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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.

CONTEXTE: Le traitement par inhalation est la pierre angulaire de la prise en charge des patients atteints de bronchopneumopathie chronique obstructive (BPCO). Le débit inspiratoire de pointe des patients a une incidence sur l'efficacité de l'inhalateur de poudre sèche et sur les résultats de la prise en charge. OBJECTIF DE L'ÉTUDE: Cette étude a évalué les débits inspiratoires de pointe et déterminé les facteurs associés aux débits inspiratoires sousoptimaux chez les patients atteints de BPCO. MÉTHODES: Une étude transversale descriptive a été menée auprès de 60 participants (30 patients atteints de BPCO stable et 30 témoins appariés selon l'âge et le sexe). Les caractéristiques socio-démographiques ont été recueillies et une spirométrie a été effectuée pour tous les participants. L'évaluation du PIFR a été réalisée à l'aide du Dial Meter In-Check et a été catégorisée comme suboptimale (< 60L/min) ou optimale (≥ 60L/min). Les valeurs P inférieures à 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: L'âge moyen des patients atteints de BPCO et des témoins sains était de 67,8 ± 10,3 ans, avec 53,3 % de femmes. Le pourcentage de VEMS/FVC après bronchodilatation chez les patients atteints de BPCO était de 54,15 ± 11,27 %. Le PIFR moyen des patients atteints de BPCO était significativement plus faible que celui des témoins sains, pour tous les DPI simulés, en particulier pour le Clickhaler (46,2±13,4 vs 60,5±11,4L/min, p<0,001). Une proportion significative de patients atteints de BPCO avait un PIFR sous-optimal, dans les résistances simulées contre Clickhaler et Turbuhaler (70% vs 80% ; p<0.001). L'âge avancé, la petite taille et un faible IMC étaient associés à une PIFR sous-optimale chez les patients atteints de BPCO. Cependant, les prédicteurs indépendants du PIFR suboptimal étaient l'IMC, le DEP, le VEMS et la CVF. CONCLUSION: Un nombre significatif de patients atteints de BPCO présente un PIFR sous-optimal par rapport aux personnes interrogées en bonne santé. Une évaluation de routine à l'aide de l'appareil de mesure In-Check Dial devrait être effectuée pour déterminer si les inhalateurs de poudre sèche conviennent aux patients atteints de BPCO. Mots clés: Inhalateur de poudre sèche, Débit inspiratoire maximal, Fonction pulmonaire.

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BACKGROUND: Epidemiological studies have linked morbidity and mortality of individuals to exposure to atmospheric gaseous and particulate matter especially fine particles (PM2.5) and coarse particles (PM10).The process of garri (cassava crisps) production (frying with firewood) is associated with production of gaseous and particulate matter which contribute to ambient particulate matter air pollution. The objective of this study was to determine the impact of air quality indices on the prevalence of respiratory symptoms among the garri processing workers in Ogbomoso. METHODOLOGY: A comparative cross-sectional study was carried out among 351 garri processing workers in Ogbomoso as subjects and 351 residents of Ogbomoso metropolis as controls that were age, sex and height-matched. A semi-structured questionnaire was used to obtain sociodemographic profiles and respiratory symptoms of participants and document physical examination findings. Particulate matter counter was used for air quality sampling. RESULTS: The mean age of subjects was 41.7 ± 14.9 years and that of controls was 41.6 ± 14.7 years (p =0.960). The two groups were also matched for socioeconomic status, sex and height. Prevalence of respiratory symptoms was higher at 48.4% among the garri workers than the control group which was 29.1% (p<0.001). Cough was the predominant symptom with a prevalence of 29.3% and 10.5% among the subjects and controls respectively. The mean count of PM1.0 in garri processing locations was significantly higher than that recorded in Ogbomoso metropolis; 73.77±42.08 vs 15.04±6.66mg/m3 (p<0.0001). CONCLUSION: Garri processing work is associated with significant increase in ambient air pollution and increased prevalence of respiratory symptoms among the workforce compared to the control population. Effective preventive strategies including education and provision of safety masks may reduce the occupational hazards associated with garri processing factory workers in Nigeria.

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OBJECTIVE: To determine mortality predictors among patients admitted for community-acquired pneumonia to the medical wards of Ladoke Akintola University of Teaching Hospital between Jan. 2003 and Dec. 2005. METHODS: The case notes of 65 patients admitted for community-acquired pneumonia were studied with respect to their admission Pneumonia Severity Index (PSI) (Score) and functional class. The duration of admission, side of lung affected on chest X-ray, co-morbid illness and outcome were also noted. RESULTS: The mean Pneumonia Severity Index score for patients who were discharged and those who died was 65.48 +/- 32.6 and 95.47 +/- 32.9 respectively (P<0.05). Bedridden patients have higher mortality than patients who walked without problems on admission (P<0.05). The mean duration of admission of discharged patients was 9.5 +/- 8.9 days while that of patients who died was 4.82 +/- 2.7 days (P<0.05). The side of lung involvement of chest X-ray does not seem to affect mortality (P>0.05). Sixteen co-morbid illnesses were identified. CONCLUSION: The Pneumonia Severity Index score remains an important mortality predictor in patients with community-acquired pneumonia, but there is need to widen its scope to include functional class, duration of admission, and locally important co-morbid illnesses.

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OBJECTIVE: To determine the pattern of tobacco use among non-pulmonary tuberculosis patients attending the chest clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria. PATIENTS AND METHODS: One hundred and four non-pulmonary tuberculosis patients attending the chest clinic between January 2003 and December 2005 were studied with respect to their tobacco use habits using a questionnaire after their consents had been obtained. Questions were asked about the form(s) of tobacco used, the mode(s) of use, the duration of use and the amount (in case of cigarette smoking), and the duration of stoppage of tobacco use. RESULTS: There were no current smokers among the patients studied, but 24% of them had used tobacco before presentation, while 84% of these had specifically smoked cigarettes. There were no pipe smokers, no cigar smokers, and no tobacco chewers. The rate of cigarette smoking was highest among the COPD patients (76.5%), and they also have the highest number of pack-years. Smoking rates in the other patients are: lung abscess (50%), empyema thoracis (50%), bronchial asthma (33.3%), and community acquired pneumonia (11.1%). No case of lung cancer was encountered. Two patients with lung abscess had smoked both cigarettes and marijuana in combination while another 2 patients with empyema thoracis had smoked the same combination before presentation. There is no relationship between the duration of stoppage of tobacco use and the subsequent development of non-tuberculous respiratory disease. CONCLUSION: Tobacco remains a very significant threat to respiratory health, as this study has demonstrated. The campaign against its use therefore must be intensified.

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OBJECTIVE: To bring into focus the existence of respiratory hazards due to air pollution as a result of industrialization, tobacco smoking (personal pollution), domestic pollution and vehicular fuel combustion on the African continent; and to stimulate health workers, and the various governments in Africa, to devote more attention to the subject of air pollution by engaging in and encouraging multidisciplinary research so that appropriate and effective control measures can be put in place. DATA SOURCES: Medline literature search through internet using the keywords: air pollution, cigarette smoking, domestic pollution, respiratory morbidity, Africa. The author's contributions to the subject of air pollution and respiratory morbidity are included. STUDY SELECTION: Relevant studies or articles from eastern, western, northern, southern and central parts of Africa are included in the review. DATA EXTRACTION: From individual study or article. DATA SYNTHESIS: Evidence of respiratory hazards sequel to the four main sources of air pollution in each part of Africa, are synchronised under the headings: introduction, respiratory impairment and the future. CONCLUSIONS: Respiratory impairment from the four main sources of air pollution is a major but highly neglected problem on the African continent. There is need for concerted efforts on the part of African governments, health administrators and health workers to ensure that necessary attention is given to multidisciplinary research on the subject so that meaningful control measures can be formulated, thereby ensuring clean air for the people to breathe.

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OBJECTIVE: To evaluate knowledge, attitudes and practices regarding tuberculosis among Nigerian senior secondary school students. DESIGN: Questionnaire. SETTING: Ilorin Grammar School, Ilorin, Kwara State, Nigeria. PARTICIPANTS: Seven hundred and ninety one senior secondary students. INTERVENTION: Questionnaire explained in English to whole class by author. MAIN OUTCOME MEASURES: Responses were streamlined and analysed based on responders, knowledge of, attitudes towards, and practices as regards tuberculosis. RESULTS: KNOWLEDGE: The response "Yes", "No", or "I don't know" was given to each of the following questions and their respective percentages are indicated: Have you ever heard of tuberculosis?: 81.4%, 13.9%, 4.7%. Have you ever been affected by it?: 8.3%, 86.3%, 5.3%. Can tuberculosis of the lung be contracted through drinking unclean water or eating unhygienic food?: 72.3%, 17.2%, 10.5%. Can it spread through air droplets?: 70.9%, 17.8%, 11.3%. Can it spread through overcrowding?: 71.6%, 18.1%, 10.4%. Is it caused by spirits, demons or evil doers?: 16.2%, 67.5%, 16.3%. Is it the only cause of long-standing cough?: 43.6%, 40.2%, 16.2%. Can it cause persistent fever?: 64.6%, 19.8%, 15.5%. Can it cause loss of weight?: 79.6%, 11.9%, 8.5%. Tuberculosis only affects the lungs?: 46.3%, 39.1%, 14.7%. Can it be cured at all?: 76.7%, 12.1%, 11.1%. Should the patient always be admitted to the hospital to receive treatment?: 69.7%, 9.7%, 20.6%. Can the disease be prevented?: 89.2%, 0.9%, 11.9%. Heaf or Mantoux test is dangerous?: 15.8%, 13.3%, 71.6%. Patients who are already on effective treatment (drugs) can still spread the disease?: 50.2%, 25.3%, 24.5%. Patients who have been cured can still spread the disease?: 33.5%, 49.6%, 16.9%. Should patients with tuberculosis be regarded as outcasts?: 40.1%, 38.9%, 21%. Can BCG vaccination prevent tuberculosis?: 57.6%, 18.6%, 23.8%. Can cigarette smoking predispose to tuberculosis of the lungs?: 66%, 15.8%, 18.1%. ATTITUDES: The responses on how tuberculosis can be cured are as follows: By making sacrifice to appease the angry spirits or demons 3%; by begging the evil doers 2.3%; by taking drugs prescribed by doctors 69.7%; by taking traditional medicines 4.8%; by a combination of all the above 20.1%. PRACTICES: On prevention of tuberculosis, 51 different methods are volunteered of which 41.2% are correct, 19.6% are controversial while 39.2% are definitely incorrect. CONCLUSIONS: A high level of ignorance, wrong knowledge, wrong attitudes and wrong practices is demonstrated among senior secondary students. Inclusion of health education in school syllabi is advocated.

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Three hundred and thirty five Nigerians working in a sugar industry were studied using a questionnaire for respiratory symptoms, physical examination of the chest and chest x-ray examination in a selected group. The frequency of occurrence of cough alone, cough with sputum, morning phlegm, nasal catarrh and chest pain were found to be statistically significant only in the control group (p < 0.05), contrary to expectation. Chest signs were absent in all except two workers who had bilateral basal crackles and the other had features of chronic obstructive pulmonary disease respectively. Only one chest x-ray showing features of chronic obstructive pulmonary disease was abnormal out of 29 that were done among the workers for various indications. Specific respiratory diagnoses were made only in two workers, namely, bronchial asthma in one and chronic obstructive lung disease in another. These disorders were not directly occupationally related. The rarity of specific respiratory disease among Africans working in a sugar industry, despite their exposure to dust, calls for further studies to ascertain if they have any special protective mechanism(s).

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