Atorvastatin improves sputum conversion and chest X-ray severity score

BACKGROUND: We report the results of a phase IIB study investigating the safety and effectiveness of atorvastatin use with standard anti-TB drugs.METHODS: In this multicentre, open-labelled study, we recruited treatment-naÏve patients with uncomplicated pulmonary TB aged at least 18 years. Participants were randomly assigned to standard-of-care or standard-of-care plus oral dose of atorvastatin (40 mg) daily for 2 months. Primary end points were safety measured by the number of participants with severe adverse events and effectiveness measured by the number of participants with negative sputum culture. Secondary endpoint was chest X-ray (CXR) severity score.RESULTS: Of the 185 participants screened, 150 were enrolled and equally assigned to the standard-of-care and atorvastatin groups. Adverse event severity was similar in the two groups. There was increased frequency of muscle pain in the trial group (12/75, 16% vs. 4/75, 5%). For efficacy analysis, respectively 64 (97%) and 57 (85.1%) patients in the trial and control groups had culture-negative results (P = 0.02) and experienced a reduction in CXR severity score of respectively 37% and 22%, with a mean difference of 1.4-4.9%.CONCLUSION: Atorvastatin is safe and associated with improved microbiological and radiological outcomes in TB.

Effect of Chronic Obstructive Pulmonary Disease Severity on Inspiratory Flow Rates via Inhaler Devices

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that affects millions of people worldwide and inhalation therapy is central to the symptomatic management of the disease. Therefore, knowledge of the minimum Peak inspiratory flow (PIF) requirements for specific inhalers especially dry powder inhalers (DPI's) is necessary when prescribing inhalation therapy. The purpose of this study is to assess the effect of COPD severity on PIF in patients with COPD.

METHODOLOGY

A total of 150 subjects (75 patients with stable COPD, and 75 apparently healthy subjects) participated in the study. PIF was assessed using the In-check Inhaler Assessment Kit (manufactured by Clement Clarke International Ltd, Harlow, UK). Lung function was assessed by spirometry with subjects divided into four groups based on the severity of their airway obstruction using the GOLD criteria. The Modified Medical Research Council (MMRC) dyspnea scale was used to assess dyspnea severity. Exercise capacity was assessed using the 6-minute walk test. Statistical analysis was performed with SPSS 23.0 software. In all the statistical tests, a p value of <0.05 was considered significant.

RESULTS

The mean age for the COPD patient and control population are 72.48 ± 8.01 and 70.69 ± 5.82 respectively. The control group had higher PIF than COPD group; however, only the clickhler and pMDI had statistically significant difference between the mean PIF of the patients compared with the control group. Generally, there was an observed trend of a decrease in mean PIF as the COPD stage progresses with a statistically significant difference observed for Easibreathe (F= 3.52, p= 0.019) and pressurized Metered dose inhaler (pMDI) (F= 4.26, p= 0.008). There was a significant positive correlation between FEV1%, FVC, Exercise capacity (6-minute walk distance) and PIF for Clickhaler, Autohaler, Easybreathe and pMDI. For pMDI, there was a statistically significant difference between means of PIF across the MMRC dyspnea scale with PIF decreasing with increasing severity of dyspnea (F= 2.85, p= 0.033).

CONCLUSION

COPD patients have slightly lower PIF than controls. Poor exercise tolerance and lower spirometric pulmonary function parameters may contribute to low PIF.

Clinical standards for the diagnosis and management of asthma in low- and middle-income countries

BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.

Frequency and Pattern of Shoulder Pain Syndrome in a Nigerian Tertiary Hospital

BACKGROUND

Shoulder pain syndrome (SPS) is a chronic condition affecting the shoulder joint, its periarticular structures, or less commonly, radicular pain typically from the neck.

OBJECTIVES

The objectives of this study were to assess the frequency and pattern of shoulder pain syndrome in OAUTHC, Ile-Ife.

METHODOLOGY

This was a descriptive study in which 50 patients with shoulder pain were recruited from the medical and general outpatient departments of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife over six months out of 350 patients with various musculoskeletal complaints. Detailed history, physical examinations and laboratory tests were done. Plain radiographs were taken for all the patients. Ethical approval was obtained and data analyzed using SPSS version 20.0.

RESULTS

The frequency of shoulder pain was 14.3%. Eighteen were males and 32 were females with a M: F ratio of 1:1.7. The mean age for all the patients was 59.74years (±10.64) with patients in the age range 50-59years accounting for the highest proportion (38%). The most common cause of shoulder pain syndrome was rotator cuff tendinopathy accounting for 72% of cases. Diabetes was the most frequent comorbidity and was found in 50% of patients.

CONCLUSION

Shoulder pain predominantly occurs in females with people in the fifth decade mostly affected. The most frequent cause of shoulder pain syndrome in this environment is rotator cuff disorder. Diabetes mellitus is an important comorbidity associated with shoulder pain. Therefore, management of shoulder pain should include assessment for risk factors.

Determinants of Suboptimal Peak Inspiratory Flow Rates among Patients with Chronic Obstructive Pulmonary Disease in Southwest, Nigeria

BACKGROUND

Inhalational therapy is the cornerstone in the management of chronic obstructive pulmonary disease (COPD) patients. Patients' peak inspiratory flow impacts effective dry powder inhaler (DPI) delivery and management outcome.

OBJECTIVE

This study assessed peak inspiratory flow rates (PIFR) and determined the factors associated with suboptimal inspiratory flow rates among COPD patients.

METHODS

A descriptive cross-sectional study was conducted among 60 participants (30 stable COPD patients and 30 age-and-sex matched controls). Socio-demographic characteristics was obtained and spirometry was done for all participants. PIFR assessment was done using the In-Check Dial Meter and was categorized as suboptimal (< 60L/min) or optimal (≥ 60L/min). P values less than 0.05 were taken as statistically significant.

RESULTS

Mean age of the COPD patients and healthy controls were both 67.8 ± 10.3 years, with 53.3% being females. Post-bronchodilation FEV 1/FVC% for COPD patients was 54.15 ± 11.27%. The mean PIFR among COPD patients was significantly lower than that of healthy controls, in all DPIs simulated, especially for Clickhaler (46.2±13.4 vs 60.5±11.4L/min, p<0.001). A significant proportion of COPD patients had suboptimal PIFR, in the simulated resistances against Clickhaler and Turbuhaler (70% vs 80%; p<0.001). Older age, shorter height and low BMI were associated with suboptimal PIFR among COPD patients. However, independent predictors of suboptimal PIFR were BMI, PEFR, FEV1% and FVC%.

CONCLUSION

Suboptimal PIFR was found in a significant number of COPD patients when compared with healthy respondents. Routine assessment using In-Check Dial meter should be done to determine the suitability of dry powder inhalers for patients with COPD.

Health and Wellbeing amidst a Prolonged Pandemic: Implications for Physicians and Patients

Health is wealth, so goes the popular maxim. The 46th West African College of Physicians Annual General and Scientific Meeting focuses on Health and Wellbeing Amidst a Prolonged Pandemic. Health and wellbeing are closely related components critical to healthy living and cannot be considered independent of each other. While health is a state of total wellbeing; wellbeing is intricately linked with happiness and satisfaction in life. The COVID- 19 pandemic has significantly impacted the health and well-being of nations all over the world. In the wake of the pandemic came the COVID-19 recession which brought a crash in the global economy, reduction in productivity, rise in unemployment, massive layoffs, collapse of businesses and manufacturing industries, disruptions in transportation and much more. These harsh economic realities have placed a huge strain on global mental health resulting in physical, mental and social disorders. The workload of the average physician and other health care workers increased tremendously resulting in burnout and psychological stress with a consequent increase in the incidence of psychological disorders including anxiety, depression, suicide and suicidal ideation amongst others. The lack of preparedness for the pandemic and the inequality in strength of healthcare systems across the world prolonged the pandemic and its adverse consequences on health and wellbeing of the populace. Promotion of health and well-being of health care professionals and the populace at large is essential for the growth of any economy and is an essential consideration for stakeholders involved in disease prevention and health promotion.

Perceived Stress and Coping Strategies among Adults with Asthma in Ile-Ife, Nigeria

BACKGROUND AND OBJECTIVES

Asthma is one of the common chronic diseases globally. There is paucity of data on perceived stress among patients with asthma in Nigeria. This study aimed to determine the extent of perceived stress and its association with coping strategies among adults with asthma.

METHODS

This is a cross-sectional descriptive study in which 100 adults with asthma were consecutively recruited from the Respiratory Clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. They completed a questionnaire containing demographic details, Perceived Stress Scale(PSS), Brief Coping Orientation to Problems Experienced (Brief-COPE) Scale and Asthma Specific Coping Scale(ASCS).

RESULTS

Most of the respondents were female (56%, n = 56) with mean age of 38.8 (±16.5), and FEV1% predicted was 78.9%±24.5. Sixty-three (63%) participants had high levels of perceived stress. Patients with asthma who had high perceived stress were significantly younger than those with low perceived stress (χ2 = 2.66; p=0.01). The mean scores of coping strategies for asthma patients with high stress level was generally higher compared with those with low stress level, and was significantly higher in the adaptive coping strategy (t=-3.36; p=0.01) and its subscales. For asthma specific coping scale, there was significant difference between those with high perceived stress and low perceived stress in the positive appraisal (t=-2.95, p=0.004) and ignoring asthma (t=-2.09, p=0.040) subscales.

CONCLUSION

The level of perceived stress is high among Nigerian patients with asthma. This study showed that the more stressed they are, the more they are likely to use coping strategies.

Acute Exacerbation of COPD: Clinical Perspectives and Literature Review

Chronic Obstructive Pulmonary Disease (COPD) COPD is a significant cause of morbidity and the third leading cause of death worldwide. COPD is a chronic progressive disease which may be interspersed by periods of acute worsening of respiratory symptoms beyond normal day-to-day variations, called exacerbations, which substantially impact health status and has cumulative effects on lung function. Acute exacerbation of COPD negatively affects disease progression, facilitating decline in pulmonary function and resulting in impaired quality of life and increased mortality risk. Therefore, early introduction of preventive measures in patients at risk of COPD remains the cornerstone of management. This article summarizes clinical perspectives and current knowledge on COPD exacerbations, with insights into practices in low- and middle-income countries.

Adult Pneumococcal Vaccination: A Review of Current Status and Challenges in Nigeria

Pneumococcus is a major cause of life-threatening invasive infections accounting for considerable morbidity and mortality among older adult population. The burden of pneumococcal infections (non-invasive) is mostly determined by Community Acquired Pneumonia. Globally and from public health perspective, vaccination has been recognised as a preventive measure of infectious diseases, thereby reducing health care cost, morbidity and mortality. Most high-income countries have included the pneumococcal vaccination in their mandatory and voluntary vaccination policies. However, many low and middleincome countries of the world have not adequately addressed the issue of adult pneumococcal vaccine. This overview describes the current status of pneumococcal vaccination and strategies to reduce the rate of pneumonia in this age group. Our aim is to stimulate the adoption of policies and production of national guidelines for the use of pneumococcal vaccines in Sub-Saharan Africa.