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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    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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    Spirometry reference norms for 13-14 year old Sri Lankan children.
    (Wiley Blackwell Scientific Publications, 2016) Amarasiri, D.L.; Warnakulasuriya, D.T.; Wickremasinghe, A.R.; Gunasekera, K.D.;
    BACKGROUND AND AIMS: Spirometry reference norms have only been reported for Peak Expiratory Flow Rate (PEFR) in Sri Lankan children. The aim of this study was to construct prediction equations for spirometry in Sri Lankan children aged 13-14 years. METHODS: Spirometry was performed in 2078 healthy 13-14 year old Sri Lankan children (1023 boys (49.2%) and 1055 (50.8%) girls) according to American Thoracic Society guidelines. Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), PEFR and Forced Mid-Expiratory Flow Rates (FEF25-75%) were measured. Correlation coefficients were established between each parameter and standing height, weight, and age. The functions were regressed over all possible combinations of variables separately for boys and girls. RESULTS: There were significant correlations between spirometry parameters and height and weight in both genders. There were significant correlations between age and PEFR, FEF25 and FEF50 in males and age and FEV1, PEF and FEF25-75% in females. The prediction equations in males for FVC: 0.047height + 0.0007age- 4.66; for FEV1: 0.041height + 0.016age - 4.22; for PEFR: 0.074height + 0.123age - 7.59 and FEF25- 75%: 0.042height + 0.066 age - 4.36. The equations in females for FVC: 0.028height + 0.031age - 2.36; for FEV1: 0.027height + 0.047age - 2.57; for PEFR: 0.038height + 0.159age - 2.93 and FEF25-75%: 0.02height + 0.136age - 3.18. CONCLUSIONS: Height and age influence ventilatory parameters and could be used to assess lung functions in Sri Lankan children.
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    The prevalence of upper respiratory symptoms in a cohort of adults presenting with symptoms of gastro-oesophageal reflux disease
    (Sri Lanka Medical Association, 2016) Amarasiri, D.L.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; Adikari, M.D.B.; Sanjeewa, P.A.B.; Jayaratne, A.; de Silva, H.J.
    INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is the pathological reflux of gastric contents into the oesophagus. The oesophagus and the upper respiratory tract have a common origin from the foregut. There is increasing evidence for multiple associations of GORD with the upper respiratory tract. OBJECTIVES: To study the presence of and association of upper respiratory symptoms (URS) with GORD. METHODS: Seventy adults scoring ≥12.5 on a previously validated GORD symptom score (GORD patients) and 70 healthy controls who had infrequent GORD symptoms or no upper gastro-intestinal complaints completed a pre-tested URS questionnaire on the frequency of 14 URS in 5 categories (laryngeal, nasal, pharyngeal, sinusal and aural). All GORD patients underwent upper gastro-intestinal endoscopy. The calculated URS score was correlated against the GORD symptom score and endoscopy findings. RESULTS: URS scores and individual symptom scores were higher in GORD patients compared to controls (mean ± SE, 4.7 ± 4.0; 1.9 ± 2.3). Individuals with higher GORD symptom scores reported more frequent URS. Pharyngeal symptoms had the highest correlation with the GORD symptom score (r=0.507, p<0.001). The presence of oeso-phagitis did not seem to influence the frequency of reporting URS. CONCLUSION: Upper respiratory symptoms are common in individuals with GORD symptoms though there appears to be no association with oesophageal mucosal damage.
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    Response of the airways and autonomic nervous system to acid perfusion of the esophagus in patients with asthma: a laboratory study
    (BioMed Central, 2013) Amarasiri, D.L.; Pathmeswaran, A.; de Silva, H.J.; Ranasinha, C.D.
    BACKGROUND: Gastro-esophageal reflux disease (GERD) predisposes to airway disease through a vagally-mediated esophago-bronchial reflex. This study investigates this vagal response to esophageal acid perfusion. METHODS: 40 asthmatics with mild stable asthma participated. Each subject underwent spirometry and autonomic function testing (valsalva maneuver, heart rate response to deep breathing and to standing from supine position) four times: a) before intubation, b) after intubation, and then immediately after perfusion with, in random order, c) concentrated lime juice solution (pH 2--3) and d) 0.9% saline. Subjects were blinded to the solution perfused. RESULTS: Asthmatics were of mean (SD) age 34.3 years (1.3), and 67.5% of them were females. pH monitoring demonstrated that 20 subjects had abnormal reflux and 20 did not. In each group 10 subjects had a positive GERD symptom score. Following perfusion with acidcompared to saline, all subjects showed significant decreases in FEV1 and PEFR and significant increases in the mean valsalva ratio and heart rate difference on deep breathing from baseline values, but no changes in FVC or heart rate ratio on standing. There were no significant differences in any of the parameters between subjects with and without reflux. CONCLUSIONS: Acid stimulation of the distal esophagus results in increased parasympathetic activity and concomitant broncho-constriction in asthmatics irrespective of their reflux state. This strengthens the hypothesis that GER triggers asthma-like symptoms through a vagally mediated esophago-bronchial reflex and encourages a possible role for anti-cholinergic drugs in the treatment of reflux-associated asthma
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    Esophageal motility, vagal function and gastroesophageal reflux in a cohort of adult asthmatics
    (BioMed Central, 2012) Amarasiri, D.L.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; Ranasinha, C.D.; de Silva, H.J.
    BACKGROUND: Asthmatics are known to have esophageal hypomotility. Vagal hypofunction and prolonged intra-esophageal acidification cause esophageal hypomotility. The contribution of gastroesophageal reflux (GER) and vagal function to esophageal motility in asthmatics is unclear. We studied the relationship between esophageal motility, GER and vagal function in a cohort of adult asthmatics. METHODS: Thirty mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory esophageal monitoring, manometry, autonomic function testing and GER symptom assessment. 27 asthmatics underwent gastroscopy. A vagal function score calculated from 3 tests (valsalva maneuver, heart rate response to deep breathing and to standing from supine position) was correlated with esophageal function parameters. RESULTS: Asthmatics (mean age 34.8 (SD 8.4), 60% female) had more frequent GERD symptoms than controls (mean age 30.9 (SD 7.7), 50% female). 10/27 asthmatics had esophageal mucosal damage, 22 showed hypervagal response, none had a hyperadrenergic response. 14 asthmatics had ineffective esophageal motility. Higher GERD-score asthmatics had significantly fewer peristaltic and more simultaneous contractions than controls, and higher esophageal acid contact times than those with lower scores. All reflux parameters were significantly higher and acid clearance time prolonged in asthmatics than controls (p < 0.001, Mann-Whitney U test). There was no correlation between vagal function score and esophageal function parameters. CONCLUSIONS: A cohort of adult asthmatics was found to have peristaltic dysfunction and pathological GER, but otherwise normal esophageal motility. The peristaltic dysfunction seems to be associated with vagal hyperreactivity rather than vagal hypofunction
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