Abstract
BACKGROUND :The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function.OBJECTIVE :To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries.METHODS :This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan. Patients were assessed using a respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians were ascertained.RESULT:A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD 16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% CI 32–40) of patients had asthma, 25% (95% CI 21–29) had chronic bronchitis, 8% (95% CI 6–11) chronic obstructive pulmonary disease (COPD), 5% (95% CI 4–8) bronchiectasis and 4% (95% CI 3–6) post-TB lung disease. Spirometry consistent with COPD was present in 35% (95% CI 30–39). Restriction was evident in 38% (95% CI 33–43). There was evidence of sub-optimal diagnosis of asthma and COPD.CONCLUSION :In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will require the widespread use of spirometry.
Highlights
Chronic respiratory diseases (CRDs) are leading noncommunicable diseases worldwide, most probably because of the ubiquity of poverty, and inhaled noxious environmental, occupational and behavioural exposures.[1]
The greatest burden of CRDs occurs in low- and middle-income countries (LMICs): almost 90% of chronic obstructive pulmonary disease (COPD) deaths and 80% of asthma deaths occur in LMICs, where they have been linked with poverty, poor access to healthcare and limited
We found that 39% of clinician-diagnosed asthma patients fulfilled the criteria for COPD, and while this may be a consequence of chronic airway remodelling, this finding raises the probability of COPD being misdiagnosed as asthma, a well-recognised issue when diagnoses are totally reliant on symptoms unsupported by spirometry.[26]
Summary
Chronic respiratory diseases (CRDs) are leading noncommunicable diseases worldwide, most probably because of the ubiquity of poverty, and inhaled noxious environmental, occupational and behavioural exposures.[1] CRDs affect more than 1 billion people worldwide, with asthma and chronic obstructive pulmonary disease (COPD) being the most prevalent: about 300 million people have asthma and 200 million have COPD.[1,2,3] The greatest burden of CRDs occurs in low- and middle-income countries (LMICs): almost 90% of COPD deaths and 80% of asthma deaths occur in LMICs, where they have been linked with poverty, poor access to healthcare and limited
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