnaire. The questionnaire included the professional characteristics, educational background, awareness and use of oxygen therapy guidelines, knowledge of oxygen, indication for acute oxygen, and oxygen delivery practices. Data were analyzed using descriptive statistics and association between variables explored with Chi-square test at P < 0.05. Results: One hundred and seventy-six health workers participated in the study with mean age of 37.30 ± 8.88 years. One hundred and twelve (63.60%) of the respondents were doctors while 64 (36.40%) of the respondents were nurses. Sixty-eight (60.70%) of the doctors and 19 (29.70%) of nurses had a high level of knowledge of oxygen therapy (p Conclusion: Results from this study suggest that the level of knowledge was high in about half of the respondents and about the same percentage had poor oxygen therapy practice in hospitals in Ondo State, South West Nigeria. Therefore, regular training of healthcare workers should be encouraged to update their knowledge and practice of oxygen therapy.

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The challenges of Respiratory Medicine in Africa go beyond the coronavirus disease 2019 (COVID-19). Communicable diseases such as Pneumonia and Tuberculosis are still important public health challenges, although considerable strides in the management have been made. Non-communicable respiratory diseases are also increasing in burden and the risk factors are pervasive in Africa. The COVID-19 pandemic had exposed the weakness of the health system in most parts of Africa and this is an opportunity for stakeholders to come together to develop sustainable strategies to build resilient health systems. A number of African initiatives such as the Pan African Thoracic Society are at the forefront to improve Respiratory health in Africa and must work in collaboration with the global community to achieve this objective.

[Background] The global prevalence of chronic obstructive pulmonary disease (COPD) has increased markedly in recent decades. Given the scarcity of resources available to address global health challenges and respiratory medicine being relatively under-invested in, it is important to define research priorities for COPD globally. In this paper, we aim to identify a ranked set of COPD research priorities that need to be addressed in the next 10 years to substantially reduce the global impact of COPD., [Methods] We adapted the Child Health and Nutrition Research Initiative (CHNRI) methodology to identify global COPD research priorities., [Results] 62 experts contributed 230 research ideas, which were scored by 34 researchers according to six pre-defined criteria: answerability, effectiveness, feasibility, deliverability, burden reduction, and equity. The top-ranked research priority was the need for new effective strategies to support smoking cessation. Of the top 20 overall research priorities, six were focused on feasible and cost-effective pulmonary rehabilitation delivery and access, particularly in primary/community care and low-resource settings. Three of the top 10 overall priorities called for research on improved screening and accurate diagnostic methods for COPD in low-resource primary care settings. Further ideas that drew support involved a better understanding of risk factors for COPD, development of effective training programmes for health workers and physicians in low resource settings, and evaluation of novel interventions to encourage physical activity., [Conclusions] The experts agreed that the most pressing feasible research questions to address in the next decade for COPD reduction were on prevention, diagnosis and rehabilitation of COPD, especially in low resource settings. The largest gains should be expected in low- and middle-income countries (LMIC) settings, as the large majority of COPD deaths occur in those settings. Research priorities identified by this systematic international process should inform and motivate policymakers, funders, and researchers to support and conduct research to reduce the global burden of COPD., National Institute for Health Research (NIHR), Health Data Research UK.

Objectives The aim of this study was to evaluate pulmonary function in patients with mandibular fractures and to determine the pattern of pulmonary functions in these patients. Materials and methods This was a cross-sectional study of pulmonary functions in Nigerian non-smoking patients with isolated mandibular fractures managed at our health institution from December 2015 to June 2017. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), and ratio of FEV1 to FVC (FEV1/FVC) were measured for all participants using a portable spirometer just before treatment. The pulmonary indices were compared with the predicted reference values for Nigerians to determine the respiratory pattern. Results Forty participants consisting of six females (15.0%) and thirty-four males (85.0%) with a female to male ratio of 1:5.7 were included in this study. The mean patient age was 34.5±13.1 years (range, 17-63 years). The mean FVC, FEV1, FEV1/FVC, and PEFR were 3.8±1.2 L, 3.0±1.0 L, 74.3%±13.8%, and 5.2±2.2 L/s, respectively. Comparison of data with predicted values revealed that 17 subjects (42.5%) had normal pulmonary function pattern while 23 subjects (57.5%) had features suggestive of obstructive and restrictive pulmonary function patterns. Conclusion Isolated mandibular fractures presented with abnormal pulmonary function pattern.

Introduction: Obstructive sleep apnea (OSA) is associated with considerable morbidity and mortality. This study assessed the prevalence of high risk of OSA and investigated which anthropometric mea...

Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder commonly assessed by spirometry and health related quality of life (HRQoL) questionnaires. COPD assessment test (CAT) is a new questionnaire used for HRQoL evaluation especially in a clinic setting. Aims: To assess HRQoL using the CAT, and to determine the relationship of CAT to other measures of COPD such as pulmonary function test (PFT), dyspnea and six minutes walking distance test (6MDWT) among patients with COPD in Nigeria. Settings and Design: Cross-sectional study. Methods: Sixty stable patients with a clinical and spirometric diagnosis of COPD according to the GOLD criteria were recruited into the study. Spirometry was performed according to ATS/ERS guidelines. Health status, dyspnea and functional capacity of the patients were assessed using the CAT questionnaire, modified medical research council (MMRC) dyspnea scale and six-minute walking distance (6MDWT) respectively. Results: The mean age was 68.8 years ± 10.3. Sixty percent of the study participants were male. The mean BMI was 21.6 ± 4.8 kg/m2, 37(61.7%) of the patients were ex-smokers, 3.3% were current smokers and 35% were never smokers. In terms of frequency of exacerbations 18.3% had ≤ 1 per year and 5.0% had ≥ 2 per year. The CAT was strongly associated with 6MWDT (r = 0.85P < 0.001), FEV1% predicted (r= 0.67, P< 0.001) and with MMRC (r=0.64, p

Introduction:the relationship between asthma control and health-related quality of life (HRQoL) in adult asthmatics is fairly established, but the unique contribution of atopy to this relationship has received less attention. The aim of this study was to quantify the contribution of atopy to this relationship. Methods:in a cross-sectional study, we assessed HRQoL using mini–Asthma Quality of Life Questionnaire (AQLQ). Asthma control, atopy and lung function were assessed using the Asthma Control Test (ACT), skin prick test and spirometry respectively. Hierarchical multiple regression was used to examine the association between of HRQol and asthma control, atopy and other clinical and demographical factors. Results:eighty-two adult asthmatics (59 females), with median age of 44 years and median duration of asthma of 15 years were recruited from a tertiary hospital. Fifty-two (63%) were classified as atopic based on sensitization to at least one aeroallergen. The atopic individuals were younger and had better quality of life in activity domain; however, there was no significant difference between the atopic and non-atopic asthmatics in ACT score (19.0 vs 18.0) p=0.91, total AQLQ score (4.9 vs 4.6) p=0.22. The ACT scores correlated positively with total AQLQ scores [rho= 0.53, 95% Confidence Interval (CI) 0.35, 0.67; p< 0.001]. However, atopy contributed significantly to the emotional domain of HRQoL score, p=0.028. Conclusion:we concluded that better asthma control is associated with better quality of life and atopy contributed uniquely to emotional domain in health-related quality of life.

Background Chronic obstructive pulmonary disease (COPD) affects respiratory functioning and psychosocial factors. However, little is known about perceived ability of people with COPD to engage in a regular exercise program. This study assessed respiratory parameters, exercise capacity, psychosocial factors and their relations in people with COPD. Methods This cross-sectional study involved patients with COPD recruited from a Nigerian university teaching hospital. Respiratory parameters including forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) were assessed by using a spirometer and FEV1/FVC ratio was calculated. Participants were sitting upright in a comfortable chair and wearing a nose clip for measurements. The procedure was performed in accordance with the American Thoracic Society criteria. Exercise capacity was assessed by the 6-min walk test (6MWT). Gait speed was assessed by the distance covered in 6 min. Perceived exercise self-efficacy (PESE) and rating of perceived exertion (RPE) were assessed by exercise self-efficacy and Borg scales, respectively. Data were analysed using descriptive and inferential statistics. Alpha level was set at P Results The mean age of the 125 participants was 62.0 ± 7.1 years (60% male). The mean values for FEV1, FVC and FEV1/FVC were 1.8 ± 0.6 L, 2.4 ± 0.5 L and 58.0 ± 8.8%, respectively, and the mean 6MWT and PESE values were 291.1 ± 41.6 m 63.1 ± 11.2%. Exercise capacity was correlated with mean values for the respiratory parameters FEV1 (r = 0.29; P = 0.035), FVC (r = 0.32; P = 0.045) and FEV1/FVC ratio (r = 0.37; P = 0.007), and both exercise capacity and PESE were correlated with gait speed (r = 0.96, P = 0.001 and r = 0.57; P = 0.042) and RPE (r = 0.42, P = 0.050 and r = −0.44; P = 0.032), but PESE was not correlated with respiratory parameter values (P > 0.05). Conclusion Participants with COPD demonstrated reduced respiratory parameter values and low exercise capacity but moderate PESE. We found significant correlations between exercise capacity and respiratory parameter values, but PESE was correlated with only gait speed and RPE. The study has implications for respiratory health promotion and exercise adherence.

This study investigated the prevalence and association between exercise-induced asthma (EIA) and parental socio-economic status (PSES) among school-aged adolescents in a semiurban community in Nigeria. Three hundred and eighty-five adolescents (185 male and 200 female adolescents) whose ages ranged between 10 and 19 years participated in this cross-sectional study. Participants were recruited from four government approved secondary schools in Ido-Ekiti using a multistage sampling technique. Peak expiratory flow rate (PEFR) was assessed at baseline and after 6-min run test (6-MRT) on a level playing ground using a standard peak flow meter. PEFR measurements were repeated at 5th, 10th, 15th, and 20th min post 6-MRT. Participants who had >15.0% PEFR fall were considered to have EIA. PSES was assessed using a validated socio-economic status questionnaire. Descriptive and inferential statistics were used to analyze data. Alpha level was set at P15.0% PEFR scores) while 53.5% belonged to middle PSES class. There was no significant difference between PEFR scores of male and female participants at baseline and 5th min post 6-MRT. However, male participants had significant higher PEFR than the female counterparts at 10th (t=2.090, P=0.037), 15th (t=2.162, P=0.031), and 20th min (t=2.978, P=0.003). There was significant association between EIA and PSES (χ2=152.4; P=0.001). The prevalence of EIA is very high among school-aged adolescents in Nigeria and was significantly associated with PSES.

Rationale: Black Africans have reduced FVC compared with white persons, but the prevalence and determinants of reduced values are not well understood. Objectives: To evaluate the prevalence and factors leading to reduced FVC in a Nigerian population and to examine current theories regarding the determinants of this difference. Methods: We studied the ventilatory function of 883 adults aged 40 years or older participating in the Burden of Obstructive Lung DiseaseStudyinIle-Ife,Nigeria.Respondentscompletedpre-andpost- bronchodilator spirometry test and provided information on their smoking history, respiratory symptoms, risk factors, and diagnoses, including anthropometric details. We used standard categories to de fi ne body mass index as either underweight, normal, overweight, or obese. We de fi ned reduced FVC as a post-bronchodilator FVC below the lower limit of normal using National Health and Nutrition Examination Survey (NHANES) equations, Global Lung Function Initiative 2012 equations, and local reference equations based on nonsmoking study participants without a respiratory diagnosis. We fi t multivariate linear regression models to FVC as a continuous measure, adjusting for age, sex, height, and other confounders. Results: The prevalence of reduced FVC was 70.4% for men and 72.8% for women when using NHANES values for white Americans, 17.8% for men and 14.4% for women using NHANES equations for African Americans, and 15.5% for men and 20.5% for women using the Global Lung Function Initiative 2012 equations. Using the equations derived from nonsmoking respondents in the survey without a respiratory diagnosis, the prevalence of reduced FVC was less than 4% for both men and women. FVC was lower in participants who had less than 7 years of education (FVC, 2 96 ml; 95% con fi dence interval [CI], 2 172 to 2 19), were underweight (FVC, 2 269 ml; 95% CI, 2 464 to 2 73), were overweight (FVC, 2 132 ml; 95% CI, 2 219 to 2 46), and were obese (FVC, 2 222 ml; 95% CI, 2 332 to 2 112). Conclusions: There is a wide variation in the prevalence of reduced FVC based on the reference standard used. This variation is not satisfactorily explained by factors thought to affect FVC within individual populations. However, the prevalence strongly associates with both education level and body mass index in this population, regardless of the speci fi c standard used.

Introduction: Wood dust exposure is associated with an increased risk of respiratory disease. There is a paucity of research on the respiratory effects of this exposure on sawmill and furniture workers in Nigeria. Objectives: To determine the level of dust exposure and association with respiratory symptoms and lung function in Nigerian furniture and sawmill workers. Methods: Questionnaires were administered to obtain respiratory and occupational history from participants. Spirometry was performed according to ATS/ERS standards. Wood dust exposure was assessed with a static sampler. Result: The study comprised 160 males (80 sawmill and 80 furniture workers) with 80 matched hospital administrative workers recruited as controls. All were never smokers. Sawmill and furniture workers were exposed to mean inhalable dust levels of 26300 mg/m3 and 16600 mg/m3 respectively. Respiratory symptoms (RS) were common, with 65% of sawmill and 59% of furniture workers reporting at least one. Nasal discharge (47%), cough (40%) and sputum production (31%) were prevalent amongst workers but did not differ between industries. Workers were four times more likely to have at least one RS versus controls (p Conclusion: Dust exposures were very high compared to EU standards. Wood dust exposure is associated with respiratory symptoms and restrictive lung function compared to controls. Further studies are needed.

Closed reduction and maxillomandibular fixation (MMF) is associated with airway obstruction. The ventilatory effect of open reduction and rigid internal fixation (ORIF) as an alternative treatment has not been determined. The aim of this study was to compare the effects of MMF and ORIF on pulmonary function (PF) in patients with mandibular fractures. Using a computer-generated simple randomization protocol, 40 eligible participants were allocated to MMF and ORIF treatment groups. PF tests were done preoperatively and at 24 hours, 1, 6, and 7 weeks postoperative in all participants in both groups, using a portable office spirometer (Spirobank G). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, and peak expiratory flow rate (PEFR) were determined. At 6 weeks postoperative, PF tests were performed after the release of MMF. PF tests in the MMF and ORIF groups were similar preoperatively. At 24 hours postoperative, FEV1/FVC was significantly lower in the MMF group than in the ORIF group (p

Bronchiectasis, once an orphan disease is now gaining renewed attention as a significant cause of morbidity and mortality. It is a morphologic term used to describe abnormal, irreversibly dilated and thick-walled bronchi, with many etiologies. The management of bronchiectasis can be challenging because its pathogenetic mechanisms is still evolving. Its diagnosis and management is particularly more demanding especially in resource-limited settings like Nigeria because of delayed diagnosis and improper management with devastating consequences, hence this case study.

Introduction: There is a paucity of data on the respiratory health status of workers in bottling factories in Benin City, Nigeria. Such data will help to drive future studies and influence policy development on occupational health and safety in the country. This study assesses the respiratory symptoms and spirometric indices of exposed workers and controls. Methods: Respiratory symptoms and spirometric parameters of 18 workers on routine mandatory annual lung screening were assessed using the modified MRC (Medical Research Council) questionnaire and spirometer respectively, according to the European Respiratory Society and American Thoracic Society (ERS/ATS) guidelines. Results: The mean age of workers was 35.1 &plusmn, 6.7 years. Workers and controls were similar in age, sex, BMI (Body Mass Index) and health status (p &gt, 0.05). Respiratory symptoms were significantly higher among workers compared to controls. Overall, the result was statistically significant in the variables of wheeze in a smoky or dusty environment, presence of at least one respiratory symptom, better symptoms at weekends and better symptoms during holidays (p &lt, 0.05). In particular, 6 (33.3%) exposed workers had wheeze in a smoky or dusty environment, 9 (50.0%) exposed workers reported at least one respiratory symptom compared with 2 (11.1%) controls, 5 (27.8%) had better symptoms at weekends, and 7 (38.9%) had better symptoms at holidays (p &lt, 0.05). Generally, the reported frequency of respiratory symptoms among exposed workers were: cough (22.2%), sputum production (5.6%), breathlessness (11.1%) and wheeze (44.4%). Similarly, workers had significantly lower spirometric indices than controls, particularly in forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC) ratio and forced expiratory flow between 25% and 75% of FVC (FEF 25&ndash, 75%) measurements. Conclusions: This study provides evidence of adverse respiratory health effects among bottling factory workers which requires further investigation.

Asthma continues to be an important cause of morbidity and mortality in developing countries. But, its burden among adult populations in university campuses is not well described.Through a multistage cluster sampling of students and staff of the Obafemi Awolowo University, Ile-Ife, Nigeria, we obtained a representative sample, each for students and staff. We administered the European Community Respiratory Health Survey (ECRHS) screening questionnaire to all the respondents. A subgroup did a spirometry test and completed a detailed questionnaire. Asthma was considered "possible", if a respondent provided affirmative response to symptoms of "wheezing or whistling", "attack of shortness of breath", "diagnosed attack of asthma" in the last 12 months or "currently taking medicines for asthma".From population of 13,750 students and 1428 staff of the university, we systematically sampled 2750 (20%) students and all the staff. Amongst these, 2372 students and 455 staff completed the screening questionnaire. The mean age (SD) of the responders was 21.9 (3.2) and 46.1 (8.9) for students and staff and most of them were men; 58.6% and 65.9%, respectively. While an estimated 2.6% (95% CI: 1.7-3.5) of students had an asthma attack in the preceding 12 months, 14.5% (95% CI: 12.5-16.5) and 25.2% (95% CI: 22.8-27.7) reported shortness of breath and nocturnal cough, respectively. The staff population reported fewer symptoms. The proportion with "possible asthma" was 18.2% (95% CI: 16.0-20.4) for students and 8.0% (95% CI: 5.4-10.7) for staff.The prevalence of asthma is high among students and staff of Obafemi Awolowo University, Nigeria.

Background : Metered dose inhalers are cornerstone in effective management of bronchial asthma when correctly used. Most studies hitherto have focused on assessing patient’s knowledge of inhaler technique. We sought to assess the knowledge of inhaler technique, spacer device and peak flow meter among doctors and nurses in a tertiary healthcare institution in Nigeria. Method : A cross sectional survey of nurses and doctors from emergency department, family and internal medicine; who were attending a continuous professional development lecture, was carried out. From a total of 100 questionnaires administered, we retrieved 87 of which 75 were completed, giving a response rate of 75%. It was a selfadministered questionnaire. Data was analysed with SPSS version 21.0. Descriptive statistics were done. Association was examined using chi-square test. Result : Mean age of respondent was 35.8 years ± 8.7, 47(62.7%) were < 40 years, 33(44%) were male, nurses were 30(40.0%). Only 28(37.3%) had ever used a peak flow meter. Only 4(14.3%) used peak flow meter frequently, while 12(26.7%) checked patient’s inhaler technique often. Only 9 out of the 75 (12%) participants all of who are doctors knew at least 3 essential steps of the techniques in using the metered dose inhaler correctly. None of the participants got all the steps for the use of pMDI totally correct. Conclusion : Knowledge regarding the use of the metered dose inhaler and spacer device was poor. Health practitioners should have constant reminders in the form of continuous medical education to update their knowledge regarding correct inhaler technique. Funding : self-funded Keywords : asthma, inhalers, knowledge, doctors, nurses

Title: The relationship of serum interleukin-13 to asthma control in a sample of Nigerian asthmatics. Background: Asthma control is the main goal of asthma management and interleukin-13 (IL-13) has a major role in Th2 response that is characteristic of allergic asthma. Aim: We aimed to investigate the correlation between serum IL-13 and asthma control as measured by asthma control test (ACT) scores, hypothesizing that serum IL-13 would correlate inversely with ACT scores. Methods: It was a cross-sectional study in which 82 consecutive stable asthmatics ( mean age 44.3±16.3 years, 59 females) in a tertiary hospital in Nigeria were recruited. All subjects had assessment of asthma control by ACT, spirometry, skin prick test and serum IL-13 assay by a commercial ELISA kit. Correlation between ACT scores and serum IL-13 was assessed by spearman’s correlation coefficient. Results: The median (IQR) ACT score was 18(13-22) and median serum IL-13 was 4.0(3.3-4.4) pg/ml. Out of the 82 subjects, 49(59.8%) had uncontrolled asthma (ACT≤20). Serum IL-13 correlated inversely with ACT, rho= -0.218, p=0.025. The serum IL -13 median (IQR) concentration did not differ significantly between non atopic 4.1(3.7-4.4)pg/ml and atopic 3.8(3.2-4.4)pg/ml; p=0.159 asthmatics as measured by skin prick test. Conclusion: Serum IL-13 may be a useful biomarker to assess asthma control in Nigerian asthmatics.

Background and objectives We examined the association of respiratory symptoms, health status, and lung function with the use of solid fuel (wood, charcoal, coal or crop residue) for cooking or heating in a predominantly non-smoking population. Methods Using the protocol of the Burden of Obstructive Lung Diseases (BOLD) initiative, we collected representative population data using questionnaires and spirometry tests. We categorized solid fuel use into ‘never user’, ‘ex user’ and ‘current user’ based on responses to the survey. We developed regression models to evaluate the relation between use of solid fuel and the prevalence of respiratory symptoms, quality of life and lung function adjusting for confounding variables. Results Out of 1147 respondents with complete information on domestic fuel type, 33% were ‘never-users’, 19% were ‘ex-users’ while 48% reported current use of solid fuel for domestic cooking and/or indoor heating. Compared with never-users, current solid fuel users were more likely to report cough (OR: 1.7, 95% CI: 1.0, 2.9), cough or phlegm (OR: 1.6, 95% CI: 1.0, 2.5) and the association was stronger among women (OR: 3.0, 95% CI: 1.3, 7.1 and OR: 2.3, 95% CI: 1.1, 5.2, respectively). Current solid fuel users also had lower mental health status (coefficient: −1.5, 95% CI: −2.8, - 0.2) compared with the group of never-users. Current or previous domestic use of solid fuels for cooking or heating was not associated with higher prevalence of chronic airflow obstruction (FEV1/FVC Conclusions Using solid fuel for domestic cooking or heating was associated with a higher risk of cough or phlegm and a lower mental quality of life. However we found no significant effect in the prevalence of chronic airflow obstruction in Ife, Nigeria.

Introduction. Obstructive sleep apnea (OSA) is a growing public health problem in developing countries. However the burden among commercial drivers is not well described. Methods. The Epworth Sleepiness Scale (ESS) and Berlin questionnaire were administered to interstate commercial road transport drivers to assess the tendency to sleep in daytime and the risk of OSA, respectively. Body mass index (BMI), neck, and waist-hip circumferences were measured. Results. Out of 138 commercial drivers, 124 (90%) responded and provided complete data. The mean (SD) age, BMI, neck, and waist circumferences were 40.4 (9.3) years, 28.0 (4.6) kg/m2, 40.0 (3.0) cm, and 92.8 (11.1) cm, respectively. Twenty-two percent had ESS score above 11 and 36% of the respondents had a high risk for obstructive sleep apnea. Adjusting for age, BMI, and waist and neck circumferences, the key predictors of road accidents were ESS score above 11 (OR 3.77, 95% CI 1.18–12.06), self-reported diagnosis of hypertension (OR 4.63, 95% CI 1.46–14.69), and increasing hip circumference (OR 1.12, 95% CI 1.01–1.23). Conclusion. Obstructive sleep apnea is common among commercial interstate road drivers in Nigeria and ESS may be a simple tool for assessing accident risk.

Background: Assessment of health-related quality of life (HRQOL) has been shown to be more relevant to patients who have chronic diseases such as asthma, as achieving the best possible quality of life is the paramount objective in the management of such patients. This study assessed the quality of life of asthma patients and correlated it with the various clinical indices of asthma, such as age, sex, the duration of the asthma, medication used and its severity.Design: The study was a cross-sectional, analytical, case-control design, involving three approaches, i.e. quality of life, clinical assessment and lung function assessment. The patients who participated in this study completed the Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ). Statistical analysis was performed using Epi InfoTM version 6.04.Setting and subjects: The clinical setting was the respiratory unit of the department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. The rec...

Introduction: Particulate air pollution is associated with increased incidence of respiratory symptoms and decreased pulmonary, function but the relative impact of pollution from different domestic energy sources is not well-known or studied. Aim: The study was aimed at assessing the association between particulate concentrations, respiratory symptoms and lung function. Materials and Methods: It was a cross-sectional study comprised of randomly selected residents of three communities. These communities were selected according to the predominant type of fuel used for household cooking which were: firewood, kerosene and liquefied petroleum gas (LPG). Assessment of the indoor PM10 levels was done by filtration using the Gent stacked filter unit sampler for collection of atmospheric aerosol in two size fractions (PM2.5 and PM10). The Medical Research Council (MRC) questionnaire was administered followed by spirometry test. Results: The mean PM10 concentration in participants using LPG, kerosene and firewood was 80.8 ± 9.52 μg/m3, 236.9 ± 26.5 μg/m3 and 269 ±93.7 μg/m3, respectively. The mean age and height-adjusted percent predicted forced expiratory volumes in 1 s (FEV1) for men were 127 ± 7, 109 ± 40 and 91 ± 20 and for women were 129 ± 13, 115 ± 14, 100 ± 14 in users of LPG, kerosene and firewood, respectively. A similar trend was found in the forced vital capacity (FVCs). Users of firewood had significantly lower FEV1 and FVC compared with LPG users (P < 0.05). The participants using firewood had the highest prevalence of pulmonary and non-pulmonary symptoms (57.1%), whereas subjects using LPG had the lowest (23.8%). Conclusion: There are high levels of particulate matter pollutions with respiratory effects in residential indoor environments in Ile-Ife, NigeriaKeywords: Ile-Ife, lung function, particulate matter, particulate, respiratory

Background: Bronchial Asthma is a disease with increasing global significance. Its prevalence is projected to increase to 400 million by the year 2025 as compared to the present estimate of 300 million. Previously asthma was assessed mainly in terms of symptoms and measures of lung functions but more recently these indices have not been able to reflect the true state of the asthmatics. The focus is now shifting to an assessment and treatment approach based on control. Asthma Control Test (ACT) is a validated, simple and inexpensive instrument to assess control among patients with bronchial asthma. However, its relationship with lung function parameters is yet to be demonstrated among Nigerian asthmatic patients. Aim: The study aimed at assessing asthma control using ACT scores and to determine its relationship with lung function parameters among persons with asthma in a university respiratory clinic. Methodology: It was a cross-sectional study. The study included 65 patients with bronchial asthma who underwent routine check-ups in respiratory clinics at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile-Ife, Nigeria between October 2009 and January 2011. The ACT was administered to assess for asthma control. Lung function test was done using the guidelines of American Thoracic Society (ATS). Results : The mean pre-bronchodilator FEV 1 was 1.97 ± 0.87L, mean ACT score was 18.2+4.28, 24 (37%) of the study subjects had well-controlled asthma. The ACT scores were weakly correlated with percentage of predicted Forced Expiratory Volume in 1 second, FEV 1(r=0.220, p=

Background: The gold standard in assessing asthma control is the Global Initiative for Asthma (GINA) criteria. It is difficult to follow GINA criteria in assessing asthma control in resource poor settings because of the lack of access to pulmonary functions tests. The Asthma Control Test (ACT) questionnaire is a simple, self-administered, accessible and validated tool that is used in assessing control among asthmatics. The ACT has the added advantage that it does not require lung function assessment. However, its relationship with GINA guideline-defined asthma control has not been clarified in our setting. Aim: The aim of this study is to assess asthma control through ACT and GINA, and to determine if the ACT can be as useful as the GINA-guidelines criteria in assessing asthma control in our setting. Methodology: It was a cross-sectional analytical study. Asthma control was assessed by the ACT and GINA criteria questionnaires. Pulmonary function tests were performed on the subjects according to American Thoracic Society (ATS) guidelines. The sensitivity, specificity, negative and positive predictive values of ACT were determined. Results: A total of 65 asthmatics participated in this study. The level of asthma control among the subjects was poor, 37% and 23% by ACT and GINA criteria respectively. There was a significant and positive correlation between the ACT and GINA. The Kappa score for the entire subjects was 0.66 representing a substantial agreement between the ACT and GINA. Conclusion: Asthma control was poor among the subjects. The fact that ACT can predict GINA guidelines-based level of control further gives credence to its usefulness in a resource-poor clinical setting.

Objective Little is known about respiratory health of women who are occupationally exposed to biomass smoke outside their homes. This study reports the exposure and respiratory health of street cooks in Ile-Ife, Nigeria. Methods We assessed exposure to biomass smoke by questionnaire in 188 street cooks and 197 control women and by personal diffusive samplers to quantify volatile organic compounds (VOCs) in a subsample of the women. Respiratory symptoms were assessed by a standardised questionnaire, and pulmonary function was assessed by spirometry before and after bronchodilation. Regression analysis was conducted to compare the outcome between the two groups. Results The study included 188 women (median age 40, IQR 30–50 years) who had worked as street cooks for a median of 7 years (IQR 3–15 years) and 197 control women with similar demographics. Benzene concentration in passive samplers worn by the street cooks was significantly higher compared with controls (median (IQR) 119.3 (82.7–343.7) µg/m 3 vs 0.0 (0.0–51.2) µg/m 3 , p Conclusions This study provides evidence of adverse respiratory effects among street cooks using biomass fuels.

Biomass is a common domestic fuel in sub Saharan Africa but its association with respiratory symptoms, lung function and quality of life among adults is less understood. Using the Burden of Obstructive Lung Diseases (BOLD) study protocol, we assessed the relation of biomass exposure to respiratory symptoms, quality of life and lung function Methods: We sampled a representative population of adults aged 40 years and above. All the respondents had spirometry testing and completed standardized questionnaires including the five-level modified Medical Research Council (mMRC) dyspnoea scale. We defined biomass exposed as those who reported using wood or coal for domestic cooking/heating ever for at least 6 months duration AND current user. We assessed quality of life using the short form 12 questionnaire. We fitted regression models to estimate the effect of biomass. on outcome variables Results: In total, 1145 (63% female) were sampled - 795 biomass exposed and 350 non-biomass exposed. The mean (SD) age of participants was 56.7 (13.1) years. Biomass exposed participants were less likely to be overweight or obese, had less education and were no more likely to be smokers compared with non-biomass exposed respondents. Biomass exposed women were more likely to have cough; 2.89 (95% CI: 1.25-6.72) compared with men. No difference in the occurrence of wheeze, sputum or dyspnoea (mMRC>2) was observed. Women had lower SF-12 physical functioning score -1.73 (95% CI: -3.17 - -0.29) compared with men but there were no differences in their lung function parameters. Conclusion: Use of biomass as domestic fuel is associated with cough and lower quality of life.

Aim: Every individual would benefit from a well planned programme of exercise, asthmatics inclusive. The aim of this study is to compare the myocardial oxygen consumption of three exercise protocols in asthmatics Methods: Forty eight consecutive asthmatics were recruited between December 2005 and December 2006; each asthmatic performed the 3 exercise protocols (Cycle ergometer, step test and free running) in random order within a week. The systolic blood pressure (SBP) and heart rate (HR) were measured pre and post exercise. Rate pressure product (RPP) was used as a measure of myocardial oxygen consumption Results: The mean age of the patients was 24 .1±4.97 with equal number of females and males. There was no significant difference in HR, SBP and RPP, among the 3 exercise protocols at pre exercise phase. The post exercise RPP means results were; 21679.2±2741.3, 21993.3±3636.2, 20205.8±2922.4 free running, step test, cycle ergometer respectively. There was significant difference in the post exercise RPP (F=4.479 p=0.013) of the 3 exercise protocols with step test having the highest myocardial oxygen consumption. RPP in step test was significantly higher than that of free running and cycle ergometer (p< 0.05). No significant difference was found between RPP between free running and ergometer (p> 0.05). Conclusion: Step test was found to increase myocardial oxygen consumption more than free running and cycle ergometer [TAF Prev Med Bull 2012; 11(5.000): 559-564]

Objective:This study was to identify specific psychiatric morbidity among asthma patients and to compare their rates to controls.Method:Hundred consecutive asthmatics were screened using the General Health Questionnaire (GHQ-30), and the Present State Examination (PSE). The same instruments were also administered to 75 healthy individuals, and 75 orthopaedic patients.Results:Patients with asthma had a higher occurrence of psychopathology. The specific psychiatric diagnoses among asthmatics were generalized anxiety disorder (23%), depressive disorder (11%), while 2% had panic disorder.Conclusion:Psychiatric morbidity is more common among asthmatics, than the general population and other patient group.