African Journal of Thoracic and Critical Care Medicine最新文献

Background: The prevalence of asthma in South Africa is among the highest in Africa, but little research has been done regarding levels of asthma control and associated determinants.

Objectives: To explore level of asthma control and perceived risk factors associated with poor control in adult patients with asthma attending respiratory clinics at three major hospitals in Johannesburg.

Methods: This was a quantitative, descriptive, cross-sectional study of all adult patients attending the clinics. Participants were given a three-section self-reporting survey, consisting of a demographic section, an Asthma Control Test (ACT) questionnaire, and an eight-item Morisky Medication Adherence Scale (MMAS-8) questionnaire.

Results: The prevalence of poor asthma control based on participants' ACT scores in this study was 71.3%. A significant linear regression was identified between the ACT and MMAS-8 scores in the uncontrolled asthma group. Significant associations between asthma control and the sociodemographic factors age, body mass index ≥25 and previous hospitalisation for exacerbation were found. No such associations existed for gender or level of education. In evaluating comorbidities, no significant association was found for hypertension, gastro-oesophageal reflux disease, sinusitis or diabetes mellitus. Of the patients, 89.3% used short-acting beta-agonists and 93.3% inhaled corticosteroids (ICSs); 58.7% were on combined long-acting beta-agonists and ICSs.

Conclusion: Asthma control in the study setting was poor. There was also an interesting inverse relationship between control and therapy adherence. Further research is needed to better understand the issues surrounding asthma control and to lay the groundwork for policies to benefit asthma patients in the future.

Study synopsis: What the study adds. This study adds to the data on asthma control and associated determinants in the adult population in South Africa (SA). Data are scarce, despite the known high prevalence of asthma in this population.Implications of the findings. The study outlines the fairly poor levels of asthma control in this population, even at a tertiary level. The outcomes reflected here provide motivation for further investigation into levels of asthma control in SA and in sub-Saharan Africa as a whole. This further investigation could ultimately impact on patient care and provide the basis of improved best practice for both patient and physician education.

Background: In Africa, with a high burden of chronic obstructive pulmonary disease (COPD), access to medication and availability and use of pulmonary rehabilitation (PR) intervention, including awareness of its effectiveness, remain limited.

Objectives: To evaluate the extent of clinical awareness and knowledge of and support for PR among healthcare providers, and to identify barriers to PR in Africa.

Methods: A comprehensive electronic survey was conducted to assess healthcare providers (HCPs)' beliefs about, knowledge, awareness and utilisation of, and access to PR in Africa, to inform strategies and policies for improved COPD prevention. The survey was adapted and validated for the African context through expert review and pilot testing with regional practitioners. It was then distributed to HCPs in clinical practice through the networks of the South African Thoracic Society and the Pan African Thoracic Society across Africa.

Results: Data were received from 108 HCPs representing diverse disciplines across rural and urban locations in 23 African countries (response rate 56%). The median (interquartile range) age was 41.0 (37.0 - 48.5) years, with no significant differences between the locations. Almost all the HCPs (98%) acknowledged the necessity of PR for severe pulmonary disease, and 58% expressed the need to improve their knowledge and skills in this area. Significant barriers such as under-reporting of symptoms by patients (74%) and a lack of easy access to spirometry (53%) were reported, hindering access to and diagnosis and rehabilitation of patients with COPD.

Conclusion: The substantial awareness and recognition of PR as an effective intervention for COPD and other chronic lung diseases across Africa is remarkable. It could indicate the feasible benefits that HCPs attach to implementing comprehensive PR in African settings. Equipping all HCPs with the requisite skills to implement an effective, locally acceptable PR programme will mitigate the burden of COPD in Africa.

Study synopsis: What the study adds. There is a paucity of recent studies in Africa that have addressed healthcare providers (HCPs)' knowledge of, attitudes to and beliefs about pulmonary rehabilitation (PR) or PR-related care activities. This study addresses that lack.Implications of the findings. The increasing recognition and acknowledgment of PR as a highly effective intervention for chronic obstructive respiratory disease and other chronic lung diseases across Africa is truly notable. It reflects the potential benefits that HCPs associate with implementing a comprehensive PR programme in African settings. Equipping all HCPs with the necessary skills to set up effective, locally accepted PR programmes will alleviate the burden of COPD in Africa.

Background: Surgical lung biopsy (SLB), performed via open lung biopsy or video-assisted thoracoscopic surgery, has traditionally been the gold standard for diagnosing interstitial lung disease (ILD) when histological confirmation is necessary. Transbronchial forceps biopsy, while less invasive, often yields small, artifact-prone specimens that are insufficient for conclusive histopathological analysis. Transbronchial lung cryobiopsy (TBLC) has emerged as a minimally invasive alternative, offering a higher diagnostic yield and superior tissue integrity due to the retrieval of larger, en bloc samples. International societies currently conditionally recommended TBLC as a potential first-line diagnostic tool for ILD, citing its favourable safety profile and diagnostic performance.

Technique procedural environment and complications: TBLC may be performed via flexible bronchoscopy with or without an artificial airway. When an artificial airway is used, general anaesthesia is administered, and a supraglottic device or endotracheal tube facilitates bronchoscope and blocker access. Without an artificial airway, the procedure is conducted under conscious sedation using an oral bite guard. A bronchial blocker is deployed to control bleeding, and biopsies are obtained under fluoroscopic guidance with freezing times of 6 - 10 seconds. At least four adequate samples (>5 mm) are collected. Post-procedure care includes positioning the patient with the biopsied lung in the dependent position and performing imaging to detect pneumothorax. While bleeding and pneumothorax are potential risks, they are generally manageable. Definitive exclusion criteria for TBLC have not yet been established, but characteristics such as severely impaired lung function, pulmonary hypertension and significant comorbidity are associated with adverse events.

Conclusion: Although TBLC yields marginally lower diagnostic rates compared with SLB, it remains a cost-effective and safer alternative, particularly in resource-limited settings. The South African Thoracic Society strongly advocates for TBLC as the first-line diagnostic modality in all cases of ILD, where histology is required, provided there are no contraindications. This recommendation is based on the lower cost and morbidity associated with TBLC compared with SLB. An exception is made for patients with non-diffuse or non-peribronchiolar disease who are suitable candidates for SLB and where the procedure is readily available. Strengthening local capacity and expertise in TBLC is crucial for improving ILD diagnostic accuracy in South Africa.

Background: Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in people with HIV (PWH), and antimicrobial resistance (AMR) leads to poor treatment outcomes. Better tests are required to overcome the low sensitivity of sputum Gram stain and culture for pneumonia diagnosis. Molecular diagnostic tests rapidly detect respiratory pathogens and markers of AMR, but few studies have examined their role in PWH.

Objectives: To investigate the additional yield of the Biofire FilmArray Pneumonia Panel plus (FilmArrayPN-PCR), an automated nested multiplex polymerase chain reaction system, over culture for diagnosis of CAP, and determine clinical predictors of AMR in PWH.

Methods: We enrolled adult PWH hospitalised with cough <2 months in a prospective cohort in Kampala, Uganda. Participants provided expectorated sputum samples for testing by FilmArrayPN-PCR and culture. We performed drug susceptibility testing of cultured sputum isolates and detection of genetic markers of AMR on sputum by FilmArrayPN-PCR.

Results: The 107 participants enrolled had a median (interquartile range) age of 40 (31 - 46) years, 50.5% (n=54/107) were female, and 74.8% (n=80/107) had recent antibiotic use. The median duration of cough was 3 (1 - 4) weeks. FilmArrayPN-PCR increased the detection of respiratory pathogens by 64.5% (95% confidence interval (CI) 54.8 - 73.1; p<0.001) and detected AMR in 25.2% (n=27/107). Baseline room air oxygen saturation <92% (adjusted odds ratio (aOR) 9.20; 95% CI 2.52 - 33.57; p=0.001) and prior antibiotic use (aOR 4.14; 95% CI 1.04 - 16.51; p=0.04) were independent predictors of AMR.

Conclusion: FilmArrayPN-PCR increased the diagnostic yield of pathogens, and a low baseline oxygen saturation (<92%) and prior antibiotic use were associated with an increased risk of AMR in hospitalised PWH with CAP.

Study synopsis: What the study adds. The Biofire FilmArray Pneumonia Panel plus detected 64.5% more respiratory pathogens compared with culture, and detected antimicrobial resistance (AMR) genes in 25.2% of patients with HIV hospitalised with community-acquired pneumonia (CAP). Baseline room air oxygen saturation <92% and prior antibiotic use were associated with nine times and four times increased odds of AMR, respectively.Implications of the findings. Multiplex polymerase chain reaction (PCR) assays increase the speed of detection and diagnostic yield of respiratory pathogens and may be useful for diagnosis of AMR in hospitalised patients with HIV and CAP. The clinical implications of these findings should be evaluated further in prospective studies and cost-effectiveness studies to define the role of multiplex PCR tests in the patient care pathway.