Chronic respiratory disease (CRD), comprised mainly of asthma and chronic obstructive lung disease (COPD), is responsible for significant morbidity and mortality worldwide. Although asthma and COPD cannot be cured, they can be controlled using appropriate medications. Poorly controlled CRD is associated with significantly poorer quality of life and mortality for patients, an increased burden on the healthcare system, and a negative economic impact due to loss of productivity. CRD is underdiagnosed, undertreated and poorly controlled, especially in low- and middle-income countries. Improving control of CRD would result in improved quality of life for patients and a reduced burden on the healthcare system and economy. Despite the increase in burden of CRD globally, limited data are available on the burden of CRD in South Africa. Such data are essential if appropriate measures are to be put in place to address these needs. In this mini-dissertation, I aimed to describe the symptomatic burden of disease and levels of treatment in adults with CRD attending primary healthcare facilities in the Western Cape. Additionally, I aimed to identify predictors of both the quality of life and receipt of treatment in this population. This study was a secondary analysis of the baseline data collected during the Primary Care 101 (PC101) trial, a large pragmatic cluster randomised controlled trial conducted in 38 primary healthcare clinics in the Eden and Overberg districts of the Western Cape between 2011 and 2012. The study population for the current study was limited to the 1 157 participants enrolled in the CRD cohort of the PC101 trial. Part A of this mini-dissertation comprises the research protocol which was submitted to, and approved by, the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee. Part B comprises the literature review, which outlines the prevalence and increasing burden of CRD both globally and in South Africa. As demonstrated in many studies from a wide variety of countries, the literature supports that CRD is underdiagnosed, undertreated, and has a significant impact both on affected individuals as well as healthcare systems and economies. Part C includes the journal-ready manuscript. Findings confirm a high burden of symptoms and activity limitation, indicating a poor quality of life amongst this population. Findings also suggest undertreatment, with 40% of patients not receiving treatment for CRD despite being symptomatic. More respiratory symptoms were associated with male sex, a positive screen for depression, previous tuberculosis, previous smoking, more activity limitation and current receipt of treatment for CRD. Greater activity limitation was associated with unemployment, diabetes, a positive screen for depression, more respiratory symptoms, recent hospital admission and receiving treatment for CRD. Participants were more likely to be on treatment if they were older, more symptomatic or had greater activity limitation due to their respiratory condition. Treatment was less likely in participants who screened positive for depression, were current smokers, had increased recent clinic visits or a recent hospital admission. In summary, we found a high burden of symptoms and activity limitation, and of undertreatment, possibly contributed to by under-recognition of respiratory disease among patients attending primary care clinics in the Western Cape. Depression, a history of previous tuberculosis and unemployment are common features in such patients. Potential interventions are to introduce a systematic approach to CRD diagnosis in primary care clinics that includes screening for depression, improving availability of essential drugs for the management of CRD, and preventive strategies such as more effective tuberculosis control, and support and pharmacotherapy to assist smokers to quit.

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Made available in DSpace on 2014-06-11T19:31:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-13Bitstream added on 2014-06-13T19:41:11Z : No. of bitstreams: 1 marcondes_js_dr_botfmvz.pdf: 1401636 bytes, checksum: b67168739cbe607c7d42214254dcfdb2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A expansão econômica da ovinocultura acarreta no aumento do número de animais mantidos em confinamento e seu maior trânsito entre as propriedades. Com isso há aumento dos índices de doenças respiratórias nessa espécie, que estão entre as enfermidades que ocasionam maiores perdas econômicas em rebanhos de vários países. Grande parte das doenças respiratórias de mortalidade elevada e sintomatologia clínica evidente está associada a infecções por Mannheimia (Pasteurella) haemolytica. Entretanto, outras enfermidades também acometem os ovinos e são pouco definidas etiológica e morfologicamente, especialmente as de etiologia viral. Os vírus têm sido incriminados como agentes precursores e agravantes quando em associação com infecção bacteriana secundária. Os métodos mais utilizados para identificação viral são a sorologia, isolamento viral, teste de vírus neutralização e reação em cadeia pela polimerase. Contudo, essas técnicas apresentam limitações quanto ao tempo de execução e a necessidade de equipamentos dispendiosos. Com a necessidade da detecção rápida de antígenos virais, métodos como imunofluorescência e ensaios imunoenzimáticos vem sendo mais estudados no diagnóstico de agentes etiológicos. A imunoistoquímica é uma opção para a identificação de diversos agentes etiológicos e vem sendo amplamente estudada nos casos de enfermidades respiratórias, devido a facilidade na execução e não necessitar equipamentos dispendiosos nem técnicas trabalhosas para armazenamento de amostras. Neste contexto, o propósito deste estudo foi avaliar ovinos com comprometimento de vias aéreas anteriores e processos broncopulmonares, detectados no exame clínico e exame histopatológico, e correlacionar os achados com a sorologia, citologia de vias aéreas anteriores e posteriores, com a imunoistoquímica para os Vírus sincicial respiratório... / The economic expansion of sheep breeding cause an increase in the number of animals kept in confinement and increased traffic between these properties, increasing the rates of respiratory diseases in this species, which are among the diseases that cause major economic losses in herds in several countries. Much of respiratory diseases and high mortality evident clinical symptoms are associated with infections by Mannheimia (Pasteurella) haemolytica, however, other diseases also affect sheep and are poorly defined etiology and morphology, especially viral diseases. Viruses have long been incriminated as agents precursors and aggravating when combined with secondary bacterial infection. The methods used for viral identification are serology, virus isolation, virus neutralization test, polymerase chain reaction. However, these techniques have limitations as to time of execution and the need for expensive equipment. With the need for rapid detection of viral antigens, methods such as immunofluorescence and enzyme immunoassays has been most studied in the search for etiologic agents. Immunohistochemistry is an option for the identification of other agents and has been widely studied in cases of respiratory illnesses due to ease of execution and does not require expensive equipment or laborious techniques for sample storage. In this context, the purposes of this research was to evaluate sheep with involvement of upper airways and bronchopulmonary cases, detected on clinical examination and histopathology, and correlate the findings with serology, cytology airways before and after, and immunohistochemistry for Virus Respiratory Syncytial and Parainfluenza virus. Was detected by serology 27.5% for the BIS-3 and 40% for BRSV positive samples. There was a predominance of interstitial pneumonia type (56.7%) and immunohistochemistry detected the presence of BPI-3 antigens in 13.3% and 20.0% ...(Complete abstract click electronic access below)