Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Effectiveness of providing health education to caregivers of hospitalized children with asthma for the prevention of recurrent attacks: a quasi-randomized trial(Informa Healthcare, 2020) Perera, N.; Abeysena, C.OBJECTIVE: To determine the effectiveness of health education intervention for caregivers of children with asthma, focused on preventing recurrent attacks and improving knowledge. METHODS: A quasi-randomized trial of 177 caregivers of asthmatic children was conducted in government hospitals in a district of Sri Lanka. At the time of discharge from the hospital, a health education booklet was prepared and given to the caregivers in the intervention group, along with individual explanation and discussion. The caregivers' knowledge of asthma and preventive practices was assessed. The primary outcome was the proportion of children with recurrent attacks of asthma who needed doctor visits during the three month post discharge period. The intention-to-treat principle was applied for data analysis.RESULTS: In comparison to the control group, the intervention group had a 76% significant reduction in visits to the doctor for recurrent attacks (95% CI:45%-90%) and a 75% significant reduction in hospital admissions required for asthmatic children (95% CI:16%-93%) at the end of three months of intervention. The mean score of knowledge of asthma in the intervention group was 1.73 units higher at three months (p < 0.01) and 1.47 units higher at six months (p < 0.01) than the control group. The mean score of preventive practices for asthma in the intervention group was 1.25 units higher at three months (p = 0.02) and 1.15 units higher at six months (p < 0.01) versus the control group.CONCLUSION: Health education intervention significantly decreased doctor and hospital visits at three months. In addition, caregiver knowledge of asthma and preventive practices also improved. TRIAL REGISTRATION NUMBER: SLCTR/2010/007.Item The role of reflux in the genesis of respiratory symptoms in a cohort of adult asthmatics in Sri Lanka(Wiley-Blackwell, 2010) Amarasiri, L.; Ranasinha, C.D.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION: The oesophagus and airways have a common origin. Reflux related respiratory symptoms may be triggered by aspiration of gastric refluxate into airways or a vagally mediated oesophago-tracheo-bronchial. This association has not been reported previously in Sri Lanka. The aim of this study was to describe the association between gastro-oesophageal reflux (GOR) events and respiratory symptoms in a cohort of adult asthmatics in Sri Lanka. METHODS: Thirty stable, mild asthmatics (American Thoracic Society criteria) underwent dual-sensor ambulatory oesophageal pH monitoring. Respiratory symptoms (cough, wheeze, difficult breathing, chest tightness) during monitoring were recorded and correlated with reflux events. RESULTS: Both proximal and distal GOR parameters were significantly higher in asthmatics than controls (P < 0.050; Mann–Whitney U-test). However, there was no difference in any parameter between asthmatics with and without respiratory symptoms. Abnormal proximal acid reflux was documented in 66.7% and distal reflux in 73.3% of 30 asthmatics. Of 102 respiratory symptoms in all asthmatics, majority (72%) were cough episodes. In total, 93% of coughs, 81% of wheeze and all of chest tightness was reflux-associated, where in most, reflux events preceded respiratory symptoms. Of 15 asthmatics with respiratory symptoms, acid exposure was normal in 4 (26%), abnormally high in proximal oesophagus in 9 (60%) and abnormally high in the distal oesophagus in 11 (73%) and abnormal at both levels in 8 (53%). Most reflux events in asthmatics occurred in the upright position. CONCLUSION: Asthmatics have more GOR and associated respiratory symptoms than non-asthmatic volunteers, with reflux episodes preceding respiratory symptoms in most cases. Distal GOR and upright acid exposure was more prominent than proximal GOR.Item Factors affecting the compliance of SLMA asthma prophylactic guidelines in children(Sri Lanka Medical Association, 2001) Karunasekera, K.A.W.; Perera, K.P.J.INTRODUCTION: Guidelines to use prophylactic drugs in childhood asthma were laid down by SLMA in 1995. Yet a fair number of children we come across in clinical practice are not on prophylactic agents, though they are indicated. OBJECTIVE: To determine the compliance with SLMA asthm a prophylactic guidelines among patients admitted with asthma and to determine the socio-demographic factors affecting compliance. METHODS: All consecutive admissions to the university paediatric unit, Ragama Hospital between January 1996 and February 1998 with asthma (356) were included. Children admitted several times during the study period were included only on the 1st admission. Diagnosis of asthma was made clinically by-a consultant paediatrician. Details regarding frequency of asthma, severity, sleep disturbances, number of admissions to hospital, school absenteeism and use of prophylactic agents were obtained together with socio-demographic data. Chi-squared test was used as the statistical test. RESULTS: Only 18.2% of 251 children for whom asthma prophylactics were indicated were using prophylactic agents. 67.3% had one indication, 28.3% had two and 3.98% had three indications to use prophylaxis. Older age, male sex and monthly income of more than Rs.lO,000/= were found as significant factors for adhering to SLMA guidelines for asthma prophylaxis (p<0.05). Parental education and occupation did not show any significant association with the use of prophylaxis (p>0.05). CONCLUSIONS: Among the children in this study, boys older children and children from households with a monthly income over Rs. 10,0007= were more likely to use prophylactics.Item Prevalence of asthma and atopy among primary school children(Sri Lanka Medical Association, 2001) Karunasekera, K.A.W.; Perera, K.P.J.INTRODUCTION : Prevalence of asthma and atopy among school children in Sri Lanka is not known. Objectives : To estimate prevalence of asthma and atopy in children between 5-11 years and to determine the influence of sex and age on the prevalence of asthma. METHODS: A total of 2043 children between 5-11 years of 3 mixed schools in Gampaha district were screened for symptoms of asthma and atopy using a questionnaire in August 1998. Diagnosis of asthma was based on the presence of 3 symptoms of the following 5 in the preceding 12 months; cough at night, breathlessness, wheezing, persistent cough more than a week after common cold and cough and/or chest tightness during or after playing. Chi squared test and Chi squared test for trend were used for analysis. RESULTS: Prevalence of asthma symptoms were cough at night 22.1%, breathiessness 17.2%, wheezing 22.6%, persistent cough after common cold 29.9% and cough or chest tightness with playing 11%. Prevalence of asthma based on questionnaire was 17.1 %, allergic rhinitis 10% and eczema 2.5%. The prevalence of asthma in males was not significantly different from that of females (p=0.4). There was a decreasing trend of the prevalence of asthma with increasing age. This trend was significant in girls (p= 0.01) but not in boys. CONCLUSIONS: Nearly one fifth of primary school children suffer from asthma and 10% have allergic rhinitis. There was no significant gender difference in Jhe prevalence of asthma in primary school children. There was a decreasing trend of the prevalence of asthma with increasing age in girls but not in boys.Item Rhinitis and asthma: it's one airway after all(Medicine Today Pty Limited, 2006) Amarasiri, D.L.; Douglass, J.The concept of `united airways disease - that allergic asthma and rhinitis are manifestations of a single inflammatory airways disease - is supported by laboratory and epidemiological studies and by treatment responsesItem Prevalence of asthma and atopic symptoms in children aged 5-11 years(Sri Lanka College of Paediatricians, 2003) Karunasekera, K.A.W.; Perera, K.P.J.; Perera, M.T.P.R.; Abeynarayana, J.OBJECTIVE: To assess prevalence of asthma and atopic symptoms in a group of school children aged 5-11years and to look at prevalence of usage of asthma medications. SETTING: Three schools in Gampaha District in August 1998. METHOD: A questionnaire translated into Sinhala was distributed to parents/guardians of 2195 children aged 5-11 years in Grades 1-5 of the schools and the filled questionnaires were collected through class teachers. Asthma, allergic rhinitis and eczema were defined using the clinical criteria of the International Study of Asthma and Allergic Conditions (ISAAC). Data was analysed using Epi Info version 6. Chi squared test and Chi squared test for trend were used for significance testing. RESULTS: Return rate of questionnaire was 93%. Sixty six percent were completed by mother, 30% by father and rest by guardian. Prevalence of asthma was 23% and of exercise induced asthma 11%. Prevalence rate of allergic rhinitis was 10% and eczema 3%. Within the specific group of asthma, in response to leading question "Has your child had asthma" only 19% of parents gave a positive answer. Prevalence of asthma in males did not significantly differ from that in females (p=0.5). A decreasing trend of asthma was observed with increasing age in girls (p less than 0.05). Eighty four percent of asthmatic children were using salbutamol orally and 9% without asthma in study population were also using salbutamol. CONCLUSIONS: One in 5 children aged 5-11 years in study population had asthma but parental perception about asthma was poor. More than 80% of asthmatics had some medications for the disease.Item Risk factors of childhood asthma: a Sri lankan study(Oxford University Press, 2001) Karunasekera, K.A.W.; Jayasinghe, J.A.C.T.; Alwis, L.W.G.R.A case-control study was carried out to evaluate the genetic and environmental risk factors of childhood asthma in a group of Sri Lankan children. Three hundred cases (admitted with symptoms of asthma) and 300 age-matched controls were compared over a period of 23 months commencing in January 1996. Family history of atopy, feeding habits in infancy, bronchiolitis in infancy, passive smoking, exposure to dust and dampness, and exposure to pet animals were studied as risk factors for asthma. The risks associated with social factors were also studied. The risk associated with variables were calculated using the chi-squared test in the bivariate analysis and the forward logistic regression model in the multivariate analysis. Parental asthma, asthma in a sibling and in a relative, parental allergic rhinitis, discontinuation of breastfeeding after 6 months in infancy, bronchiolitis in infancy, living in a dusty environment, and a father with primary education compared to secondary education were independently associated with an increased risk of asthma (p 0.05). This study reinforces the view that asthma has a multifactorial aetiology. Influence of paternal asthma is more than that of maternal asthma. As a preventive measure continuation of breastfeeding beyond 6 months is important.