Asthma clinic attendance improves quality of life of Jamaican asthmatic children and their parents

Clinical features of a paediatric asthma population in Trinidad

AIM

Clinical features and management of paediatric asthma, highly prevalent in the Caribbean, was explored in Trinidadian children.

MATERIALS

Children (2-16 years) with acute [visiting Accident and Emergency (A&E) in the past 12 months (50.2%, 120)] or stable asthma [controlled during the previous 3 months (49.8%, 119)] were studied.

RESULTS

There were more (P < 0.001) boys (71.5%) than girls. Asthma was associated with asthmatic mothers (48.5%), fathers (19.2%) and both parents (15.1%) (P < 0.001). Children's average age of first wheeze was 2.5 (standard deviation = 1.3) years; 30.1% were nebulized before 1 year. In the past 12 months, frequencies of A&E visits were once (20.6%), >1 (61.9%) and >3 times (26.4%) (P < 0.001). Sufferers of exacerbations showed negative logistic regression for age (-0.129, standard error = 0.039, P < 0.001) independent of gender. Acute asthmatics who suffered cough, fever and sore throat in the preceding week were respectively 15.2 [odds ratio (OR) = 15.2, 95% confidence interval (CI) = 6.8-34.0], 13.7 (OR = 13.7, 95% CI = 6.7-28.2) and 3.4 (OR = 3.4, 95% CI = 1.7-6.7) times more likely to suffer wheeze exacerbations than stable children. Most stable children (76.5%) inhaled corticosteroids with salbutamol reliever compared with 22.5% of acute asthmatics, whereas 40.8% of the latter group used salbutamol alone compared with 19.3% of stable children (P < 0.001).

CONCLUSION

Childhood wheeze occurs before 3 years and is associated with maternal asthma. Cough, fever and sore throat in the previous week are strongly associated with exacerbations. Defining these associations could enhance preventive approaches to combat childhood asthma.

Asthma in Nigeria: are the facilities and resources available to support internationally endorsed standards of care?

OBJECTIVE

The objective of this study was to assess the facilities and resources available to support internationally endorsed standards of asthma care at tertiary hospitals (University teaching, Federal Medical Centre and State specialist Hospitals) in Nigeria.

METHODS

This cross sectional study was conducted among 68 tertiary hospitals (TH) in Nigeria from June 2009 to December 2009. Structured standards of care questionnaires on asthma based on the Global initiative for asthma (GINA) guideline were completed by physician working in each of the TH.

RESULTS

Most TH lacked the services of respiratory physicians, internists, and pediatricians. Available basic infrastructures were asthma clinics (0%), clinic registers (20.6%), and hospital protocol (17.6%), doctor's attendance of asthma CME (8.8%) and nurse educator with a bias for asthma (14.7%). Thirty eight percent of TH had peak flow meter, 29.4% had spirometer, skin allergy test kits (15.6%), pulse oximeter (38.2%) while 17.6% had arterial blood gases analyser. Nebuliser and spacer were available in 41.2% and 20.6% of TH respectively. Oral short acting beta 2 agonist (SABA) was available in 79.4% of the hospitals, glucocorticosteroid (79.4%), theophyllines (76.5%), and SABA (metered-dose inhaler MDI: 76.5%, Nebules: 35.3%). Long acting beta 2 agonist (LABA) and steroid fixed dose combination inhaler (50%) was available in 50% of TH. Glucocorticosteroid nasal spray was available in 33.3% of TH and <10% reported the availability of anti-cholinergic and chromoglycate inhaler and oral leukotriene antagonist. Standard oxygen delivery system and self-educational support materials were available in 52.9% of TH.

CONCLUSION

The available facilities and human resources for asthma management in Nigerian tertiary hospitals were not enough to support the standard internationally endorsed for asthma care. Provisions of deficient infrastructures and continuous training of health care personnel in asthma management are imperative to enhance the quality of care.