asthma clinics in primary healthcare centres in oman do they make a difference?

Objectives: This study aimed to determine the effect of newly established asthma clinics [ACs] on asthma management at primary healthcare centres [PHCs] in Oman

Methods: This retrospective crosssectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All >/=6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented

Results: A total of 452 asthmatic patients were included in the study. The mean age was 35 +/- 21 years old [range: 6.95 years] and the majority [57%] were female. In total, 288 [64%] cases were managed at ACs and 164 [36%] were managed at general clinics [GCs]. Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms [91% versus 19%; P <0.001], trigger factors [79% versus 16%; P <0.001] and a history of atopy [81% versus 17%; P <0.001], smoking [61% versus 7%; P <0.001], asthma exacerbations [73% versus 10%; P <0.001] or previous admissions [63% versus 10%; P <0.001]. Furthermore, prescription rates of inhaled corticosteroids [72% versus 61%; P = 0.021] and short-acting Beta-agonists [93% versus 82%; P = 0.001] were significantly higher at ACs compared to GCs

Conclusion: Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs

Is clinical judgment of asthma control adequate? A prospective survey in a tertiary hospital pulmonary clinic

Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma [GINA] scoring. Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases [67.5%]. In the other 32.5% [n = 51], the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists [72%] as compared to non-pulmonologists [47%; P = 0.009]. Physicians classified 76 patients [48.4%] as well-controlled by clinical judgment compared to 48 [30.6%] using GINA criteria [P <0.001]. Conversely, they classified 34 patients [21.7%] as uncontrolled as compared to 57 [36.3%] by GINA criteria [P <0.001]. In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate [PEFR] [46.7%] and limitation of activity [21.4%] were the most frequent parameters for downgrading the level of control. Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control

Gender difference in relationship of apnoea/hypopnoea index with body mass index and age in the Omani population

Obstructive sleep apnoea/hypopnoea syndrome [OSAHS] is a disorder characterised by repetitive upper airway collapse during sleep in association with daytime sleepiness. It has an estimated prevalence of 2% and 4% among middle-aged women and men respectively. The aim of the study was to look at the association of body mass index [BMI], age and gender and prevalence of OSAHS in the Omani population. Polysomnography reports and hospital medical records of all patients who took part in the Sleep Study at the Sleep Laboratory of the Clinical Physiology Department, Sultan Qaboos University Hospital, between January 1995 and December 2006, were retrospectively reviewed. Data from both sources was gathered and analysed. A total of 1,042 sleep studies were conducted with 608 valid studies for analysis. The study showed that the apnoea/ hypopnoea index [AHI] >15 was more prevalent in men compared to women [47.9% versus 33.5%, P = 0.001]. There was significant correlation of AHI with BMI [P <0.0001] among men compared to women [P = 0.1]; however, age was significantly correlated with AHI among women [P <0.0001], but not with men [P = 0.1]. The results indicate that there is a gender difference in the prevalence of OSAHS and obesity is a major risk factor for OSAHS among Omani men whereas age is found to be a risk factor for OSAHS among women

Effects of Pranayam breathing on respiratory pressures and sympathovagal balance of patients with chronic airflow limitation and in control subjects

The objective of this study was to compare the effects of Pranayam breathing on respiratory muscle strength measured as maximum expiratory and inspiratory pressures [MEP and MIP] and relevant spirometry parameters in patients with chronic obstructive pulmonary disease [COPD] and in control subjects, and on the sympatho-vagal balance in both the groups. The research was performed in the Clinical physiology Department, Sultan Qaboos University Hospital, Oman. Eleven patients [mean age 43.91 +/- 20.56 yr; mean BMI 21.9 +/- 5.5 kg/m[2]] and 6 controls [43.5 +/- 14.6 yr; 25.4 +/- 3.2 kg/m[2]] learnt and practiced Pranayam. Their respiratory "well being" was noted as a visual analogue score [VAS]. The respiratory parameters were expressed as a percentage change of predicted values. Patients' respiratory parameters were significantly lower than those of controls. Patients' maximum respiratory pressures did not improve after Pranayam; however, they showed significant improvement in VAS 5.4 +/- 2.4 to 7.2 +/- 1.2 [P< 0.03]. Controls showed significant increase in their systolic blood pressure and stroke index after exercise. The vago-sympathetic balance shifted towards sympathetic in both patients and controls after exercise. The improvement in MIP in controls indicated the positive effect of Pranayam exercise; however, it may not be an adequately stressful exercise to produce changes in the respiratory parameters of COPD patients. The increase in VAS in patients suggested improvement in respiratory distress and quality of life

Screening of patients with snoring and obstructive sleep opnoea using heart rate variability indices

Snoring and obstructive sleep apnea [OSA] are common disorders. Snoring associated with excessive daytime sleepiness is the most prevalent symptoms of OSA. Heart rate variability [HRV] is altered in patients with OSA and the degree of alteration may be linked to the severity of OSA. Alterations in HRV in 24 hour tachograms have recently been used in screening OSA patients. Autonomic components causing HRV can be reliably studied using spectral analysis techniques involving fast Fourier transformation [FFT]. Twenty-three subjects, 13 with severe OSA and 10 controls matched for age and body mass index, were selected from patients who had undergone polysomnography [PSG] for snoring at Sultan Qaboos University Hospital, Oman. A 24- hour electrocardiogram [ECG] Holter recording was done at home, starting at 10am. Spectral analysis of ECG from sleep Holter and PSG recordings was analysed using fast Fourier transformation [FFT]. The ECG RR intervals of snorers with OSA were significantly shorter than in snorers without OSA [p <0.01]. The low frequency [LF] spectral densities of HRV from polysomnography and Holter were significantly higher in OSA patients than in snorers, [p < 0.0001]. The power spectral density of the high frequency bands was similar in the two groups. The overnight ECG Holter accurately identified all 13 snorers with severe OSA. The spectral power of the LF band obtained using FFT of sleep HRV from Holter tachograms may be a useful and cost effective test in identifying snorers with severe OSA

Assessment of aerobic fitness and its correlates in Omani adolescents using the 2o-metre shuttle run test. A pilot study

To assess aerobic fitness in male and female adolescents using the multistage ŸcŸa-metre shuttle run test and correlate it with selected fitness variables. The subjects comprised 83 girls and 64 boys aged 15-16 years, randomly selected from two segregated government schools in Muscat. After the pupils filled in a short questionnaire on their personal leisure time activities of the preceding week, their heights and weights were measured. Aerobic fitness was assessed by estimating each pupil's minimal oxygen uptake levels [VO[2max]] using the multistage 20-metre shuttle running test [20-MST]. Boys spent more time than girls on leisure physical activities, television, computer and video games and the Internet. The estimated VO[2max] in both boys and girls showed high correlation with their weekly physical activities. The time spent on television and computer negatively correlated with VO[2max] in girls but not in boys. Girls had higher body mass index [BMI] and less VO[2max] compared to boys; BMI showed a negative correlation with VO[2max] in girls but not in boys. Aerobic fitness in this sample was higher in boys than in girls and was strongly influenced by weekly physical activities in both genders. The 20-MST has proved a simple and inexpensive field test for aerobic fitness that could be implemented on a wide scale