Int J Biol Med Res. 211; 2(4): 1 13 Int J Biol Med Res Volume 2, Issue 4, Ot 211 www.biomedsidiret.om BioMedSiDiret Publiations Contents lists available at BioMedSiDiret Publiations International Journal of Biologial & Medial Researh Journal homepage: www.biomedsidiret.om International Journal of BIOLOGICAL AND MEDICAL RESEARCH Original Artile The use of omplementary and alternative mediine by asthma patients reeiving are in an urban tertiary entre in nigeria. O.O Adeyeye*, B.O Onadeko, O.Ogunleye, R.T Bamisile,A.Olubusi Department of Mediine, Lagos State University College Of Mediine, PMB 216 IKEJA, Nigeria A R T I C L E I N F O A B S T R A C T Keywords: Asthma Complementary Alternative Mediine Herbal Abstrat Introdution: There is inreasing use of Complementary and Alternative Mediine () by individuals with hroni illness. Data on prevalene of utilisation by asthmatis are however limited as well as the pattern of its use partiularly in Nigeria. The study was to determine the frequeny and pattern of use of among patients with bronhial asthma attending a speialist asthma lini, as well as desribe the soio-demographi and other fators assoiated with its use. Materials And Method: This ross setional study involved one hundred and ninety onseutive asthma patients attending the Asthma lini of Lagos State University Teahing Hospital over a three month period. The patients were interviewed with a strutured questionnaire whih sought information on soio-demographi harateristis, duration of asthma diagnosis, mediation use, asthma ontrol, type of omplementary and alternative mediine in use, soures of information on, reasons for its use and ost of mediations. The questionnaires were previously pretested among newly diagnosed asthmatis. Asthma ontrol was based on the GINA(Global initiative for the study of asthma) guidelines and lassified into intermittent and mild persistent, moderate persistent and severe persistent. Results: There were 7 males (36.8%) and (63.2%) females. The mean age of respondents was 45.83 ±19.52 years with the mean duration of asthma diagnosis of 1.48±9.8 years. Current use was reported in 96 (5.5%) respondents. Biologi based therapies were the most widely used form of among the patients. Native loal herbs was mostly used in 68 (7.8%), bitter leaf (vermonia amygdalina ) and prayer was used by 58(6.4%) and (47.9%) respetively. Longer duration of asthma was assoiated with use of omplementary and alternative mediine. The eduational level and inome were not assoiated signifiantly with use however severity of asthma was assoiated with use. Conlusion: Use of is frequent among asthma patients and therefore it is important that physiians enquire from the patients about its use. Copyright 21 BioMedSiDiret Publiations IJBMR - ISSN: 976:6685. All rights reserved. 1. Introdution Asthma is a hroni lung disease affeting about 3million people worldwide [1]. It is estimated to affet about 1.4% of Nigerian * Corresponding Author : Dr. O.O ADEYEYE Department of Mediine, Lagos State University College Of Mediine, PMB 216 IKEJA, Nigeria Phone: 2348333935 E.mail: olufunkeadeyeye@yahoo.om Copyright 21 BioMedSiDiret Publiations. All rights reserved. [2].The 27 National Health Interview Survey (NHIS) done in the United States show that approximately 38% of Amerian adults use [3]. The use of omplementary and alternative mediine is on the inrease globally partiularly among people suffering from hroni illnesses. Although Complementary and alternative mediine () is believed to be widely used by asthma patients, t h e r e a r e l i m i t e d s t u d i e s a b o u t t h i s i n N i g e r i a.
O.O Adeyeye et.al / Int J Biol Med Res. 211; 2(4): 1 13 7 Defining is diffiult but the National Centre for Complementary and Alternative Mediine (NC) defines as a group of diverse medial and health are systems, praties and produts that are not generally onsidered part of onventional mediine. Complementary mediine refers to together with onventional mediine [3]. The National institute of Health (NIH) lassifies into five major ategories : alternative medial system e.g traditional oriental mediine, aupunture, Ayurveda, naturopathy, homeopathy, Native Amerian Healing, Tibetan mediine), Mind body interventions (meditations, hypnosis, dane, art and musi therapy, spiritual healing and prayer), biologi therapies (herbal mediine and dietary supplements, speial diets and orthomoleular mediine), manipulative and body based methods (hiroprati, massage, other body works system and aspets of osteopathi mediine suh as ranio-saral work and energy therapies (reiki, therapeuti touh and other methods affeting the bioeletri fields of the body [4]. Several reasons had been given for the use of in asthmatis most ommon of whih inlude ineffetiveness of orthodox treatment for their omplaints, dissatisfation with are, hroniity of illness neessitating long term and ontinuing self-are, ost of prourements, dissatisfation with therapy and onern about side effets partiularly of steroids. In hroni onditions when adherene to mediations frequently affet outome disontinuation of onventional mediine for may adversely affet asthma ontrol. To our knowledge there has not been any loal study done in Nigeria evaluating omplementary and alternative mediine use among adult asthmatis. The objetives of this study were to determine the prevalene and pattern of by adult patients with asthma reeiving treatment at the Lagos State University Teahing Hospital Asthma lini and to evaluate the linial and soio- demographi fators assoiated with its use. defined as use of any therapy lassifiable as either a omplementary or alternative therapy. 2.1.Statistial analysis Data analysis was done using the SPSS version17. Numerial data were expressed as mean ±SD and omparison of mean done with student t test. Categorial variables are expressed as proportions and ompared using the hi square test. Statistial signifiane was assumed at P value <.5. 3.Results The soio-demographi and eonomi profiles of the 19 asthma patients evaluated are shown in Tables 1 and 2. The mean age of the asthma patients was 45.83±19.52 years. There were more females ompared to males. The eduational level and inome level did not have any effet on the use of. The mean duration of asthma was 1.48±9.78 years. There were statistially signifiant assoiation between duration of asthma and the use of omplementary and alternative mediine. The presene of omorbidities did not show any statistially signifiant effet on the use of. Asthma severity were graded based on the GINA (global initiative for the study of asthma) as Intermittent/mild persistent in 91(47.9%), moderately persistent in 76(4%) and severe persistent in 23(.1%). Severity of asthma was assoiated with use of. Table 1. The Demographi Charateristis of Asthmatis Users and Non Users. Variables Mean age, years (SD) Overall population N=19 ±SD (%) USERS NON USERS N=94 (49.5%) TEST STATI- STICS* P VALUE 45.83±19.52 5.94±16.29 4.62±21.19 3.76. 2. Materials and Methods This ross-setional desriptive study was arried out at the asthma lini of the Lagos State University Teahing Hospital. Ikeja Lagos. The inlusion riteria were diagnosed asthmatis attending follow up for at least three visits. The diagnosis of asthma was based on history of episodi wheeze, shortness of breath, ough, hest tightness relieved with bronhodilator as well as spirometry showing reversible airway obstrution. The study was approved by the ethis ommittee of the hospital. One hundred and ninety asthma patients onsented to the study and were interviewed with a pre tested questionnaire. The questionnaire sought information on soio-demography, inome, age, sex, eduational level, duration of asthma diagnosis. SEX Male Female Eduational Level None Primary Seondary Tertiary Inome level Low Middle High 7(36.8) (63.2) 38 56 7 145(76.3) 3(15.8) 15(7.9) 28(29.5) 67(7.5) 78 11 7 42(43.6) 53 (56.4) 14 3 38 67 19 8 3.76 6.9 3.14.35 Sig 17 NS.22 NS Three monthly inome groups were used: low inome (less than N2, (Twenty thousand Naira)i.e.lessthan US$25 at 155 Naira to 1US dollar, medium inome>n2,-n2, i.e US$25-US$1,3 and high inome >N2, i.e>$1,3.) Symptoms and spirometri data were used in lassifying patients into intermittent, mild persistent, moderate persistent and severe persistent asthma. The Use of was evaluated with standard questions about use and type. utilisation was *Statistial omparison of the users and non-users. Student T test ompare mean values and hi square test omparing proportions.
8 O.O Adeyeye et.al / Int J Biol Med Res. 211; 2(4): 1 13 Table 2: The Clinial Profile of Asthmatis Users And Non Users Variables Mean Duration of Asthma, Co-morbidities with out Severy of Asthma Mild Overall population N=19 ±SD (%) 1.48±9.78 19 51 9 91 99 91 Users Non Users N=94 (49.5%) P Value.89±11.2 8.11±7.5.2 sig 3 96 43 53 51 63 21 94 48 4.2 sig.8.33 3.1.Profile of omplementary and alternative mediine use Complementary and alternative mediine was reportedly utilised by 96 (5.5%). The speifi used either alone or in ombination with other and their frequenies among the 96 urrent users were as shown in Table 3. Biologi based therapies were the most widely used form of omplementary and alternative mediine among the patients. Native loal herbs was most frequently used 68(7.8%), followed by bitter leaf ( vermoniaamygdalina) and 58 (6.42%) Prayer was used by (47.9%). Based on the lassifiation of, none of the patients used healing systems, energy therapy or manipulation. Convetional asthma drugs were used along with by 8 (83.3 %) of the patients while 16(16.7%) of the asthma patients stopped their hospital mediations to take. Soures of information about inluded friends, 39(4.6%) and family 38(39.6%). Other soures inlude radio and television in 16 (16.7%) and the print media responsible 2 (2.1%). This is shown in Figure I. Figure I: The Soures Of Information About Complementary And Alternative Mediine. Moderate persistent Sever persistent 76 23 3 15 8 *Statistial omparison of the users and non-users. Student T test. Table 3 : The Type of Commonly Used By The Asthma Patients Type of Cam Based On Nih % BIOLOGIC-BASED THERAPIES Loal herbs Bitter leaf Garli Aloe vera Herbal tea Edmark tea Nutritional supplements and multivitamins 68 58 16 8 7.83 6.42 33.33 16.67 8.33 Figure II: The Reasons Given By Asthma Patients For Using Complementary And Alternative Mediine Mind Body Interventions Prayer Alternative Medial System Chinesetianshi 4 4.17 Manipulative And Body Based Methods Energy Therapies Some users used more than one type.
O.O Adeyeye et.al / Int J Biol Med Res. 211; 2(4): 1 13 9 4. Disussion Several studies have demonstrated the use & in hroni diseases like hypertension, diabetes, sikle ell diseases and epilepsy [5,6].The atual prevalene of use in hroni illness in this environment remains unknown but the NIH (National Institute of Health of the United States of Ameria) estimated that about 4% of Amerians use for health problems [2]. In our loality, the use of omplementary and alternative mediine appears to be onsidered strongly by asthma patients. In this study we reported on the prevalene of use among the asthma patients attending our tertiary asthma lini in an urban area and explore the types of frequently used, possible patients' harateristis determining its use and the reasons frequently given for using. The prevalene of urrent use among the population studied was 5.5%. This is similar to the finding of Blan et al [7] and Ernst et al [8] who found 59% and 41% of asthma patients using in the UK and USA respetively. However this prevalene is higher than the.5% and 27.2% in Germany and Singapore [9] respetively. More reently Marino et al [1] found a prevalene of use of 39.6% among adults asthmati but did not find any signifiant assoiation with use by sex, age or eduational status. We found that eduational levels and inome did not affet the use of in our patients. These finding s are at variane with that of Marino et al who found that use was higher among patients with signifiant finanial barrier to asthma are [1-16]. This may be due to the ultural aeptane of omplementary and alternative mediine in our soiety thus making it a form of treatment modality aeptable by most people. In addition to this, the availability of these modalities may make it a hoie treatment. The presene of Co-morbidities did not have any signifiant assoiation with use in our study. However, patients with severe asthma and longer duration of asthma were more likely to use. This finding is similar to several other studies where asthma severity seems to be an important preditor of use [9,1].The length of the disomfort assoiated with asthma and the lak of satisfation with onvetional medial therapy may be some of the reasons why these groups of asthmatis may be more favourably disposed to the use of. The most frequently used in our study was Loal herbs. This is not surprising sine several loal herbs had been identified loally for the use of respiratory symptom. Sonibare et al [11] in a study of ethno-botanial survey of anti- asthmati plants in South Western Nigeria found forty six plants belonging to three different families in the twenty markets surveyed. The ready availability of these phyto-mediines probably makes it an attrative option for asthmatis and their are givers in the ommunity. Our finding is also onsistent with several other studies on the management of hroni ailments in Nigeria where loal herbs were the most frequently used [5]. It is frightening to know that there is lak of information about the safety and the usefulness of these remedies despite their widespread usage. In a survey of 61 patients with asthma by Blan et al [], the use of herbal mediine was assoiated with inreased risk of hospitalisation in the last months. This was attributed to possible lak of ontrol of airway inflammation in herbal remedy users. It is important to note that these agents have biologi ativities and therefore side effets and possible drug -drug interations with onventional therapies are real issues to deal with. For example, Mizushima and Kobayashi [13] published a series of 24 ases of interstitial pneumonitis indued by herbal remedies. The most prevalent mind body intervention in this study was prayer. This is similar to the finding of George et al [14]. This may be due to the ultural and religious belief that most illnesses has spiritual origin and in reent times there has been inreasing belief in divine healing by virtually all religious set thus making prayer an important aspet of treatment.manipulative and energy therapy were not used by any of the patients. This may be due to the fat that these modalities are unommon in Nigeria and where available may not be affordable to the predominantly low inome patients in this study. There are many reasons why patients hoose as a substitute for onventional are or as an additional therapeuti agent. In this study, some of the reasons given inluded the fat that they onsidered it heaper, readily available. Some onsidered it to be more effetive and some opined it was with fewer side effets. The reasons given were similar to findings to other studies. Most of the patients obtained information about from family and friends. It is surprising however that only few patients in our study obtained their information from our news and print media despite the largely unregulated advertisement of traditional mediines and alternative are provider in Nigeria. 5. Conlusion The use of is ommon among asthma patients attending the asthma lini of the Lagos State University Teahing Hospital. The usage of is dependent on duration of illness as well as severity. Soio demographi fators and eonomi fators did not signifiantly a ffet t he u se of in our study. It is therefore important for physiians managing patients with asthma to inquire about the use of to enable appropriate evaluation of all fators responsible for patients' ontrol. It is also important to provide adequate information to patients on potential harm or benefits of all mediations in use. Further researh on the potentials benefit and otherwise of on treatment of asthma in this environment is suggested to get a better insight into the role of in asthma management. 6. Referenes [1] GINA Report, Global Strategy for Asthma management and prevention. http:// www.ginasthma.org/pdf/gina_report_21.pdf. [2] ISAAC STEERING COMMITTEE. Worldwide variation in prevalene of asthma symptom: the international study of asthma and allergies in hildhood (ISACC) Eur. Respir J. 1998; : 315-335.
13 O.O Adeyeye et.al / Int J Biol Med Res. 211; 2(4): 1 13 [3] Hughes EF, Jaobs BP, Berman BM: omplementary and alternative mediine. In urrent Medial diagnosis and treatment Edited by: Tierney LM, MPhee SJ, Papadakis MA. New York, MGraw Hill; 25;1696-1719 [4] What is Complementary and Alternative Mediine? National Centre for omplementary and alternative mediine (NC). Available at: http://nam.nih.gov/health/whatis am. Aessed Marh 5, 21. [5] Amira CA, Okubadejo NU. Frequeny of omplementary and alternative mediine utilization in hypertensive patients attending an urban tertiary are entre in Nigeria. [6] BMC omplementary and alternative mediine 27, 7:3 doi: 1. 1186/1472-6882-7-3. [7] Oshikoya KA, Sebanjo IO, Njokama OF and Soipe A. use of omplementary and alternative mediine for hildren with hroni onditions in lagos Nigeria. [8] BMC omplementary and alternative mediine 28, 8;66doi; 1, 1186/1472-6882-8-66. [9] Blan PD, Trupin L, Earnest G et al. Alternative therapies among adults with a reported diagnosis of asthma or rhino sinusitis: data from a population based survey. Chest 21: : 11-17. [9] Blan PD, Trupin L, Earnest G et al. Alternative therapies among adults with a reported diagnosis of asthma or rhino sinusitis: data from a population based survey. Chest 21: : 11-17. [1] Ernst E: omplementary therapies for asthma: what patients use. J asthma 1998: 35: 667-671 [11] Ng TP, Wong ML, Hong CY, Koh KTC, Goh LG. the use of omplementary and alternative mediine by asthma patients. QJM (23) 96(1): 747-754. Doi: 1.193/qjmed/hg1. [] Marino LA, shen, Joannie. Charateristis of omplementary and alternative mediine use among adults with urrent asthma. Journal of Asthma : 47;5; 21: 521-525. [13] Sonibare MA, Gbile ZO. Ethnobotanial survey of anti- asthma plants in south western Nigeria. Afr. J. trad. 28:5;34-345. [14] Blan PD, kushner WG, Katz PP et al.use of herbal produts, offee or blak tea and over the ounter mediations as self-treatment among adults with asthma. J Allergy Clinimmunol 1997, 1:789-791. [15] Mitzushima Y, Kobayashi M: Clinial features of pneumonitis indued by herbal drugs. Phytother Res 1998,11:295-298. [16] George M, Birk K, Hufford DJ, Jemmott LS, Weaver TE. Beliefs about asthma and omplementary and alternative mediine in low inome inner ity Afrian-amerian adults. J Gen Intern Med :1317-14. Copyright 21 BioMedSiDiret Publiations IJBMR - ISSN: 976:6685. All rights reserved.