Sateesh Sakhamuri

The primary purpose of spirometry is to identify the obstructive ventilatory defect, indicated by diminished forced expiratory volume in 1 s to forced vital capacity ratio (FEV₁/FVC). However, it also has several screening and prognostic applications by detecting nonobstructive abnormal spirometry (NOAS), a condition where either FEV₁ or FVC or both are reduced while the ratio remains normal. Both FVC and FEV₁ are known to be related to all-cause mortality and morbidity even in the general population [1]. Studies indicate that NOAS is prevalent in up to 30% of the general population [2] and an even greater proportion of those experiencing symptoms. However, there is substantial variation in how NOAS is interpreted. Additionally, it is worth noting that NOAS differs from the nonspecific pattern (NSP) described by Hyatt et al. [3], around 15 years ago. NSP is characterised by an abnormally low FEV₁ with normal FEV₁/FVC ratio and normal total lung capacity.

Objective: This study assessed recommendations for asthma care that community pharmacists in Trinidad offer to adult and adolescent asthma patients. Methods: A convenience study was conducted in community pharmacies in Trinidad, utilising a 17-question survey, delivered electronically via email by clicking a survey link, which ensured that all responses were anonymous. Key findings: There were 210 responses, and the majority (54.2%) believed that inhaled salbutamol was the treatment for mild intermittent asthma. Many (65.2%) demonstrate inhaler technique to new patients. Recommendations for using peak flow metres (46.2%) or asthma diaries (48.6%) were poor, and 68.1% dispense prednisolone without a prescription. Conclusion: Continuing education on asthma management for community pharmacists in Trinidad can optimise disease outcomes and make them partners in patient care.

Globally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5–10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of the World Health Organization’s (WHO) End TB Strategy. This study aims to examine the screening practices for prevention and treatment employed by the National Tuberculosis Program of Trinidad and Tobago in comparison to the WHO’s standard guidelines. A cross-sectional retrospective study was conducted from the TB registers (2018–2019) for persons aged 18 years and above with recorded tuberculin skin test reactions (TST). Bivariate comparisons for categorical variables were made using Chi-square or Fisher’s exact test. Binary logistic regression was used for exploring predictors of TST positivity with adjustment for demographic confounders in multivariable models. Of the total 1972 eligible entries studied, 384 (19.4%) individuals were tested positive with TST. TB contact screening (aOR 2.49; 95% CI 1.65, 3.75) and Bacillus Calmette–Guerin (BCG) vaccination status (aOR 1.66; 95% CI, 1.24 to 2.22) were associated with a positive TST reaction, whereas, preplacement screening failed to show such association when compared to those screened as suspect cases. The findings suggest that TB contact screening and positive BCG vaccination status are associated with TST positivity independent of age and gender.

OBJECTIVE Asthma, a major cause of disability and reduced quality of life, has a high global prevalence and burden of death. Despite the propitious guidelines, a substantial portion of asthmatics reportedly have poorly controlled disease. In the current study, we have examined risk factors for uncontrolled asthma in specialty clinics and its association with impaired quality of life. METHODS A multicentre cross-sectional survey of asthma patients, 18 years and older, was conducted in Trinidad. Asthma Control Test (ACT) and the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ–J) were used to assess the disease control and quality of life, respectively. Data were analyzed using the Chi-square test and multivariable logistic regression controlling for gender. RESULTS Of a total of 428 patients included, asthma was uncontrolled in 72.4% and asthma related quality of life was moderate to severely impaired in 86% of the studied population. In the multivariate regression models, poorly controlled asthma was associated with obesity (OR 2.25; 95% CI 1.30-3.39), late-onset asthma (OR 1.72; 95% CI 1.04-2.84), features of sleep apnea (OR 1.77; 95% CI 1.01-3.07) and depression (OR 2.01; 95% CI 1.04-3.86). Impaired quality of life was associated with Indo-Caribbean ethnicity (OR 3.19; 95% CI = 1.68-6.06). CONCLUSIONS In this Caribbean population, uncontrolled asthma was independently associated with obesity, late-onset disease, and comorbidities of sleep apnea and depression. Poor asthma-related quality of life was independently associated with Indo-Caribbean ethnicity.