RATIONALE FOR THE STUDY The focus of asthma management is to achieve control of symptoms. Over the years, several questionnaires have been developed for subjective assessment of asthma control with reports of geographical variability due to factors such as environmental and health system differences. Unique environmental factors, limited healthcare access and potential variations in asthma phenotypes in Sub-Saharan Africa necessitate tailored asthma control assessment. Despite this, there is paucity of data on the effectiveness of the commonly used questionnaires in the Sub-Sahara African population. METHODS It was a cross-sectional study of 100 asthmatic patients recruited consecutively at Obafemi Awolowo University Teaching Hospitals Complex, a tertiary health institution in Nigeria [79% females, age 38.1±14.6 years]. The Global Initiative for Asthma (GINA), Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), Royal Society of Physicians 3 Questions (RCP-3Qs) and Asthma Therapy Assessment Questionnaire (ATAQ) were administered to assess the level of asthma control among the participants. Asthma control was dichotomized into well-controlled and not well-controlled. Taking GINA as the gold standard questionnaire for asthma control assessment, Receiver Operating Characteristic (ROC) test was used to determine the ability of each of the four questionnaires (ACT, ACQ, RCP-3Qs and ATAQ) to accurately predict GINA-defined well-controlled asthma in terms of their sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and area under the curve (AUC). RESULTS The diagnostic accuracy of ACT, ACQ and RCP-3Qs in predicting GINA-defined well-controlled asthma was high with an AUC of 0.9 each [95% confidence interval (CI): 0.76-0.95;0.75-0.94 and 0.78-0.92] while that of ATAQ was low with AUC of 0.5 [95% CI: 0.29-0.59]. ACT demonstrated a high specificity of 92.6% and a moderate sensitivity of 73.7% with a PPV of 70.0% and a NPV of 93.7%. ACQ exhibited high sensitivity of 94.7% but lower specificity of 70.4% with a PPV and NPV of 42.9% and 98.3% respectively. RCP achieved a sensitivity of 100% but had a specificity of 70.4% with a PPV of 44.2% and NPV of 100%. ATAQ showed a low sensitivity of 26.3%, specificity of 85.2% with a PPV and NPV of 29.4% and 83.1% accordingly. CONCLUSION The findings suggest that ACT, ACQ and RCP-3Qs are useful surrogates for identifying GINA-defined well-controlled asthma in African clinical settings based on their overall high predictive performance while ATAQ's low predictive performance may limit its utility within this population.

IntroductionPrevious population-based studies, mainly from high-income countries, have shown that a higher forced vital capacity (FVC) is associated with a lower risk of developing cardiometabolic diseases. The aim of this study was to assess the longitudinal association between spirometry measures and the onset of cardiometabolic diseases across sites in low-income, middle-income and high-income countries.MethodsThe study population comprised 5916 individuals from 15 countries participating in the Burden of Obstructive Lung Disease baseline and follow-up assessments. Postbronchodilator forced expiratory volume in 1 s (FEV1), FVC and FEV1/FVC were measured at baseline. Participants who reported having doctor-diagnosed hypertension, diabetes, heart disease and stroke at follow-up but not at baseline were considered new cases of these diseases. The association between lung function and the onset of participant-reported cardiometabolic diseases was assessed in each site using regression models, and estimates were combined using random effects meta-analysis. Models were adjusted for sex, age, smoking, body mass index and educational level.ResultsParticipants with greater per cent predicted FVC were less likely to have new-onset diabetes (OR per 10%=0.91, 95% CI 0.84 to 0.99), heart disease (OR per 10%=0.86, 95% CI 0.80 to 0.92) and stroke (OR per 10%=0.81, 95% CI 0.73 to 0.89) during the follow-up period (mean±SD 9.5±3.6 years). A greater percentage of FEV1was associated with a lower risk of onset of heart disease and stroke. No significant association was found between FEV1/FVC and onset of reported cardiometabolic diseases, except for a higher risk of diabetes (OR per 10%=1.21, 95% CI 1.08 to 1.35) in participants with higher FEV1/FVC.ConclusionsThe findings of this study suggest that a low FVC is more important than a low FEV1/FVC as a risk factor for developing cardiometabolic diseases. The value of including FVC in risk score models to improve their precision in predicting the onset of cardiometabolic diseases should be explored.

Spirometry is used to determine what is "unusual" lung function compared with what is "usual" for healthy non-smokers. This study aimed to investigate regional variation in the forced vital capacity (FVC) and in the forced expiratory volume in one second to FVC ratio (FEV1/FVC) using cross-sectional data from all 41 sites of the multinational Burden of Obstructive Lung Disease study. Participants (5,368 men; 9,649 women), aged >= 40 years, had performed spirometry, had never smoked and reported no respiratory symptoms or diagnoses. To identify regions with similar FVC, we conducted a principal component analysis (PCA) on FVC with age, age2 and height2, separately for men and women. We regressed FVC against age, age2 and height2, and FEV1/FVC against age and height2, for each sex and site, stratified by region. Mean age was 54 years (both sexes), and mean height was 1.69 m (men) and 1.61 m (women). The PCA suggested four regions: 1) Europe and richer countries; 2) the Near East; 3) Africa; and 4) the Far East. For the FVC, there was little variation in the coefficients for age, or age2, but considerable variation in the constant (men: 2.97 L in the Far East to 4.08 L in Europe; women: 2.44 L in the Far East to 3.24 L in Europe) and the coefficient for height2. Regional differences in the constant and coefficients for FEV1/FVC were minimal (<1%). The relation of FVC with age, sex and height varies across and within regions. The same is not true for the FEV1/FVC ratio.

INTRODUCTION:Evidence of an association between breathlessness and quality of life from population-based studies is limited. We aimed to investigate the association of both physical and mental quality of life with breathlessness across several low-, middle- and high-income countries. METHODS:We analysed data from 19 714 adults (31 sites, 25 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We measured both mental and physical quality of life components using the SF-12 questionnaire, and defined breathlessness as grade ≥2 on the modified Medical Research Council scale. We used multivariable linear regression to assess the association of each quality-of-life component with breathlessness. We pooled site-specific estimates using random-effects meta-analysis. RESULTS:Both physical and mental component scores were lower in participants with breathlessness compared to those without. This association was stronger for the physical component (coefficient = -7.59; 95%CI -8.60, -6.58; I2 = 78.5%) than for the mental component (coefficient = -3.50; 95%CI -4.36, -2.63; I2 = 71.4%). The association between physical component and breathlessness was stronger in high-income countries (coefficient = -8.82; 95%CI -10.15, -7.50). Heterogeneity across sites was partly explained by sex and tobacco smoking. CONCLUSION:Quality of life is worse in people with breathlessness, but this association varies widely across the world.

Objective: This study aimed to assess the respiratory muscle strength in stable chronic obstructive pulmonary disease (COPD) patients, via measuring maximal respiratory mouth pressures [maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax)] to determine its association with disease severity and quality of life.Material and Methods: The study was a cross-sectional comparative study. A hundred and forty subjects (70 COPD patients and 70 controls) were recruited. Measurements of PImax, PEmax and spirometry were then performed. The health-related quality of life, severity of obstruction and dyspnea in the COPD patients were assessed using the COPD Assessment Test (CAT), post-bronchodilator Forced Expiratory Volume in 1 second (FEV 1) and the modified Medical Research Council (mMRC) dyspnea scale, respectively. Data was analyzed using Statistical Package for the Social Science (SPSS) version 25.0 (SPSS IL USA.).Results: The mean (±S.D.) PImax and PEmax of the COPD patients (31.78±14.40 cmH2O and 54.80±18.89 cmH2O, respectively) were significantly lower (p<0.001) than the controls (80.40±7.50 cmH2O and 95.44±12.52 cmH2O, respectively). Both the PImax and PEmax correlated positively with the FEV1 of the COPD patients (r=0.658 and 0.534, respectively, p<0.001). The PImax and PEmax decreased as the mMRC dyspnea grade worsened (p<0.001). There was a negative correlation between PImax; PEmax and the CAT score of the COPD patients (r=-0.704 and–0.583, respectively, p<0.001).Conclusion: There was significant respiratory muscle weakness in the COPD patients compared with the controls. The respiratory muscle weakness worsened as the airflow obstruction and dyspnea worsened. Respiratory muscle weakness may also add to the negative impact COPD has on the health status of COPD patients.

Vaccination programs have proven successful in the prevention and control of infectious diseases among children on a global scale, but the majority of adult populations remain unvaccinated. immunocompromised adults as well as older adults aged low-income countries as Streptococcus pneumoniae infections are associated with substantial morbidity and mortality among 65 years and above. Despite the introduction of pneumococcal conjugate vaccines (PCVs), the burden of vaccine-type serotypes remains high in there are no clear policies for adult vaccination. As per the Global Burden of Disease 2019 report, about 120,000 individuals aged 70 years and older died as a result of LRTIs) in sub-Saharan Africa. A medical advisory board meeting was conducted in April 2022 to discuss the burden of pneumococcal diseases in adults, the current status of policies and practices of adult vaccination, unmet needs, and challenges in Ghana. This expert opinion paper outlines the pneumococcal epidemiology and burden of disease in Ghana, as well as the rationale for adult pneumococcal vaccination. It also highlights the potential barriers to adult vaccination and offers recommendations to overcome these obstacles and enhance vaccine acceptance in Ghana.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) affects millions of people with increasing global prevalence, morbidity and mortality. Inhaled medications are central to the management of COPD. Therefore, understanding the minimum Peak Inspiratory Flow (PIF) requirements for inhaler devices is vital for optimal drug delivery. This study assessed PIF in patients with COPD compared with controls and, the influence of age, sex and anthropometric measurements on PIF. Methodology: A total of 150 subjects (75 patients with stable COPD, and 75 controls) participated in the study. Demographic and anthropometric data were collected from the study participants. Peak inspiratory flow was assessed using the In-check peak flow meter. Lung function was assessed by spirometry. In all the statistical tests, a p value of <0.05 was considered significant. Results: The control group had higher PIF than COPD group. All of the COPD patients had clinically effective PIF for Clickhaler, Diskus, Easibreathe, and pMDI. Majority of the COPD patients had clinically effective PIF for Turbohaler, and Autohaler. The mean PIF of male patients with COPD was significantly greater than that of females for Turbohaler. For the COPD group, there was a significant negative correlation between PIF and age for Diskus, Autohaler and Easibreathe. Significant positive correlation was also noted between PIF and weight for turbohaler, autohaler and easibreathe. Conclusion: Majority of COPD patients utilizing dry powder inhalers (DPIs) are able to generate effective PIF. Increasing age, female gender, low body weight and low BMI may contribute to low PIF.

Background:Asthma control is critical in reducing morbidity and improving quality of life, yet, many patients struggle with accurately assessing their own asthma control. Current evidence suggests that many patients may overestimate their level of control causing discrepancies between patients' self-perception and clinical measures, such as those defined by the Global Initiative for Asthma (GINA). Understanding these differences is essential for optimizing asthma management in specialist clinics. Objective:This study aims to compare self-perceived asthma control with GINA-defined standards to highlight gaps and improve patients' outcomes in Nigeria. Methods:It was a cross-sectional study, 100 asthmatic patients in a tertiary teaching hospital were recruited consecutively [79% females, age 38.1±14.6 years]. The chi-square test of association was used to determine the relationship between perception of asthma control and actual test scores of controls as defined by GINA. Results:The association between respondents' perception of their asthma control and GINA-defined control was 2 = statistically significant (ꭓ 43.876, p = 0.001). Of the 19 participants categorized by GINA as well controlled,18(94.7%) regarded themselves as being well controlled whereas 1(5.3%) assessed symptoms as partly controlled. For the GINA partly controlled category 13(40.6%) appropriately graded their control as partly controlled while in the uncontrolled group, 22(44.9%) assessed their symptoms as uncontrolled. Conclusions:Overall, the patients showed a good perception of their disease in comparison with GINA-defined criteria. However, the percentage was higher among those with well-controlled asthma compared with the other categories. This finding emphasises the need for continuous patient education.