Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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    The Prevalence of asthma in Sri Lankan adults
    ((Wiley Blackwell Scientific Publications, 2016) Amarasiri, D.L.; Undugodage, U.C.M.; Silva, H.K.M.S.; Sadikeen, A.; Gunasinghe, W.; Fernando, A.; Wickremasinghe, A.R.; Gunasekera, K.D.
    BACKGROUND AND AIMS: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and related symptoms amongst adults in the general population. METHODS: A multi-centered, cross-sectional study was conducted using an interviewer-administered translated version of the screening questionnaire of the European Community Respiratory Health Survey from June to December 2013 in 7 provinces of Sri Lanka. Subjects were selected randomly from different regions by stratified sampling. The prevalence of asthma was defined as "wheezing in the past 12 months (current wheeze)", 'self-reported attack of asthma in the past 12 months' or 'current asthma medication use'. RESULTS: The study comprised 1872 subjects (45.1% males, 48.8% aged18-45 years) of which 12.2% were current smokers. In the total population, the prevalence of current wheeze was 23.9% (95% CI: 22.0%-25.9%), of self-reported asthma was 11.8% (95% CI: 10.3%- 13.2%) and of current asthma medication use was 11.1% (95% CI: 9.6%- 12.5%). The prevalence of asthma according to a positive response to either of the above questions was 31.4% (95% CI: 29.3%-33.4%) The prevalence of symptoms was higher in adults aged >45 years. Of those with current wheeze, 60.9% denied a diagnosis of asthma and only 38.2% admitted to use of asthma medication. In those with current wheeze, wheezing was the only symptom in 19.9% whereas 80.1% had at least one other respiratory symptom (tightness of chest, cough or shortness of breath) of which cough was the most common symptom. In those without current wheeze, self-reported asthma and current asthma medication use, 30%, 35.9% and 36.6% respectively had at least one other respiratory symptom. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is high in comparison with global data. A significant percentage of symptomatic individuals deny having asthma and are not on medication.
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    The Prevalence of reflux oesophagitis in adult asthmatics
    (Wiley- Blackwell, 2009) Amarasiri, L.; Ranasinha, C.D.; de Silva, H.J.
    BACKGROUND/PURPOSE: Asthma and gastro-oesophageal reflux disease are known to be associated. The severity of asthma is related to the degree of reflux. This relationship has been little studied in South Asia. METHODS: Thirty asthmatics underwent a reflux symptom assessment using a validated questionnaire assessing 7 upper gastro-intestinal (UGI) symptoms graded on a 5-point Likert scale (Amarasiri LD 2009). They further underwent UGI endoscopy. RESULTS: All asthmatics had mild stable asthma. 20 of the 30 asthmatics had apositive GORD symptom score. 27 asthmatics consented to UGI endoscopy. The grade of oesophagitis was classified using Savary Miller criteria. 10 of the 27 asthmatics had evidence of mucosal damage (see Table 1). There was no correlation between the grade of oesophagitis and the GORD score (r = 0.025; P = 0.896, Spearman Rank correlation). CONCLUSIONS: The prevalence of reflux oesophagitis in asthmatics was 37%. There was no association of severity of oesophagitis with symptoms. Both these findings are consistent with the global data, but have not previously been described in a South Asian population.
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    Prevalence of asthma and comparison of ventilator capacity of asthmatics (when free of asthma) and non asthmatics among workers in selected garment factories
    (College of the Community Physicians of Sri Lanka, 2009) Abeysena, C.; Jayawardana, P.; Wickramasinha, W.P.K.; Dassanayake, I.S.
    INTRODUCTION: Asthma has been reported to be common among garment factory workers. Objective: To determine the prevalence of asthma and to compare the lung functions among asthmatics and non asthmatics among garment factory workers. METHODS: A descriptive comparison study was conducted among 774 workers of selected garment factories in the Ekala Industiral Area, Ja ela. All workers who have served for a minimum period of one year in the factory were included in the study. An interviewer administered questionnaire was used to assess personal details and presence of wheezing, dysponoea and cough and other relevant data. All those with wheezing and those with presence of both cough and dyspnoea in the absence of wheezing during the past one year were considered as asthmatics. Spirometry was performed using an electronic spirometer. Forced Vital Capacity (FVC), Forced Expiratory Volume in first second of FVC (FEV) and Peak Expiratory Flow Rate (PEFR) were assessed. The ventilatory capacity was compared among asthmatics and non asthmatics using Student T test, Mann Whitney U test or chi-squired test. Results: The prevalence of asthma was 30% (95%CI: 26.7%, 33%). The mean ventilator capacity of asthmatics and non asthmatics respectively were as follows FVC: 2.24 L versus 2.39 L (p<0.05), FEV-i.o: 2.17 L versus 2.37 L (p<0.001), PEFR {geometric mean): 5.87 L/sec versus 7.17 L/sec (p<0.001). The mean difference between the predicted normal values and observed values among asthmatics and non asthmatics were as follows: FVC: 0.53 L versus 0.58 L (p>0.05), FEVro: 0.30 L versus 0.25 L (p>0.05), PEFR (median): 1.21 L/sec versus 0.45 L/sec (p<0.001). Ninety three (40.3%) of asthmatics and 149 (27.5%) non-asthmatics had PEFR <80% of the predicted which was statistically significant (p<0.001). CONCLUSION: Prevalence of asthma was high among garment factory workers. Ventilatory capacity and predicted normal values of asthmatics when free of asthma were affected in comparison to non asthmatics.
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    Peristaltic dysfunction in asthma is secondary to increased Gastro-Oesophageal Reflux
    (American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2010) Amarasiri, L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.
    BACKGROUND: Vagal dysfunction and prolonged intra-oesophageal acidification cause oesophageal hypomotility. Asthmatics have ineffective oesophageal motility, but demonstrate increased vagal activity. Whether oesophageal hypomotility in asthmatics is a primary abnormality or secondary to pathological gastro-oesophageal reflux is unclear. Our aim was to investigate the relationship of oesophageal motility and gastro-oesophageal reflux (GOR)to vagal function in asthmatics. METHODS: Thirty consecutive mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory dual-sensor oesophageal monitoring, stationary oesophageal manometry and autonomic function testing. They also underwent gastro-oesophageal reflux disease (GORD) symptom assessment. Twenty seven of the thirty asthmatics underwent gastroscopy. A parasympathetic autonomic function score was calculated from vagal function tests (valsalva manouvre, heart rate variation to deep breathing, heart rate and blood pressure response to standing from a supine position) and correlated with gastro-oesophageal function parameters. RESULTS: Age and sex of asthmatics (mean age(SD), 34.8 years (8.4); 60% female) and controls (mean age(SD), 30.9 years (7.7); 50% female) were comparable. Asthmatics had a higher frequency and severity of GORD symptoms and 10/27 (39%) had oesophageal mucosal damage. Twenty two (69%) asthmatics showed a hypervagal response and none had a hyperadrenergic response. Manometrically, LOS and UOS parameters were similar in the two groups, but 14 asthmatics had ineffective oesophageal motility. Asthmatics with higher GORD symptom scores had a significantly lower percentage of peristaltic contractions and a higher percentage of simultaneous contractions than controls. They also had higher total and upright oesophageal acid contact times in the proximal oesophagus than those with low symptom scores. All reflux parameters were significantly higher in asthmatics. Twenty (66.7%) asthmatics had abnormal distal acid reflux and 22 (73.3%) had abnormal proximal acid reflux. Asthmatics also had significantly prolonged proximal and distal acid clearance times than controls. There was no association between parasympathetic function and either oesophageal motility or reflux parameters. CONCLUSIONS: Asthmatics with mild, stable asthma have abnormal oesophageal motility and pathological GOR. The asthmatics did not show any evidence of vagal dysfunction nor did the vagal function score correlate with oesophageal motility parameters. It seems likely that the peristaltic dysfunction is secondary to damage due to GOR and not primary vagal dysfunction.