Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study
A.B. Binegdie, Hellen Meme, A. El Sony, Tewodros Haile, Rashid Osman, Barbara Miheso, Lindsay Zurba, Maia Lesosky, John R. Balmes, Peter Burney, Kevin Mortimer, Graham Devereux, on behalf of the lung health in Africa across
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.