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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 18-19

Authors' Response – Pulmonary function abnormalities in Nigerian children with sickle cell anemia: Prevalence, pattern, and predictive factors


Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria

Date of Web Publication9-May-2019

Correspondence Address:
Bankole Peter Kuti
Department of Paediatrics and Child Health, Obafemi Awolowo University, P.M.B. 013, Ile-Ife
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/prcm.prcm_5_19

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How to cite this article:
Kuti BP, Adegoke SA. Authors' Response – Pulmonary function abnormalities in Nigerian children with sickle cell anemia: Prevalence, pattern, and predictive factors. Pediatr Respirol Crit Care Med 2019;3:18-9

How to cite this URL:
Kuti BP, Adegoke SA. Authors' Response – Pulmonary function abnormalities in Nigerian children with sickle cell anemia: Prevalence, pattern, and predictive factors. Pediatr Respirol Crit Care Med [serial online] 2019 [cited 2019 Dec 14];3:18-9. Available from: http://www.prccm.org/text.asp?2019/3/1/18/257933



Sir,

Thank you for the interest in our article titled, “Pulmonary Function Abnormalities in Nigerian Children with Sickle Cell Anemia: Prevalence, Pattern, and Predictive Factors” published in the October–December 2018 issue of the Pediatric Respirology and Critical Care Medicine. We are particularly delighted with the suggestions and points raised by the correspondent and hereby wish to respond to the issues.

While we totally agree with the fact that Knudson reference equation used for our population may not be the most appropriate for Nigerian children. We however quickly want to call the attention of the correspondent to the nonavailability of an ideal standard nationwide reference equation for our population. Nigeria is a multiethnic nation, and a population-based spirometry reference equation that takes into account the various ethnic groups in the country is needed, which is unfortunately not available at present.

The reference values suggested by Njoku and Anah[1] were suggested in adults and they only gave values for peak expiratory flow rates, so are not applicable to our pediatric population.

Spirometry standard suggested by Olanrewaju[2] about 30 years ago was also not representative of Nigeria population, and the number of children assessed for the study was too few to be used as a standard reference value. Akhiwu and Aliyu[3] gave their reference equation by studying 710 children in Kano, Northwest part of the country, who were predominantly Hausa/Fulani ethnic group and the equation may not be representative of the other ethnic groups in the country. In addition, the number of children studies was too small to represent the entire child population of the country. Moreover, the age group covered by their study (6–11 years) excluded the age range of our population of interest (6–16 years), so the equation may not be appropriate for the interpretation of our lung function values. Similarly, other suggested normative values in Nigerian children are given as pilot study because of the small sample size and are nonrepresentative of the various ethnic populations in the country.[4]

We decided to use Knudson reference value for our population because our study compared the lung function values for our cases (sickle cell anemic [SCA] children) with age- and sex-matched comparative group (children with Hb genotype AA). Although Knudson reference values (done in Caucasian population) may overestimate lung function abnormalities in our population and there is a need to switch to modern spirometry equation,[5],[6] the fact that lung function abnormalities were not equally observed in apparently healthy children compared to the SCA children (3.7% vs. 29.8%)[7] clearly shows that its application to our population is justifiable.

No doubt, there is a need for a modern, all-inclusive reference equation for Nigerian population; however, the need for routine assessment of lung functions in children with SCA, particularly adolescents and those with acute chest syndrome and multiple vaso-occlusive crises (VOC), which our study[6] clearly highlight, should not be overlooked.

Acknowledgments

The authors are grateful to the clinicians at the Paediatric Department of the Wesley Guild Hospital who assisted in patient recruitment and the children with their caregivers who kindly accepted to participate in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Njoku CH, Anah CO. Reference values for peak expiratory flow rate in adults of African descent. Trop Doct 2004;34:135-40.  Back to cited text no. 1
    
2.
Olanrewaju DM. Spirometric standards for healthy Nigerian children and adolescents. East Afr Med J 1991;68:812-9.  Back to cited text no. 2
    
3.
Akhiwu HO, Aliyu I. Spirometric values in healthy Nigerian school children aged 6-11 years. J Adv Med Med Res 2017;22:1-8.  Back to cited text no. 3
    
4.
Oloyede IP, Ekrikpo UE, Ekanem EE. Normative values and anthropometric determinants of lung function indices in rural Nigerian children: A pilot survey. Niger J Paediatr 2013;40:406-11.  Back to cited text no. 4
    
5.
Enright P. Switch now to modern spirometry reference equations. Ann Am Thorac Soc 2016;13:772.  Back to cited text no. 5
    
6.
Stanojevic S, Wade A, Stocks J. Reference values for lung function: Past, present and future. Eur Respir J 2010;36:12-9.  Back to cited text no. 6
    
7.
Kuti BP, Adegoke SA. Pulmonary function abnormalities in Nigerian children with sickle cell anaemia: Prevalence, pattern and predictive factors. Paediatr Respirol Crit Care Med 2018;2:73-9.  Back to cited text no. 7
    




 

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