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1.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
Não convencional em Inglês | MedCarib | ID: biblio-1024469

RESUMO

Objectives: To examine factors associated with asthma related quality of life impairment (AQLI) among patient attending asthma clinics in Trinidad. Design and Methodology: A consecutive sample of 428 patients, ≥18 years, attending asthma clinics in Trinidad were recruited. Data were collected using intervieweradministered questionnaires which captured demography, comorbidities, triggers, hospital admissions and emergency department (ED) visits. AQLI was evaluated using the Juniper Mini AQL questionnaire to capture both the physical and emotional impact of the disease. The data were analysed using Chi-square test and multivariable logistic regression (SPSS Version 25). Results: Majority of patients were female (81%), ≥40 years (80.4%), of Indo-Caribbean descent (61.9%), and overweight (71.7%). The most commonly reported health conditions were gastrooesophageal reflux (53.0%), hypertension (47.2%), allergic rhinitis (45.1%), anxiety (42.8%), sleep apnoea (35.0%), and depression (32.5%). Environmental allergens (73.8%) were the most commonly reported trigger factor. The prevalence of moderate to severe AQLI was 60% and significantly associated variables were: age group (p=.0003), ethnicity (p<.0001), trigger factors (p=.013), sleep apnoea (OR=3.07, p=.001), gastrooesophageal reflux (OR=2, p=.014), depression (OR=3.59, p=.001) and anxiety (OR=2.52, p=.003), frequent (two or more) exacerbations (OR=4.07, p<.001) and having ever visited the ED (OR=4.78, p<.001) in the last 12 months. Independent predictors of AQLI were age, ethnicity, sleep apnoea and ED visits (Nagelkerke's pseudo R2=41%). Conclusion: Asthmatics demonstrate a high prevalence of moderate to severe quality of life impairment associated with demography and co-morbidities. Understanding these factors may improve doctor patient interactions, treatment and management.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Asma/prevenção & controle , Trinidad e Tobago , Região do Caribe/etnologia
2.
West Indian med. j ; 65(Supp. 3): 53-54, 2016.
Artigo em Inglês | MedCarib | ID: med-18106

RESUMO

OBJECTIVE: To measure the control of bronchial asthma, quality of life, trigger factors and co-morbidities in patients of different weight classes. SUBJECTS AND METHODS: This cross-sectional study involved 365 adult asthmatics from outpatient clinics at four major health facilities in Trinidad. Data were obtained from patient interviews, asthma control test (ACT) and the Mini Asthma Quality of Life Questionnaire (Mini AQLQ). Weight and height measurements were taken to determine body mass index (BMI), waist circumference and waist/hip ratio. Data obtained were analysed to determine associations between obesity and asthma control, associated co-morbidities, risk factors and impaired quality of life. RESULTS: A significant number of participants was females(81%), aged 60+ years (37%), Indo-Trinidadians (62%),obese (41%) and uncontrolled asthmatics (72%). Chisquared analysis revealed significant association between obesity and asthma control status (5.810; df = 1; p =0.016). Receiver operating characteristic analysis revealed BMI (AUC = 0.648) as the strongest predictor of asthma control among all obesity parameters. Logistic regression showed that higher BMI (OR = 1.05; p = 0.008) or general obesity (OR = 2.37; p = 0.003) were significantly associated with the increased odds of having uncontrolled asthma. Major trigger factors and co-morbidities were similar among obese and non-obese asthmatics. Sub analysis of obese asthmatics showed that the following were significantly associated with poor asthma control: sleep apnoea (OR = 0.45, p = 0.006), allergic rhinitis (OR= 0.562, p = 0.031) and stress (OR = 0.480, p = 0.027). CONCLUSION: Obesity negatively affects asthma control and the quality of life of asthmatics. Further studies are needed to confirm these findings and to evaluate the role of weight reduction in asthma control.


Assuntos
Humanos , Asma , Obesidade , Trinidad e Tobago
3.
In. Caribbean Public Health Agency. Caribbean Public Health Agency: 60th Annual Scientific Meeting. Kingston, The University of the West Indies. Faculty of Medical Sciences, 2015. p.[1-75]. (West Indian Medical Journal Supplement).
Monografia em Inglês | MedCarib | ID: med-17997

RESUMO

OBJECTIVE: The association of health literacy with compliance, inhaler technique and disease control with respect to both asthma and chronic obstructive pulmonary disease (COPD) patients is poorly addressed. We examined the association between health literacy, inhaler technique and disease control in patients suffering from obstructive lung disease in Trinidad. DESIGN AND METHODS: The method was a cross-sectional study which employed 781 patients from Chest Clinics in Trinidad (Arima Health Facility, Eric Williams Medical Sciences Complex, Port of Spain and San Fernando General Hospitals). Out-patients were interviewed on a pilot tested questionnaire for information on compliance and disease control. Morisky 8- item Medication Adherence Questionnaire, Asthma Control Test (ACT), and COPD Assessment Test (CAT) were used to assess compliance, asthma and COPD control respectively. Health literacy was assessed using Rapid Estimate of Adult Literacy in Medicine – short form (REALM- SF), and inhaler technique was observed on dummies.


Assuntos
Cooperação do Paciente , Educação , Nebulizadores e Vaporizadores , Asma/prevenção & controle , Doença Pulmonar Obstrutiva Crônica , Trinidad e Tobago
4.
Expert review of respiratory medicine ; 4(3): 271-274, Jun. 2010.
Artigo em Inglês | MedCarib | ID: med-17689

RESUMO

William Osler's comprehensive definition of bronchial asthma as "a neurotic affection characterized by hyperemia and turgescence of the mucosa of the smaller bronchial tubes … a peculiar exudate of mucin attacks … due to direct irritation of the bronchial mucosa or induced reflexly, by irritation of the nasal mucosa, and indirectly by reflex influences from stomach, intestines or genital organs" has been chiseled away to a chronic inflammatory disorder of the airways [1]. Asthma’s sharp climb in developing countries parallels their growing urbanization and westernization, eclipsing its rising prevalence in developed nations. Disease morbidity and mortality is higher in low- and lower–middle-income countries [101] particularly among the elderly, where atypical presentations and comorbidities render it likely to be underdiagnosed [2]. Common comorbidities associated with frequent exacerbations in difficult-to-treat asthma include hiatus hernia with or without associated gastroesophageal reflux disease (GERD), rhinosinusitis, recurrent respiratory infections, psychological disturbances and obstructive sleep apnea (OSA) [3,4]. Undiagnosed comorbid disease influences diagnosis, treatment response, disease management and control of asthma.


Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Feminino , Asma , Comorbidade , Diabetes Mellitus , Obesidade , Doenças Respiratórias , Trinidad e Tobago
5.
Italian journal of pediatrics ; 2009: [1-10], Jun. 2009. tabgraf
Artigo em Inglês | MedCarib | ID: med-17876

RESUMO

BACKGROUND: Childhood asthma in the Caribbean is advancing in prevalence and morbidity. Though viral respiratory tract infections are reported triggers for exacerbations, information on these infections with asthma is sparse in Caribbean territories. We examined the distribution of respiratory viruses and their association with seasons in acute and stable asthmatic children in Trinidad. METHODS: In a cross-sectional study of 70 wheezing children attending the emergency department for nebulisation and 80 stable control subjects (2 to 16 yr of age) in the asthma clinic, nasal specimens were collected during the dry (n=38, January to May) and rainy (n=112, June to December) seasons. A multitarget, sensitive, specific high-throughput Respiratory MultiCode assay tested for respiratory-virus sequences for eight distinct groups: human rhinovirus, respiratory syncytial virus, parainfluenza virus, influenza virus, metapneumovirus, adenovirus, coronavirus, and enterovirus. RESULTS: Wheezing children had a higher [chi square =5.561, p=0.018] prevalence of respiratory viruses compared with stabilized asthmatics (34.3 per cent (24) versus (vs.) 17.5 per cent (14)). Acute asthmatics were thrice as likely to be infected with a respiratory virus (OR = 2.5, 95 per cent CI = 1.2 - 5.3). The predominant pathogens detected in acute versus stable asthmatics were the rhinovirus (RV) (n=18, 25.7 per cent vs. n=7, 8.8 per cent; p=0.005), respiratory syncytial virus B (RSV B) (n=2, 2.9 per cent vs. n=4, 5.0 per cent), and enterovirus (n=1, 1.4 per cent vs. n=2, 2.5 per cent). Strong odds for rhinovirus infection were observed among nebulised children compared with stable asthmatics (p=0.005, OR = 3.6, 95 per cent CI = 1.4 - 9.3,). RV was prevalent throughout the year (Dry, n=6, 15.8 per cent; Rainy, n=19, 17.0 per cent) and without seasonal association [chi square =0.028, p=0.867]...


Assuntos
Humanos , Rhinovirus , Asma , Crianças Adultas , Trinidad e Tobago , Região do Caribe
6.
Artigo em Inglês | MedCarib | ID: med-17744

RESUMO

SETTING: Underdiagnosis of chronic obstructive pulmonary disease (COPD) in asthmatics attending specialty care in Trinidad, West Indies. OBJECTIVE: To determine the prevalence of COPD in diagnosed asthmatics receiving specialty respiratory care. DESIGN: In a cross-sectional study, 258 asthmatics were screened for lung function measures to examine forced expiratory volume after 1 second (FEV1), forced vital capacity (FVC) and post-bronchodilator FEV1/FVC (COPD was defined as FEV1/FVC < 70 per cent). RESULTS: Of 165 patients evaluated (response rate 64.0 per cent), 53 (32.1 per cent, 95 per centCI 25.0-39.2) had a study diagnosis of COPD and a mean FEV1/FVC of 60.12 +/- 1.2. Proportionally, more males had COPD (50.9 per cent) than asthma (24.1 per cent, P < 0.001). Patients with COPD were 10 years older than asthmatics (P < 0.001). Persons with asthma who smoked were more likely to have COPD (56.0 per cent) (OR 3.26, 95 per cent CI 1.36-7.80, P = 0.006). In both sexes, FEV1/FVC was lower among older people (P < 0.001), with a greater effect (OR 2.75, 95 per cent CI 1.00-7.56, P < 0.01) seen among men in this cross-sectional study. CONCLUSIONS: One third of diagnosed asthmatics in specialty care also have COPD. Lung function was lower among older persons. Early spirometric evaluation of elderly asthmatics who smoke can determine the presence of COPD and facilitate appropriate management.


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica , Asma , Trinidad e Tobago
7.
The journal of allergy and clinical immunology ; 119(5): 1111-1118, May 2007. graf, tab
Artigo em Inglês | MedCarib | ID: med-17354

RESUMO

BACKGROUND: Myosin light chain kinase (MYLK) is a multifunctional protein involved in regulation of airway hyperreactivity and other activities relevant to asthma. OBJECTIVE: To determine the role of MYLK gene variants in asthma among African Caribbean and African American populations. METHODS: We performed association tests between single nucleotide polymorphisms (SNPs) in the MYLK gene and asthma susceptibility and total serum IgE concentrations in 2 independent, family-based populations of African descent. Previously we identified variants/haplotypes in MYLK that confer risk for sepsis and acute lung injury; we compared findings from our asthma populations to findings in the African American sepsis and acute lung injury groups. RESULTS: Significant associations between MYLK SNPs and asthma and total serum IgE concentrations were observed in the African Caribbean families: a promoter SNP (rs936170) in the smooth muscle form gave the strongest association (P=.009). A haplotype including rs936170 corresponding to the actin-binding activity of the nonmuscle and smooth muscle forms was negatively associated with asthma (eg, decreased risk in both the American (P=.005) and Caribbean families (P=.004), and was the same haplotype that conferred risk for severe sepsis (P=.002). RNA expression studies on PBMCs and rs936170 suggested a significant decrease in MYLK expression among patients with asthma with this variant (P=.025). CONCLUSION: MYLK polymorphisms may function as a common genetic factor in clinically distinct disease involving broanchial smooth muscle contraction and inflammation. CLINICAL IMPLICATIONS: Genetic variants in MYLK are significantly associated with both asthma and sepsis in populations of African ancestry (AU)


Assuntos
Humanos , Asma , Haplótipos , Sepse , Quinase de Cadeia Leve de Miosina/genética , Região do Caribe , Barbados
8.
Journal of the National Medical Association ; 98(8): 1278-1285, Aug. 2006. tab, ilus
Artigo em Inglês | MedCarib | ID: med-17642

RESUMO

BACKGROUND: Subsets of asthmatic children, particularly in the Caribbean, burden the health system through repeated emergency room (ER) visits. We examined children to determine predictors of repeated ER visits in Trinidad. METHODS: Caregivers of 300 asthmatic children in primary healthcare in Trinidad reported on perceived factors of exacerbated wheeze requiring ER services. RESULTS: Prevalence of ER utilization in the past 12 months was 59.7% and 40.3% for repeated visits. Average age of wheezing onset was 2.8 (SD = 2.5) years. From the logistic regression analyses, independent predictors of repeat ER visits were mothers with a history of asthma (OR = 2.0, 95%Cl = 1.0-4.0), exposure to perfumes/odors (OR = 2.4, 95% Cl = 1.4-4.2), using inhaled corticosteroids (ICS) (OR = 2.2, 95% Cl = 1.2-4.0), and young age group (1-5 vs. 13-16 years) (OR = 2.7, 95% Cl = 1.1-6.4). More 1-5 year-olds (63.8%) and 6-12-year-olds (60.2%) wheezed in the dry and wet seasons, respectively (p = 0.04). Follow-up was poor (32.3%), and disease management did not include educational interventions. CONCLUSIONS: Repeated ER use in pediatric asthma underscores a pressing need for health providers and caregivers to develop an asthma management plan noting the identified predictors to assist in reducing Trinidad's asthma burden.


Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Criança , Adolescente , Asma , Trinidad e Tobago
9.
Journal of the National Medical Association ; 98(8): 1278-1285, August 2006. tab
Artigo em Inglês | MedCarib | ID: med-17397

RESUMO

BACKGROUND: Subsets of asthmatic children, particularly in the Caribbean, burden the health system through repeated emergency room (ER) visits. We examined children to determine predictors of repeated ER visits in Trinidad. Methods: Caregivers of 300 asthmatic children in primary healthcare in Trinidad reported on perceived factors of exacerbated wheeze requiring ER services. RESULTS: Prevalence of ER utilization in the past 12 months was 59.7 per cent and 40.3 per cent for repeated visits. Average age of wheezing onset was 2.8 (SD = 2.5) years. From the logistic regression analyses, independent predictors of repeat ER visits were mothers with a history of asthma (OR = 2.0, 95 per cent Cl = 1.0-4.0), exposure to perfumes/odors (OR = 2.4, 95 per cent Cl = 1.4-4.2), using inhaled corticosteroids (ICS) (OR = 2.2, 95 per cent Cl = 1.2-4.0), and young age group (1-5 vs. 13-16 years) (OR = 2.7, 95 per cent Cl = 1.1-6.4). More 1-5 year-olds (63.8 per cent) and 6-12-year-olds (60.2 per cent) wheezed in the dry and wet seasons, respectively (p = 0.04). Follow-up was poor (32.3 per cent), and disease management did not include educational interventions. CONCLUSIONS: Repeated ER use in pediatric asthma underscores a pressing need for health providers and caregivers to develop an asthma management plan noting the identified predictors to assist in reducing Trinidad's asthma burden.


Assuntos
Criança , Adolescente , Humanos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/tendências , Asma/complicações , Asma/patologia , Asma/terapia
10.
The journal of allergy and clinical immunology ; 118(1): 70-77, July 2006. graf
Artigo em Inglês | MedCarib | ID: med-17353

RESUMO

BACKGROUND: The gene encoding acyloxyacyl hydrolase (AOAH), an enzyme that hydrolyzes secondary fatty acyl chains of LPS, is localised on chromosome 7p14-p12, where evidence for linkage to total IgE (tIgE) concentrations and asthma has been previously reported. OBJECTIVE: We hypothesized that variants in AOAH are associated with asthma and related phenotypes. Because both AOAH and soluble CD14 respond to LPS, we tested for gene-gene interaction. METHODS: We investigated the association between 28 single nucleotide polymorphisms throughout the AOAH gene and asthma, concentrations of tIgE, the ratio of IL-13/IFN-y, and soluble CD14 levels among 125 African Caribbean, multiplex asthmatic pedigrees (n=834). Real-time PCR was used to assess whether AOAH cDNA expression differed with AOAH genotype. RESULTS: Significant effects were observed for all 4 phenotypes and AOAH markers in 3 distinct regions (promoter, introns 1-6, and the intron 12/exon 13 boundary/intron 13 region) by means of single-marker and haplotype analyses, with the strongest evidence for a 2-single-nucleotide-polymorphism haplotype and log [tIgE] (P=.006). There was no difference in AOAH expression levels by AOAH genotype for any of the markers. Comparing genotypic distributions at both the AOAH marker rs2727831 and CD14(-260)C>T raises the possibility of gene-gene interaction (P=.006-.036). CONCLUSION: Our results indicate that polymorphisms in markers within the AOAH gene are associated with risk of asthma and associated quantitative traits (IgE and cytokine levels) among asthmatic subjects and their families in Barbados, and there is an interactive effect on tIgE and asthma concentrations between an AOAH marker and the functional CD14(-260)C>T polymorphism. CLINICAL IMPLICATIONS: AOAH is a novel innate immunity candidate gene associated with asthma and related phenotypes in an African ancestry population.


Assuntos
Humanos , Asma , Receptores de Lipopolissacarídeos
11.
BMC public health ; 5(96): 8p, 14 Sept. 2005. mapastab
Artigo em Inglês | MedCarib | ID: med-17427

RESUMO

BACKGROUND: A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago. METHODS: Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11–19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. RESULTS: A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago); wheezing in the previous 12 months (13.1 per cent & 13.4 per cent, RR 0.98, 95 per cent CI 0.84–1.15); a previous or current diagnosis of asthma (12.8 per cent & 13.5 per cent, RR 0.95, 95 per cent CI 0.82–1.12) and night cough in the past 12 months (35.4 per cent & 38.3 per cent, RR0.93, 95 per cent CI 0.86–1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4 per cent & 15.8 per cent, RR 0.85, 95 per cent CI 0.73–1.00, p = 0.0004), night waking as a result of wheeze (7.4 per cent & 10.9 per cent, RR 0.68, 95 per cent CI 0.56–0.83, p < 0.0001) and speech limitation in the past year (5.2 per cent & 8.7 per cent, RR 0.59, 95 per cent CI 0.47–0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5 per cent & 20.2 per cent, RR 0.87, 95 per cent CI 0.76 – 0.98, p = 0.04). CONCLUSION: Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze.


Assuntos
Humanos , Asma/etiologia , Trinidad e Tobago/epidemiologia , Coleta de Dados/estatística & dados numéricos , Coleta de Dados/tendências , Região do Caribe
12.
International journal of biometerology ; 49(6): 371-376, July 2005. mapasilus^cgraf^etab
Artigo em Inglês | MedCarib | ID: med-17557

RESUMO

Objective: To determine if there is any association between paediatric Accident & Emergency (A&E) asthma admissions and Saharan dust cloud cover Methods: A retrospective ecological study of paediatric asthma patients who attended the A&E department of the Eric Williams Medical Sciences Complex in relation to Saharan dust visibility andother climactic variables for the period May 23 2001 to May 13 2002. A quasi-likelihood approach was used to develop a statistical model for the relationship between acute paediatric asthma A&Evisits and Saharan dust cover.Results: 2655 A&E visits for acute asthma during the study period. There were significant associations between paediatric admissions and two climate variables; Saharan dust levels (p <0.05)and barometric pressure (p <0.01). In the absence of dust however, barometric pressure by itself hadno predictive power. Dust cover & barometric pressure were most strongly associated with increased admissions the day after dust cover Conclusions: Saharan dust cloud cover over Trinidad was associated with an increase inpaediatric asthma A&E visits on the following day. The dust effect was strongly influenced by prevailing barometric pressure; heavy dust cover and low pressure were most strongly associated with increased acute asthma visits.


Assuntos
Humanos , Poeira , Asma/complicações , Asma/etiologia , Trinidad e Tobago/epidemiologia
13.
The journal of allergy and clinical immunology ; 115(6): 1203-1209, June 2005. tab
Artigo em Inglês | MedCarib | ID: med-17383

RESUMO

BACKGROUND: Both a functional promoter polymorphism in the gene encoding CD14 (C-260T) and exposure to endotoxin are believed to play key roles in modulating the immune response and expression of atopic disease. OBJECTIVE: We aimed to evaluate the role of the CD14 C-260T polymorphism in a population of African descent and to test for interaction between this genotype and house dust endotoxin (HDE) exposure on atopic phenotypes. METHODS: Asthmatic probands and their families were recruited as part of the Barbados Asthma Genetics Study. The C-260T polymorphism and two additional CD14 promoter markers (G-1461T, C-1721T) were genotyped. Endotoxin was measured in house dust samples. RESULTS: Using a Family-Based Association Test, the C-260T allele appeared to be protective against asthma (z=−2.444; P=.015) and asthma severity (z=−2.615; P=.009) under a recessive model. No significant associations were observed for the G-1461T and C-1721T markers both individually and in haplotypes. In a case-control analysis, the CD14 TT genotype was found to reduce risk of asthma compared with the CD14 CC/CT genotypes (odds ratio [OR], 0.26; 95% CI, 0.14-0.49) and was associated with lower asthma severity scores (P < .002). The TT genotype might protect against asthma for individuals with low HDE (OR, 0.09; 95% CI, 0.03-0.24), but may be a risk factor for individuals with high HDE (OR, 11.66; 95% CI, 1.03-131.7), suggesting a gene-environment interaction. CONCLUSION: These data suggest that the CD14-260 polymorphism may play a role in controlling risk to atopic disease and underscore the importance of incorporating key environmental exposures into studies of genetic risk factors.


Assuntos
Humanos , Asma , Alergia e Imunologia , Imunoglobulina E , Endotoxinas , Genética , Barbados , Região do Caribe
14.
BMC complementary medicine ; 5(3): 8p, 15 Feb. 2005. tab
Artigo em Inglês | MedCarib | ID: med-17425

RESUMO

Background: There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad. Methods: A descriptive, cross-sectional study was conducted at the Chest Clinic in Trinidad using a de novo, pilot-tested, researcher-administered questionnaire between June and July 2003. Results: Fifty-eight out of 191 patients (30.4 per cent) reported using herbal remedies for symptomatic relief. Gender, age, ethnicity, and asthma severity did not influence the decision to use herbs; however, 62.5 per cent of patients with tertiary level schooling used herbs, p = 0.025. Thirty-four of these 58 patients (58.6 per cent) obtained herbs from their backyards or the supermarket; only 14 patients (24.1 per cent) obtained herbs from an herbalist, herbal shop or pharmacy. Relatives and friends were the sole source of information for most patients (70.7 per cent), and only 10.3 per cent consulted an herbalist. Ginger, garlic, aloes, shandileer, wild onion, pepper and black sage were the most commonly used herbs. Conclusions: Among patients attending the Chest Clinic in Trinidad the use of herbal remedies in asthma is relatively common on the advice of relatives and friends. It is therefore becoming imperative for healthcare providers to become more knowledgeable on this modality and to keep abreast with the latest developments.


Assuntos
Humanos , Plantas Medicinais/efeitos dos fármacos , Plantas Medicinais/fisiologia , Asma/tratamento farmacológico , Trinidad e Tobago/epidemiologia
15.
BMC complementary and alternative medicine ; 5(3): 8p, Feb.15, 2005. tab
Artigo em Inglês | MedCarib | ID: med-17446

RESUMO

BACKGROUND: There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad. METHODS: A descriptive, cross-sectional study was conducted at the Chest Clinic in Trinidad using a de novo, pilot-tested, researcher-administered questionnaire between June and July 2003. RESULTS: Fifty-eight out of 191 patients (30.4 per cent) reported using herbal remedies for symptomatic relief. Gender, age, ethnicity, and asthma severity did not influence the decision to use herbs; however, 62.5 per cent of patients with tertiary level schooling used herbs, p = 0.025. Thirty-four of these 58 patients (58.6 per cent) obtained herbs from their backyards or the supermarket; only 14 patients (24.1 per cent) obtained herbs from an herbalist, herbal shop or pharmacy. Relatives and friends were the sole source of information for most patients (70.7 per cent), and only 10.3 per cent consulted an herbalist. Ginger, garlic, aloes, shandileer, wild onion, pepper and black sage were the most commonly used herbs. CONCLUSIONS: Among patients attending the Chest Clinic in Trinidad the use of herbal remedies in asthma is relatively common on the advice of relatives and friends. It is therefore becoming imperative for healthcare providers to become more knowledgeable on this modality and to keep abreast with the latest developments.


Assuntos
Humanos , Plantas Medicinais/fisiologia , Asma/tratamento farmacológico , Asma/patologia , Trinidad e Tobago/epidemiologia , Região do Caribe
16.
Rev. panam. salud p£blica ; 16(3): 193-198, Sept. 2004. tab
Artigo em Inglês | MedCarib | ID: med-17065

RESUMO

Objective. To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. Methods. Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6,611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5,511 pupils on Trinidad and 1,100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. Results. A total of 3,170 completed questionnaires were suitable for further analysis (2,618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9 percent) lived in homes where one or both parents smoked, and 513 (19.6 percent) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0 percent) had parents who smoked, and 84 (15.4 percent) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95 percent confidence interval (CI): 1.11-1.83), exercise-induced wheezing (OR: 2.12; 95 percent CI: 1.59-2.82), nocturnal coughing (OR: 1.64; 95 percent CI: 1.37-1.97), and symptoms of rhinitis (OR:1.35; 95 percent CI: 1.10-1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95 percent CI: 1.11-1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95 percent CI: 1.13-1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occured most commonly in the households of pupils of mixed race. Conclusions. Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely asociated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children (AU)


Assuntos
Criança , Asma , Rinite , Trinidad e Tobago , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Criança
17.
Chest ; 121(6): 1833-1840, Jun. 2002. tab
Artigo em Inglês | MedCarib | ID: med-17666

RESUMO

STUDY OBJECTIVES: Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies. SETTING: Chest Clinic, Ministry of Health, Trinidad. PARTICIPANTS: Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000. MEASUREMENTS AND RESULTS: A consecutive sample of patients who were > 7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%). CONCLUSIONS: Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.


Assuntos
Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Asma , Corticosteroides , Albuterol , Nebulizadores e Vaporizadores , Trinidad e Tobago , Região do Caribe
18.
West Indian med. j ; 50(Suppl 7): 39-40, Dec. 2001.
Artigo em Inglês | MedCarib | ID: med-30

RESUMO

Asthma is the commonest respiratory disease of the paediatric population and its prevalence is increasing in all parts of the world. Repeated readmission to hospital often leads to poorer school attendance, disruption of family life and increased cost to the state. Thus, global recommendations stress preventive strategies. Previous studies of readmissions of paediatric cases in developed countries have highlighted non-compliance with preventive medication and lack of parental and patient education as some of the factors that contribute to the re-admission. The purpose of this study was to determine the factors that contribute to the readmission of paediatric patients to hospitals in Trinidad. The method adopted was a descriptive survey using a questionnaire instrument. The study population consisted of 23 consecutive parents or guardians of children, aged 3-12 years, who had two or more admissions in the last year to the Emergency Room (ER) department at the Eric Williams Medical Sciences Complex for the treatment of acute bronchial asthma. The survey was conducted over a three-day period in May 2000. We found that 74 percent of the patients were less than 8 years of age with a male predominance (57 percent). Seventy-eight percent had at least four acute asthmatic attacks in the year prior to the survey and 74 percent had visited the ER at least three times during this period with 39 percent having to be warded for further management between attacks. This may have been due to a lack of education about the disease; 65 percent of parents/guardians had received no teaching about asthma. Seventy-seven of these children missed school at least once as a result of their illness in the two months prior to the survey. In a few instances, the patients' physical activities were being curtailed by parents who thought that this would prevent the child's asthma. The parents/guardians of paediatric asthma patients with frequent re-admissions to hospital have limited knowledge of their children's disorder, despite recurrent contact with healthcare professionals during their children's ER and ward admissions. Most of these children have not received adequate preventative care between attacks. Failure of the healthcare staff to follow-up these patients in clinic and educate parents and guardians about asthma may contribute to frequent hospital admissions and poor school attendance. (AU)


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Masculino , Readmissão do Paciente , Asma/prevenção & controle , Trinidad e Tobago/epidemiologia , Fatores Epidemiológicos , Educação em Saúde
19.
West Indian med. j ; 50(3): 189-93, Sept. 2001. ilus, tab
Artigo em Inglês | MedCarib | ID: med-304

RESUMO

Homemade spacer devices are commonly used by children with asthma to improve aerosol deposition from pressurized metered dose inhalers (pMDI); however, the efficacy and efficiency of these devices are not fully characterized. We determined the quality of fine particle fraction (<4.7 um) and ultrafine particle fraction (<3.3 um) of three bottles (from 280 ml to 500 ml) commonly used as spacers in Trinidad and Tobago and compared their performance to the commercially available valved holding chamber (OpT) and pMDI. These data were obtained in vitro using a cascade impactor. All 3 bottles and OpT were similar (p>0.05) in reducing the amount of albuterol emitted as large particles (>4.7 um) to less than 10 ug. The diffreent sized bottles (from 280 ml to 500 ml) produced identical quantities of albuterol in the fine particle and ultrafine particle ranges (p>0.05). All of the sample bottle spacers emitted a higher amount (p<0.002) of fine and ultrafine particles than the OpT and pMDI alone. The OpT resulted in a significantly higher fraction of fine particles (p<0.05) and greater quantity of drug (<0.05) in the ultrafine range as compared to MDI only. The sizes of particles obtained from the bottle spacers are those that have a high probability of reaching the lower airway; however, the clinical relevance of these findings remains to be determined. (AU)


Assuntos
Humanos , Técnicas In Vitro , Estudo Comparativo , Nebulizadores e Vaporizadores/normas , Sistemas de Liberação de Medicamentos/instrumentação , Sistemas de Liberação de Medicamentos/normas , Trinidad e Tobago , Asma/tratamento farmacológico , Tamanho da Partícula , Plásticos
20.
Caribbean health ; 4(2): 18-20, Apr. 2001. tab
Artigo em Inglês | MedCarib | ID: med-17322

RESUMO

Findings have highlighted the need to improve asthma management in the Caribbean. The Caribbean Guidelines for the Management and Treatment of Asthma were developed at a meeting in Trinidad in July 1997, organised by the Commonwealth Caribbean Medical Research Council (CCMRC) and the Global Initiative for Asthma (GINA). The guidelines recommend that the best way to control asthma is the use of anti-inflammatory agents, particularly inhaled corticosteroid, since these are currently the most effective long-term control medication. Haahtela et al in their seminal study demonstrated that controlling airway inflammation with inhaled corticosteroids is beneficial in asthma. Compared with trebutaline, regular treatment with the inhaled corticosteroid, budesonide, resulted in improved control of lung function, fewer symptoms and fewer asthmatic exacerbations (AU)


Assuntos
Humanos , Asma/tratamento farmacológico , Broncoconstrição , Anti-Inflamatórios , Budesonida/análise , Budesonida/uso terapêutico , Barbados , Asma/complicações , Antiasmáticos , Região do Caribe
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