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Meme H, Amukoye E, Bowyer C, Chakaya J, Dobson R, Fuld J, Gray CM, Kiplimo R, Lesosky M, Mortimer K, Ndombi A, Obasi A, Orina F, Quint JK, Semple S, West SE, Zurba L, Devereux G. Preterm birth, birth weight, infant weight gain and their associations with childhood asthma and spirometry: a cross-sectional observational study in Nairobi, Kenya. BMJ Open Respir Res 2023; 10:e001895. [PMID: 37735103 PMCID: PMC10514609 DOI: 10.1136/bmjresp-2023-001895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, the origins of asthma and high prevalence of abnormal lung function remain unclear. In high-income countries (HICs), associations between birth measurements and childhood asthma and lung function highlight the importance of antenatal and early life factors in the aetiology of asthma and abnormal lung function in children. We present here the first study in sub-Saharan Africa to relate birth characteristics to both childhood respiratory symptoms and lung function. METHODS Children attending schools in two socioeconomically contrasting but geographically close areas of Nairobi, Kenya, were recruited to a cross-sectional study of childhood asthma and lung function. Questionnaires quantified respiratory symptoms and preterm birth; lung function was measured by spirometry; and parents were invited to bring the child's immunisation booklet containing records of birth weight and serial weights in the first year. RESULTS 2373 children participated, 52% girls, median age (IQR), 10 years (8-13). Spirometry data were available for 1622. Child immunisation booklets were available for 500 and birth weight and infant weight gain data were available for 323 and 494 children, respectively. In multivariable analyses, preterm birth was associated with the childhood symptoms 'wheeze in the last 12 months'; OR 1.64, (95% CI 1.03 to 2.62), p=0.038; and 'trouble breathing' 3.18 (95% CI 2.27 to 4.45), p<0.001. Birth weight (kg) was associated with forced expiratory volume in 1 s z-score, regression coefficient (β) 0.30 (0.08, 0.52), p=0.008, FVC z-score 0.29 (95% CI 0.08 to 0.51); p=0.008 and restricted spirometry, OR 0.11 (95% CI 0.02 to 0.78), p=0.027. CONCLUSION These associations are in keeping with those in HICs and highlight antenatal factors in the aetiology of asthma and lung function abnormalities in sub-Saharan Africa.
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Affiliation(s)
- Helen Meme
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Evans Amukoye
- Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cressida Bowyer
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - Jeremiah Chakaya
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Jonathan Fuld
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cindy M Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Richard Kiplimo
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Medicine, College of Health Sciences University of KwaZulu-Natal, Cambridge, UK
| | - Amos Ndombi
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Fred Orina
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sarah E West
- Department of Environment and Geography, University of York, York, UK
| | | | - Graham Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Ahmed R, Osman R, Nightingale R, Nagem D, Thomson R, Malmborg R, Elmustafa M, Amaral AFS, Patel J, Burney P, El Sony A, Mortimer K. Prevalence and determinants of chronic respiratory diseases in adults in rural Sudan. Int J Tuberc Lung Dis 2023; 27:841-849. [PMID: 37880887 PMCID: PMC10599415 DOI: 10.5588/ijtld.22.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/19/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: Chronic respiratory diseases (CRDs) greatly contribute to worldwide mortality. Despite new data emerging from Africa, prevalence estimates and determinants of CRDs in rural settings are limited. This study sought to extend the existing research conducted in urban Sudan by conducting a rural comparison.METHODS: Participants aged ≥18 years (n = 1,850), living in rural Gezira State completed pre-and post-bronchodilator spirometry and a questionnaire. Prevalence of respiratory symptoms and spirometric abnormalities were reported. Regression analyses were used to identify risk factors for CRDs.RESULTS: Prevalence of chronic airflow obstruction (CAO) was 4.1% overall and 5.5% in those aged ≥40 years. Reversibility was seen in 6.4%. Low forced vital capacity (FVC) was seen in 58.5%, and at least one respiratory symptom was present in 40.7% of the participants. CAO was more common among people aged 60-69 years (OR 2.07, 95% CI 1.13-3.82) and less common among highly educated participants (OR 0.50, 95% CI 0.27-0.93). Being underweight was associated with lower FVC (OR 3.07, 95% CI 2.24-4.20).CONCLUSIONS: A substantial burden of CRD exists among adults in rural Sudan. Investment in CRD prevention and management strategies is needed.
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Affiliation(s)
- R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Osman
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Nightingale
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - D Nagem
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Thomson
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - M Elmustafa
- University of Gezira, Wad Medani, Wad Medani College of Medical Sciences and Technology, Wad Medani, Sudan
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London
| | - J Patel
- National Heart and Lung Institute, Imperial College London, London
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London
| | - A El Sony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK, National Heart and Lung Institute, Imperial College London, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, University of Cambridge, Cambridge, UK, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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3
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Arigliani M, Lum S, Zuiani C, Raywood E, Dogara LG, Zubair R, Castriotta L, Sunday AD, Inusa B, Cogo P. Comparison of Lung Function in Healthy Nigerian Children Living in Nigeria and in the United Kingdom. Am J Respir Crit Care Med 2022; 206:221-224. [PMID: 35426775 PMCID: PMC9887425 DOI: 10.1164/rccm.202201-0093le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Michele Arigliani
- University Hospital S. Maria della MisericordiaUdine, Italy,Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom,Corresponding author (e-mail: )
| | - Sooky Lum
- UCL Great Ormond Street Institute of Child HealthLondon, United Kingdom
| | - Chiara Zuiani
- University Hospital S. Maria della MisericordiaUdine, Italy
| | - Emma Raywood
- UCL Great Ormond Street Institute of Child HealthLondon, United Kingdom
| | | | | | | | | | - Baba Inusa
- Guy’s and St Thomas’ NHS TrustLondon, United Kingdom
| | - Paola Cogo
- University Hospital S. Maria della MisericordiaUdine, Italy
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Hsan S, Lakhdar N, Harrabi I, Zaouali M, Burney P, Denguezli M. Reduced forced vital capacity is independently associated with, aging, height and a poor socioeconomic status: a report from the Tunisian population-based BOLD study. BMC Pulm Med 2022; 22:267. [PMID: 35818049 PMCID: PMC9275164 DOI: 10.1186/s12890-022-02062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Reduced forced vital capacity (FVC) is a risk factor of all-cause mortality; however, the prevalence and determinants of reduced FVC are not available for the Tunisian population. This study investigated the association of reduced FVC with risk factors and health variables in an urban population of subjects aged ≥ 40 years and living in the city of Sousse in Tunisia. Methods A cross-sectional survey was performed using data from the Tunisian Burden of Obstructive Lung Disease (BOLD) study. We defined reduced FVC as a post-bronchodilator FVC below the lower limit of normal using National Health and Nutrition Examination Survey (NHANES) values and Global Lung Function Initiative 2012 equations (GLI 2012) and determined the relation between this finding and the potential risk factors (demographic and socioeconomic factors and the presence of chronic diseases), using multivariable regression analysis. Results The prevalence of reduced FVC was 26.6% (176/661) when using NHANES values for white Americans and 14.2% (94/661) using the GLI 2012 equations. Compared to people with normal FVC, those with a reduced FVC were significantly older, taller, had a lower body mass index (BMI), more respiratory symptoms and a higher prevalence of heart disease and hypertension. Multivariable analysis showed that reduced FVC was essentially driven by exposure to biomass smoke for heating, a number of schooling years lower than or equal to 6 years, a childhood history of hunger for a lack of money, aging and height. Conclusions The prevalence of reduced FVC is associated with a poor socioeconomic status aging and height.
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Affiliation(s)
- Safa Hsan
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia
| | - Nadia Lakhdar
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia
| | - Imed Harrabi
- Service d'épidémiologie, Faculté de Médecine de Sousse, Hôpital Farhat Hached, Université de Sousse, 4000, Sousse, Tunisia
| | - Monia Zaouali
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Meriam Denguezli
- Laboratoire de recherche: Physiologie de l'exercice et physiopathologie: de l'intégré au moleculaire, LR19ES09, Faculté de Médecine de Sousse, Université de Sousse, 4000, Sousse, Tunisia. .,Faculté de Médecine Dentaire de Monastir, Université de Monastir, Avenue Avicenne, Monastir, Tunisia.
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Sze DFL, Howarth TP, Lake CD, Ben Saad H, Heraganahally SS. Differences in the Spirometry Parameters Between Indigenous and Non-Indigenous Patients with COPD: A Matched Control Study. Int J Chron Obstruct Pulmon Dis 2022; 17:869-881. [PMID: 35480554 PMCID: PMC9037718 DOI: 10.2147/copd.s361839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Comparison of spirometry parameters between Indigenous and non-Indigenous patients with underlying chronic obstructive pulmonary disease (COPD) has been sparsely reported in the past. In this study, differences in the lung function parameters (LFPs), in particular spirometry values for forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC ratio between Indigenous and non-Indigenous patients with COPD were assessed. Methods In this retrospective study, Indigenous and non-Indigenous patients with a diagnosis of COPD between 2012-2020 according to spirometry criteria (ie; post-bronchodilator (BD) FEV1/FVC < 0.7) were included. A further analysis was undertaken to compare the differences in the spirometry parameters, including lower limit of normal (LLN) values matching for age, sex, height and smoking status between these two diverse ethnic populations. Results A total of 240/742 (32%) Indigenous and 873/4579 (19%) non-Indigenous patients were identified to fit the criteria for COPD. Indigenous patients were significantly younger (mean difference 9.9 years), with a greater proportion of females (50% vs 33%), underweight (20% vs 8%) and current smokers (47% vs 32%). Prior to matching, Indigenous patients' post-BD percent predicted values for FVC, FEV1, and FEV1/FVC ratio were 17, 17%, and -2 points lower (Hedges G measure of effect size large (0.91), large (0.87), and small (0.25), respectively). Among the matched cohort (111 Indigenous and non-Indigenous), Indigenous patients LFPs remained significantly lower, with a mean difference of 16%, 16%, and -4, respectively (Hedges G large (0.94), large (0.92) and small (0.41), respectively). The differences persisted despite no significant differences in LLN values for these parameters. Conclusion Indigenous Australian patients with COPD display a significantly different demographic and clinical profile than non-Indigenous patients. LFPs were significantly lower, which may or may not equate to greater severity of disease in the absence of normative predictive lung function reference values specific to this population.
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Affiliation(s)
- Dorothy F L Sze
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Timothy P Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
| | - Clair D Lake
- Pulmonary Function Laboratory, Royal Darwin Hospital, Darwin, NT, Australia
| | - Helmi Ben Saad
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Research laboratory "Heart Failure, LR12SP09", Farhat HACHED Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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6
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Eze JN, Ozoh OB, Otuu FC, Shu EN, Anyaehie BU. Respiratory symptoms and lung function among inmates in a Nigerian prison: a cross sectional study. BMC Pulm Med 2022; 22:84. [PMID: 35287649 PMCID: PMC8918425 DOI: 10.1186/s12890-022-01882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Prisoners in low- and middle-income countries are vulnerable to poor lung health from multiple adverse conditions confronted within the prison such as overcrowding, poor ventilation and exposure to second hand smoke. Evidence for poor lung health in this disadvantaged group is needed to inform policy on prison conditions in this region. We assessed the respiratory symptoms and lung function measured by spirometry among prisoners in Enugu, Nigeria and explored the associations between them.
Methods This was a cross‑sectional study among prison inmates aged 16–76 years. We assessed frequency of respiratory symptoms in the preceding one-year, previous respiratory diagnosis, tobacco smoking status and spirometry. The relationships between respiratory symptoms, smoking status and spirometry pattern were determined using the Chi‑square test. Results Of 245 participants, 170 (69.4%) reported at least one respiratory symptom. In all, 214 (87.3%) performed spirometry and 173 (80.8%) had good quality spirometry tests. Using the Global Lung Function Initiative (GLI) predicted values for ‘African Americans’, spirometry results were abnormal in 41 (23.7%) of the participants and when the GLI reference values for ‘Other’ ethnic groups was applied, 78 (45.1%) had abnormal results. Restrictive impairment was most common occurring in 21 (12.1%) and 59 (34.1%) respectively based on the two reference values, and obstructive pattern was found in 18 (10.4%) and 13 (7.5%) respectively. There was no significant association between abnormal spirometry pattern and presence of respiratory symptoms or smoking status. No previous diagnosis for asthma, or bronchitis/chronic obstructive pulmonary disease (COPD) had been made in any of the participants. Conclusions We reported high rates of respiratory symptoms and abnormal lung function with under-diagnosis of chronic respiratory diseases among inmates in Enugu prison. The restrictive abnormalities based on GLI equations remain unexplained. There is need for improvement in prison facilities that promote lung health and enhanced access to diagnosis and treatment of respiratory non-communicable disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01882-7.
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Affiliation(s)
- Joy Nkiru Eze
- Department of Paediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, 400001, Nigeria.
| | - Obianuju Beatrice Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Elvis Neba Shu
- Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Bond Ugochukwu Anyaehie
- Department of Human Physiology, Faculty of Basic Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Mortimer K, Montes de Oca M, Salvi S, Balakrishnan K, Hadfield RM, Ramirez-Venegas A, Halpin DMG, Ozoh Obianuju B, Han MeiLan K, Perez Padilla R, Kirenga B, Balmes JR. Household air pollution and COPD: cause and effect or confounding by other aspects of poverty? Int J Tuberc Lung Dis 2022; 26:206-216. [PMID: 35197160 PMCID: PMC8886958 DOI: 10.5588/ijtld.21.0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
SETTING : Household air pollution (HAP) and chronic obstructive pulmonary disease (COPD) are both major public health problems, reported to cause around 4 million and 3 million deaths every year, respectively. The great majority of these deaths, as well as the burden of disease during life is felt by people in low- and middle-income countries (LMICs). OBJECTIVE AND DESIGN : The extent to which HAP causes COPD is controversial; we therefore undertook this review to offer a viewpoint on this from the Global Initiative for COPD (GOLD). RESULTS : We find that while COPD is well-defined in many studies on COPD and HAP, there are major limitations to the definition and measurement of HAP. It is thus difficult to disentangle HAP from other features of poverty that are themselves associated with COPD. We identify other limitations to primary research studies, including the use of cross-sectional designs that limit causal inference. CONCLUSION : There is substantial preventable morbidity and mortality associated with HAP, COPD and poverty, separately and together. Although it may not be possible to define clear causal links between HAP and COPD, there is a clear urgency to reduce the avoidable burden of disease these inflict on the world’s poor.
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Affiliation(s)
- K Mortimer
- University of Cambridge, Cambridge, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela and Centro Médico de Caracas, Caracas, Venezuela
| | - S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | | | - R M Hadfield
- Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - A Ramirez-Venegas
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - D M G Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - B Ozoh Obianuju
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - R Perez Padilla
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - J R Balmes
- Department of Medicine, University of California, San Francisco and Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
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Mozun R, Berger F, Singer F. One size does not fit all-Why do pediatric spirometry estimates vary across populations "down under"? Pediatr Pulmonol 2022; 57:345-346. [PMID: 34767695 DOI: 10.1002/ppul.25751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Rebeca Mozun
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Florian Berger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Florian Singer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Paediatrics, PEDNET, Paediatric Clinical Trial Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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10
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Bhakta NR, Kaminsky DA, Bime C, Thakur N, Hall GL, McCormack MC, Stanojevic S. Addressing Race in Pulmonary Function Testing by Aligning Intent and Evidence With Practice and Perception. Chest 2021; 161:288-297. [PMID: 34437887 PMCID: PMC8783030 DOI: 10.1016/j.chest.2021.08.053] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 10/27/2022] Open
Abstract
The practice of using race or ethnicity in medicine to explain differences between individuals is being called into question because it may contribute to biased medical care and research that perpetuates health disparities and structural racism. A commonly cited example is the use of race or ethnicity in the interpretation of pulmonary function test (PFT) results, yet the perspectives of practicing pulmonologists and physiologists are missing from this discussion. This discussion has global relevance for increasingly multicultural communities in which the range of values that represent normal lung function is uncertain. We review the underlying sources of differences in lung function, including those that may be captured by race or ethnicity, and demonstrate how the current practice of PFT measurement and interpretation is imperfect in its ability to describe accurately the relationship between function and health outcomes. We summarize the arguments against using race-specific equations as well as address concerns about removing race from the interpretation of PFT results. Further, we outline knowledge gaps and critical questions that need to be answered to change the current approach of including race or ethnicity in PFT results interpretation thoughtfully. Finally, we propose changes in interpretation strategies and future research to reduce health disparities.
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Affiliation(s)
- Nirav R Bhakta
- University of California, San Francisco, San Francisco, CA.
| | | | - Christian Bime
- College of Medicine, The University of Arizona Health Science, Tucson, AZ
| | - Neeta Thakur
- University of California, San Francisco, San Francisco, CA; Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Graham L Hall
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute and School of Allied Health, Curtin University, Perth, WA, Australia
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Ndukwu CI, Ozoh OB, Ale BM, Ayuk AC, Elo-Ilo JC, Awokola BI. Spirometry Abnormalities and Its Associated Factors Among Primary School Children in a Nigerian City. Clin Med Insights Pediatr 2021; 15:11795565211001897. [PMID: 33795943 PMCID: PMC7983488 DOI: 10.1177/11795565211001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is paucity of data on objectively measured lung function abnormalities in Nigerian children using diagnostic testing methods such as spirometry. Such assessments could prompt early diagnosis and therapeutic interventions. METHODS This was a cross sectional study among children aged 6 to 12 years in South-Eastern Nigeria. We selected participants from one school using a multistage stratified random sampling technique. A structured respiratory questionnaire was administered to obtain necessary data. The lung functions of the children were measured by spirometry. We used Lower Limits of Normal (LLN) based on GLI reference equations for African-American and mixed ethnicities to define abnormal spirometry. We studied the association between the exposures and lung function using logistic regression/chi-squared tests. RESULTS A total of 145 children performed acceptable and repeatable tests. There were 73 males (50.3%), mean age of 9.13 years (+1.5) and age range 6 to 12 years. Frequency of respiratory symptoms was cough- 64 (44.1%) and wheeze in 19 (13.1%). Using GLI for African-Americans, fifty-five (37.9%) children had abnormal spirometryobstructive pattern in 40 (27.6%) and restrictive pattern in 15 (10.3%). The two references showed significant differences in interpretation of abnormality (χ2 = 72.86; P < .001). Respiratory symptom-wheeze was an independent determinant of abnormal lung function in this population.(OR = 0.31; 95%CI: 0.10-0.94; P = .04). CONCLUSION There is a high burden of respiratory symptoms and abnormal spirometry among these children. The need for objective evaluation of lung function especially for children with respiratory symptoms is evident.
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Affiliation(s)
| | - Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Adaeze C Ayuk
- Department of Paediatrics, College of Medicine, University of Nigeria - Enugu Campus, Enugu, Nigeria
| | - Jacinta C Elo-Ilo
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Babatunde I Awokola
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Clinical Services Department, Medical Research Council Gambia at LSHTM, Fajara, The Gambia
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12
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Heraganahally SS, Howarth T, White E, Sorger L, Biancardi E, Ben Saad H. Lung function parameters among Australian Aboriginal 'apparently healthy' adults: an Australian Caucasian and Global Lung Function Initiative (GLI-2012) various ethnic norms comparative study. Expert Rev Respir Med 2020; 15:833-843. [PMID: 33166208 DOI: 10.1080/17476348.2021.1847649] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: There is sparse literature evidence evaluating the applicability of the GLI-2012 spirometric norms for Australian Aboriginal adults.Methods: Lung function parameters (LFPs) were compared between Australian Aboriginal and Australian Caucasians, and the fit of Australian Aboriginals LFPs with various ethnic GLI equations was tested.Results: Of 1350 and 5634 Pulmonary function tests (PFTs) in Australian Aboriginal and Australian Caucasian adults, 153 and 208 PFTs matched for anthropometrics and normal chest radiology, respectively. Absolute FVC and FEV1 values were 20% lower in Australian Aboriginals compared to Australian Caucasians. Differences remained significant after accounting for age, sex, height, weight and smoking status in multivariate regression (FVC -0.84 L (-0.98, -0.71), FEV1 - 0.72 L (-0.84, -0.59), but with nearly preserved FEV1/FVC. GLI-2012 transformation resulted in z-scores significantly below zero for each of FVC, FEV1 and FEV1/FVC with z-scores ranging from -4.52 (-4.87, -4.16) for North East Asian FVC transformation for males, to -0.34 (-0.73, 0.05) for Black FVC transformation for females.Conclusions: Australian Aboriginal adults had 20% lower values for FVC and FEV1 but nearly preserved absolute FEV1/FVC in comparison to Australian Caucasians. The GLI-2012 spirometric norms do not appear to fit for Australian Aboriginal adults regardless of which ethnicity options selected, including 'others/mixed'.
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Affiliation(s)
- Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia
| | - Timothy Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Elisha White
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Lisa Sorger
- Department of Medical Imaging, Royal Darwin Hospital, Darwin, Australia
| | - Edwina Biancardi
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Helmi Ben Saad
- Faculté de Médecine de Sousse, Laboratoire de Physiologie, Université de Sousse, Sousse, Tunisia.,Department of Physiology and Functional Exploration, Farhat HACHED Hospital of Sousse, Sousse, Tunisia.,Heart Failure Research Laboratory (LR12SP09), Farhat HACHED Hospital, Sousse, Tunisia
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13
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Mishra N, Salvi S, Lyngdoh T, Agrawal A. Low lung function in the developing world is analogous to stunting: a review of the evidence. Wellcome Open Res 2020; 5:147. [PMID: 33381655 PMCID: PMC7745193 DOI: 10.12688/wellcomeopenres.15929.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Low vital capacity, one of the consequences of restricted lung growth, is a strong predictor of cardiovascular mortality. Vital capacity is lower in the developing world than the developed world, even after adjusting for height, weight and gender. This difference is typically dismissed as ethnic variation, adjusted for by redefining normal. Whether this is a consequence of stunted lung growth, rather than just genetically smaller lungs, has not been investigated in detail. Therefore, we sought to compare factors implicated in both stunting and lung development, particularly in the developing world. Methods: We conducted a manual screen of articles identified through Google Scholar and assessed risk of bias. No language restrictions were applied, so long as there was an associated English abstract. We queried VizHub (Global Burden of Disease Visualization Tool) and Google Dataset search engines for disease burden and genome wide association studies. The scope of the article and the heterogeneity of the outcome measures reported required a narrative review of available evidence. To the extent possible, the review follows PRISMA reporting guidelines. Results: Early life influences operate in synergism with genetic, environmental and nutritional factors to influence lung growth and development in children. Low lung function and stunting have common anthropometric, environmental and nutritional correlates originating during early development. Similar anthropometric correlates shared chronic inflammatory pathways, indicated that the two conditions were analogous. Conclusion: The analogy between poor lung function and stunting is conspicuous in the developing world, with malnutrition at the center of non -achievement of growth potential, susceptibility to infectious diseases and intrauterine programming for metabolic syndrome. This counter the idea of redefining the normal for lung function measurements, since observed inter-ethnic variations are likely a mix of natural genetic differences as well as differences in nurture such that reduced lung function reflects early life adversities.
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Affiliation(s)
- Navya Mishra
- Public Health Foundation of India, Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | | | | | - Anurag Agrawal
- Academy of Scientific and Innovative Research, Ghaziabad, India.,CSIR Institute of Genomics and Integrative Biology, Delhi, Delhi, India
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14
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Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study of adults in Malawi. PLoS One 2020. [DOI: 10.1371/journal.pone.0242226
expr 968654662 + 861456751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Purpose
The aim of this article is to provide a detailed description of the Chikwawa lung health cohort which was established in rural Malawi to prospectively determine the prevalence and causes of lung disease amongst the general population of adults living in a low-income rural setting in Sub-Saharan Africa.
Participants
A total of 1481 participants were randomly identified and recruited in 2014 for the baseline study. We collected data on demographic, socio-economic status, respiratory symptoms and potentially relevant exposures such as smoking, household fuels, environmental exposures, occupational history/exposures, dietary intake, healthcare utilization, cost (medication, outpatient visits and inpatient admissions) and productivity losses. Spirometry was performed to assess lung function. At baseline, 56.9% of the participants were female, mean age was 43.8 (SD:17.8) and mean body mass index (BMI) was 21.6 Kg/m2 (SD: 3.46)
Findings to date
The cohort has reported the prevalence of chronic respiratory symptoms (13.6%, 95% confidence interval [CI], 11.9–15.4), spirometric obstruction (8.7%, 95% CI, 7.0–10.7), and spirometric restriction (34.8%, 95% CI, 31.7–38.0). Additionally, an annual decline in forced expiratory volume in one second [FEV1] of 30.9mL/year (95% CI: 21.6 to 40.1) and forced vital capacity [FVC] by 38.3 mL/year (95% CI: 28.5 to 48.1) has been reported.
Future plans
The ongoing phases of follow-up will determine the annual rate of decline in lung function as measured through spirometry and the development of airflow obstruction and restriction, and relate these to morbidity, mortality and economic cost of airflow obstruction and restriction. Population-based mathematical models will be developed driven by the empirical data from the cohort and national population data for Malawi to assess the effects of interventions and programmes to address the lung burden in Malawi. The present follow-up study started in 2019.
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15
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Njoroge MW, Rylance S, Nightingale R, Gordon S, Mortimer K, Burney P, Rylance J, Obasi A, Niessen L, Devereux G. Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study of adults in Malawi. PLoS One 2020; 15:e0242226. [PMID: 33180873 PMCID: PMC7660567 DOI: 10.1371/journal.pone.0242226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/28/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this article is to provide a detailed description of the Chikwawa lung health cohort which was established in rural Malawi to prospectively determine the prevalence and causes of lung disease amongst the general population of adults living in a low-income rural setting in Sub-Saharan Africa. PARTICIPANTS A total of 1481 participants were randomly identified and recruited in 2014 for the baseline study. We collected data on demographic, socio-economic status, respiratory symptoms and potentially relevant exposures such as smoking, household fuels, environmental exposures, occupational history/exposures, dietary intake, healthcare utilization, cost (medication, outpatient visits and inpatient admissions) and productivity losses. Spirometry was performed to assess lung function. At baseline, 56.9% of the participants were female, mean age was 43.8 (SD:17.8) and mean body mass index (BMI) was 21.6 Kg/m2 (SD: 3.46). FINDINGS TO DATE The cohort has reported the prevalence of chronic respiratory symptoms (13.6%, 95% confidence interval [CI], 11.9-15.4), spirometric obstruction (8.7%, 95% CI, 7.0-10.7), and spirometric restriction (34.8%, 95% CI, 31.7-38.0). Additionally, an annual decline in forced expiratory volume in one second [FEV1] of 30.9mL/year (95% CI: 21.6 to 40.1) and forced vital capacity [FVC] by 38.3 mL/year (95% CI: 28.5 to 48.1) has been reported. FUTURE PLANS The ongoing phases of follow-up will determine the annual rate of decline in lung function as measured through spirometry and the development of airflow obstruction and restriction, and relate these to morbidity, mortality and economic cost of airflow obstruction and restriction. Population-based mathematical models will be developed driven by the empirical data from the cohort and national population data for Malawi to assess the effects of interventions and programmes to address the lung burden in Malawi. The present follow-up study started in 2019.
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Affiliation(s)
- Martin W. Njoroge
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Sarah Rylance
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Rebecca Nightingale
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Stephen Gordon
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Burney
- National heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jamie Rylance
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - Angela Obasi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louis Niessen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Graham Devereux
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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16
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Ozoh OB, Eze JN, Adeyeye OO, Eromosele O, Dede SK, Ndukwu CI, Zyl-Smit RV. Unrecognized Respiratory Morbidity among Adolescents and Young Adults in Nigeria: Implications for Future Health Outcomes. Niger Med J 2020; 61:210-217. [PMID: 33284873 PMCID: PMC7688032 DOI: 10.4103/nmj.nmj_36_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/08/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background: Lung function impairment is a major determinant of morbidity and mortality. Unrecognized respiratory morbidity may be a missed opportunity to improve future health outcomes. Aim: The aim of this study was to investigate the prevalence of respiratory symptoms and the relationship to spirometry abnormalities and respiratory diagnosis among medical students in Lagos, Nigeria. Methods: This was a cross-sectional study among students aged 16–35 years. We assessed frequency of respiratory symptoms, previous respiratory diagnosis, and spirometry abnormalities. The relationship between respiratory symptoms, spirometry pattern, and previous respiratory diagnosis was determined using the Chi-square test and stepwise forward logistic regression analysis. Results: Of 640 participants, 464 (72.5%) performed good quality spirometry tests. Two hundred and forty-four (52.6%) had at least one respiratory symptom. Preexisting conditions were only identified in 60 (12.9%): 49 (7.7%) asthma, 29 (4.5%) allergic rhinitis, 16 (2.5%) treated tuberculosis, and 8 (1.3%) bronchitis/chronic obstructive pulmonary disease. Using the Global Lung Function Initiative (GLI) lung function predicted values, obstructive (8.4%) and restrictive abnormalities (25.4%) were common. An obstructive pattern was associated with previous diagnosis of asthma, but there was no significant association for the restrictive spirometry pattern. Conclusions: Among otherwise healthy students, respiratory symptoms and lung function abnormalities are common. The vast majority are without a formal diagnosis. Asthma accounted for the majority of obstructive spirometry pattern seen, but the restrictive abnormalities based on GLI equations remain unexplained. Further research is required to determine the cause of these abnormalities and long-term implications in apparently healthy young individuals.
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Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Joy N Eze
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Olufunke O Adeyeye
- Department of Medicine, Lagos State University College of Medicine and the Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ojiebun Eromosele
- Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Sandra K Dede
- Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chizalu I Ndukwu
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Richard Van Zyl-Smit
- Department of Medicine, Division of Pulmonology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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17
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Mishra N, Salvi S, Lyngdoh T, Agrawal A. Low lung function in the developing world is analogous to stunting: a review of the evidence. Wellcome Open Res 2020; 5:147. [DOI: 10.12688/wellcomeopenres.15929.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Low vital capacity, one of the consequences of restricted lung growth, is a strong predictor of cardiovascular mortality. Vital capacity is lower in the developing world than the developed world, even after adjusting for height, weight and gender. This difference is typically dismissed as ethnic variation, adjusted for by redefining normal. Whether this is a consequence of stunted lung growth, rather than genetically smaller lungs, has not been investigated in detail. Therefore, we sought to compare factors implicated in both stunting and lung development, particularly in the developing world. Methods: We conducted a manual screen of articles identified through Google Scholar and assessed risk of bias. No language restrictions were applied, so long as there was an associated English abstract. We queried VizHub (Global Burden of Disease Visualization Tool) and Google Dataset search engines for disease burden and genome wide association studies. The scope of the article and the heterogeneity of the outcome measures reported required a narrative review of available evidence. To the extent possible, the review follows PRISMA reporting guidelines. Results: Early life influences operate in synergism with environmental and nutritional factors to influence lung growth and development in children. Low lung function and stunting have common anthropometric, environmental and nutritional correlates originating during early development. Similar anthropometric correlates and shared chronic inflammatory pathways indicated that the two conditions were analogous. Conclusion: The analogy between poor lung function and stunting is conspicuous in the developing world, where malnutrition lies at the center of non -achievement of growth potential, susceptibility to infectious diseases and intrauterine programming for metabolic syndrome. The common pathological mechanisms governing stunting and lung function deficits counter the idea of redefining the normal for lung function measurements.
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18
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Rylance S, Jewell C, Naunje A, Mbalume F, Chetwood JD, Nightingale R, Zurba L, Flitz G, Gordon SB, Lesosky M, Balmes JR, Mortimer K. Non-communicable respiratory disease and air pollution exposure in Malawi: a prospective cohort study. Thorax 2020; 75:220-226. [PMID: 32079666 PMCID: PMC7063402 DOI: 10.1136/thoraxjnl-2019-213941] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE There are no population-based studies from sub-Saharan Africa describing longitudinal lung function in adults. OBJECTIVES To explore the lung function trajectories and their determinants, including the effects of air pollution exposures and the cleaner-burning biomass-fuelled cookstove intervention of the Cooking and Pneumonia Study (CAPS), in adults living in rural Malawi. METHODS We assessed respiratory symptoms and exposures, spirometry and measured 48-hour personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO), on three occasions over 3 years. Longitudinal data were analysed using mixed-effects modelling by maximum likelihood estimation. MEASUREMENTS AND MAIN RESULTS We recruited 1481 adults, mean (SD) age 43.8 (17.8) years, including 523 participants from CAPS households (271 intervention; 252 controls), and collected multiple spirometry and air pollution measurements for 654 (44%) and 929 (63%), respectively. Compared with Global Lung Function Initiative African-American reference ranges, mean (SD) FEV1 (forced expiratory volume in 1 s) and FVC (forced vital capacity) z-scores were -0.38 (1.14) and -0.19 (1.09). FEV1 and FVC were determined by age, sex, height, previous TB and body mass index, with FEV1 declining by 30.9 mL/year (95% CI: 21.6 to 40.1) and FVC by 38.3 mL/year (95% CI: 28.5 to 48.1). There was decreased exposure to PM2.5 in those with access to a cookstove but no effect on lung function. CONCLUSIONS We did not observe accelerated lung function decline in this cohort of Malawian adults, compared with that reported in healthy, non-smoking populations from high-income countries; this suggests that the lung function deficits we measured in adulthood may have origins in early life.
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Affiliation(s)
- Sarah Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Andrew Naunje
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Frank Mbalume
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - John D Chetwood
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lindsay Zurba
- Education for Health Africa, Vereeniging, South Africa
| | - Graham Flitz
- School of Public Health, University of California, Berkeley, California, USA
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - John R Balmes
- School of Public Health, University of California, Berkeley, California, USA
- Environmental Health Sciences Division, University of California San Francisco, San Francisco, California, USA
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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19
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Rylance S, Nightingale R, Naunje A, Mbalume F, Jewell C, Balmes JR, Grigg J, Mortimer K. Lung health and exposure to air pollution in Malawian children (CAPS): a cross-sectional study. Thorax 2019; 74:1070-1077. [PMID: 31467192 PMCID: PMC6860406 DOI: 10.1136/thoraxjnl-2018-212945] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/25/2019] [Accepted: 06/01/2019] [Indexed: 11/30/2022]
Abstract
Background Non-communicable lung disease and exposure to air pollution are major problems in sub-Saharan Africa. A high burden of chronic respiratory symptoms, spirometric abnormalities and air pollution exposures has been found in Malawian adults; whether the same would be true in children is unknown. Methods This cross-sectional study of children aged 6–8 years, in rural Malawi, included households from communities participating in the Cooking and Pneumonia Study (CAPS), a trial of cleaner-burning biomass-fuelled cookstoves. We assessed; chronic respiratory symptoms, anthropometry, spirometric abnormalities (using Global Lung Initiative equations) and personal carbon monoxide (CO) exposure. Prevalence estimates were calculated, and multivariable analyses were done. Results We recruited 804 children (mean age 7.1 years, 51.9% female), including 476 (260 intervention; 216 control) from CAPS households. Chronic respiratory symptoms (mainly cough (8.0%) and wheeze (7.1%)) were reported by 16.6% of children. Average height-for-age and weight-for-age z-scores were −1.04 and −1.10, respectively. Spirometric abnormalities (7.1% low forced vital capacity (FVC); 6.3% obstruction) were seen in 13.0% of children. Maximum CO exposure and carboxyhaemoglobin levels (COHb) exceeded WHO guidelines in 50.1% and 68.5% of children, respectively. Children from CAPS intervention households had lower COHb (median 3.50% vs 4.85%, p=0.006) and higher FVC z-scores (−0.22 vs −0.44, p=0.05) than controls. Conclusion The substantial burden of chronic respiratory symptoms, abnormal spirometry and air pollution exposures in children in rural Malawi is concerning; effective prevention and control strategies are needed. Our finding of potential benefit in CAPS intervention households calls for further research into clean-air interventions to maximise healthy lung development in children.
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Affiliation(s)
- Sarah Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andrew Naunje
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Frank Mbalume
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - John R Balmes
- Environmental Health Sciences Division, University of California Berkeley, Berkeley, California, USA
| | - Jonathan Grigg
- Centre for Child Health, Queen Mary University London, London, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK .,Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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20
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21
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Sakhamuri S, Lutchmansingh F, Simeon D, Conyette L, Burney P, Seemungal T. Reduced forced vital capacity is independently associated with ethnicity, metabolic factors and respiratory symptoms in a Caribbean population: a cross-sectional study. BMC Pulm Med 2019; 19:62. [PMID: 30866890 PMCID: PMC6416949 DOI: 10.1186/s12890-019-0823-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background Relationships between low forced vital capacity (FVC), and morbidity have previously been studied but there are no data available for the Caribbean population. This study assessed the association of low FVC with risk factors, health variables and socioeconomic status in a community-based study of the Trinidad and Tobago population. Methods A cross-sectional survey was conducted using the Burden of Obstructive Lung Disease (BOLD) study protocol. Participants aged 40 years and above were selected using a two-stage stratified cluster sampling. Generalized linear models were used to examine associations between FVC and risk factors. Results Among the 1104 participants studied a lower post-bronchodilator FVC was independently associated with a large waist circumference (− 172 ml; 95% CI, − 66 to − 278), Indo-Caribbean ethnicity (− 180 ml; 95% CI, − 90 to − 269) and being underweight (− 185 ml; 95% CI, − 40 to − 330). A higher FVC was associated with smoking cannabis (+ 155 ml; 95% CI, + 27 to + 282). Separate analyses to examine associations with health variables indicated that participants with diabetes (p = 0∙041), history of breathlessness (p = 0∙007), and wheeze in the past 12 months (p = 0∙040) also exhibited lower post-bronchodilator FVC. Conclusion These findings suggest that low FVC in this Caribbean population is associated with ethnicity, low body mass index (BMI), large waist circumference, chronic respiratory symptoms, and diabetes. Electronic supplementary material The online version of this article (10.1186/s12890-019-0823-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sateesh Sakhamuri
- Faculty of Medical Sciences, Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fallon Lutchmansingh
- Faculty of Medical Sciences, Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Donald Simeon
- Dean's Office, Faculty of Medical Sciences, The University of The West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Liane Conyette
- South-West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Peter Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - Terence Seemungal
- Faculty of Medical Sciences, Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
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22
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Perez-Padilla R. Household Air Pollution: Consider Lifelong Exposure. Am J Respir Crit Care Med 2019; 199:553-555. [DOI: 10.1164/rccm.201809-1656ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rogelio Perez-Padilla
- COPD and Tobacco ClinicInstituto Nacional de Enfermedades RespiratoriasCiudad de México, México
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23
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Ozoh OB, Kalejaiye OO, Eromesele OE, Adelabu YA, Dede SK, Ogunlesi FO. Pulmonary dysfunction among adolescents and adults with sickle cell disease in Nigeria: Implications for monitoring. Ann Thorac Med 2019; 14:269-277. [PMID: 31620211 PMCID: PMC6784438 DOI: 10.4103/atm.atm_58_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: Pulmonary complications of sickle cell disease (SCD) contribute to excess morbidity and mortality. The burden of pulmonary dysfunction among Nigerians with SCD has not been well elucidated. OBJECTIVES: The objectives of this study are to describe the frequency and pattern of spirometry abnormalities in SCD and to explore the association between pulmonary dysfunction and selected parameters. METHODS: A cross-sectional study among adolescents and adults with SCD attending a University Teaching Hospital and healthy age- and gender-matched controls. Respiratory symptoms, oxygen saturation, spirometry, complete blood counts, and fetal hemoglobin (Hb) were measured. RESULTS: A total of 245 participants with SCD and 216 controls were included in the study. Frequency of respiratory symptoms was similar between the two groups. The median forced expiratory volume 1 (FEV1), forced vital capacity (FVC), and the FEV1/FVC were significantly lower in SCD as compared to controls (P = 0.000 in all instances). The frequency of abnormal pulmonary patterns was higher in SCD as compared to controls with abnormal spirometry pattern in 174 (71%) and 68 (31.5%) of participants with SCD and controls, respectively (P = 0.000). The suggestive of restrictive pattern was predominant (48% vs. 23%), but obstructive (11.8% vs. 7.4%) and mixed patterns (11% vs. 0.9%) were also found among SCD versus controls. Hb concentration was positively associated with FEV1 and FVC, whereas white cell count and age were negatively associated with FVC and FEV1, respectively. CONCLUSION: There is a high burden of pulmonary dysfunction in SCD among Nigerians which may be related to the severity of disease. There is a need for further research to explore the effectiveness of potential interventions so as to harness the benefits from monitoring and early detection.
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Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olufunto O Kalejaiye
- Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Ojiebun E Eromesele
- Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Yusuf A Adelabu
- Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Sandra K Dede
- Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Folasade O Ogunlesi
- Division of Pulmonary and Sleep Medicine, Children's National Health Systems, Washington, DC, USA.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Lung Function of Children at Three Sites of Varying Ambient Air Pollution Levels in Uganda: A Cross Sectional Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122653. [PMID: 30486291 PMCID: PMC6313711 DOI: 10.3390/ijerph15122653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022]
Abstract
Air pollution is a major cause of sub-optimal lung function and lung diseases in childhood and adulthood. In this study we compared the lung function (measured by spirometry) of 537 Ugandan children, mean age 11.1 years in sites with high (Kampala and Jinja) and low (Buwenge) ambient air pollution levels, based on the concentrations of particulate matter smaller than 2.5 micrometres in diameter (PM2.5). Factors associated with lung function were explored in a multiple linear regression model. PM2.5 level in Kampala, Jinja and Buwenge were 177.5 µg/m³, 96.3 µg/m³ and 31.4 µg/m³ respectively (p = 0.0000). Respectively mean forced vital capacity as % of predicted (FVC%), forced expiratory volume in one second as % of predicted (FEV₁%) and forced expiratory flow 25⁻75% as % of predicted (FEF25⁻75%) of children in high ambient air pollution sites (Kampala and Jinja) vs. those in the low ambient air pollution site (Buwenge subcounty) were: FVC% (101.4%, vs. 104.0%, p = 0.043), FEV₁% (93.9% vs. 98.0, p = 0.001) and FEF25⁻75% (87.8 vs. 94.0, p = 0.002). The proportions of children whose %predicted parameters were less than 80% predicted (abnormal) were higher among children living in high ambient air pollution than those living in lower low ambient air pollutions areas with the exception of FVC%; high vs. low: FEV1 < 80%, %predicted (12.0% vs. 5.3%, p = 0.021) and FEF25⁻75 < 80%, %predicted (37.7% vs. 29.3%, p = 0.052) Factors associated with lung function were (coefficient, p-value): FVC% urban residence (-3.87, p = 0.004), current cough (-2.65, p = 0.048), underweight (-6.62, p = 0.000), and overweight (11.15, p = 0.000); FEV₁% underweight (-6.54, p = 0.000) and FEF25⁻75% urban residence (-8.67, p = 0.030) and exposure to biomass smoke (-7.48, p = 0.027). Children in study sites with high ambient air pollution had lower lung function than those in sites with low ambient air pollution. Urban residence, underweight, exposure to biomass smoke and cough were associated with lower lung function.
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