Browsing by Author "Paul, Devon"
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Item Open Access Asthma, Airflow Obstruction, and Eosinophilic Airway Inflammation Prevalence in Western Kenya: A Population-Based Cross-Sectional Study.(International journal of public health, 2023-01) Navuluri, Neelima; Lagat, David; Egger, Joseph R; Birgen, Elcy; Diero, Lameck; Murdoch, David M; Thielman, Nathan; Kussin, Peter S; Que, Loretta G; Paul, DevonObjectives: Determine the prevalence of airway disease (e.g., asthma, airflow obstruction, and eosinophilic airway inflammation) in Kenya, as well as related correlates of airway disease and health-related quality of life. Methods: A three-stage, cluster-randomized cross-sectional study in Uasin Gishu County, Kenya was conducted. Individuals 12 years and older completed questionnaires (including St. George's Respiratory Questionnaire for COPD, SGRQ-C), spirometry, and fractional exhaled nitric oxide (FeNO) testing. Prevalence ratios with 95% confidence intervals (CIs) were calculated. Multivariable models were used to assess correlates of airflow obstruction and high FeNO. Results: Three hundred ninety-two participants completed questionnaires, 369 completed FeNO testing, and 305 completed spirometry. Mean age was 37.5 years; 64% were women. The prevalence of asthma, airflow obstruction on spirometry, and eosinophilic airway inflammation was 21.7%, 12.3% and 15.7% respectively in the population. Women had significantly higher SGRQ-C scores compared to men (15.0 vs. 7.7). Wheezing or whistling in the last year and SGRQ-C scores were strongly associated with FeNO levels >50 ppb after adjusting for age, gender, BMI, and tobacco use. Conclusion: Airway disease is a significant health problem in Kenya affecting a young population who lack a significant tobacco use history.Item Open Access The Role of Fractional Exhaled Nitric Oxide Measurements in Identifying Subjects with Asthma Symptoms in Western Kenya(2017) Paul, DevonAbstract
Background: Fractional exhaled nitric oxide (FeNO) is a novel biomarker that is utilized as a tool to assist with the diagnosis and management of asthma in developed countries. Little data exists from sub-Saharan Africa to understand the role for exhaled nitric oxide in subjects suspected of having asthma. In this study, we aim to elucidate if a relationship exists between elevated FeNO levels and symptoms of asthma.
Methods: Using a cluster randomized stratified sampling strategy, 154 subjects age 12 and above in Uasin Gishu County, Kenya were enrolled. Questionnaires including ISAAC written and video questionnaires and the St George’s Respiratory Questionnaire for COPD were completed. Subjects were tested for FeNO, pre-and post-bronchodilator spirometry, and exhaled carbon monoxide. Odds ratios for the presence of asthma symptoms based on FeNO levels above or below a cutoff point of 71 ppb were generated.
Results: Overall, 5.8% of subjects were identified with asthma symptoms by video questionnaires, and 17.5% by written questionnaires. Median FeNO levels were significantly higher in subjects with wheezing compared to those without. The odds ratio for wheezing in individuals with FeNO levels greater than 71 ppb compared to less than 71 ppb was 7.8 (video questionnaire) and 11.3 (written questionnaire).
Conclusions: A statistically significant relationship exists between elevated levels of FeNO and symptoms of asthma in this western Kenyan population. Further work is needed to explore this link for clinical and research purposes.