Lung Health in the Solomon Islands: A Mixed Methods Study

Abstract

James Di Michiel,1 Julie Gawthorne,2 Aruna Shivam,2 Kevin Maruno,2– 4 Sarah Cohn,3,5 Christopher Lemon,3,6 Zhixin Liu,7 Anthony Byrne1,3 1Department of Thoracic Medicine, St Vincent’s Hospital, Sydney, NSW, 2010, Australia; 2Department of Emergency Medicine, St Vincent’s Hospital, Sydney, NSW, 2010, Australia; 3University of New South Wales, St Vincent’s Medical School, Sydney, NSW, 2010, Australia; 4University of Notre Dame, St Vincent’s Medical School, Sydney, NSW, 2010, Australia; 5Department of Psychiatry, Prince of Wales Hospital, Sydney, NSW, 2031, Australia; 6Department of Psychiatry, St Vincent’s Hospital, Sydney, NSW, 2010, Australia; 7Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW, 2052, AustraliaCorrespondence: James Di MichielDepartment of Thoracic Medicine, St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW, 2010, AustraliaEmail [email protected] and Objectives: Despite a population of 600,000 people from 900 islands, there is little published data on the prevalence of lung disease in the Solomon Islands. We sought to 1) estimate the prevalence of obstructive lung disease (OLD) in Gizo, Solomon Islands, 2) identify risk factors for respiratory disease in this population and 3) review current management practices for respiratory disease through an audit of local emergency department (ED) presentations.Methods: A two-part mixed methods study was performed between March and May 2019; the first was a population-based, cross-sectional study conducted in Gizo, Solomon Islands, with a random sample undergoing questionnaires and spirometry. The second was an audit of Gizo Hospital ED records to assess presentation numbers, diagnoses and outcomes.Results: A total of 104 patients were randomly selected for spirometry. The mean age was 46.9 years. Current smoking rates were high (24.0% overall, 43.3% age 10h/week) exposure to indoor/enclosed wood fire ovens (51.5%). The prevalence of COPD was 3.2% overall. A further 9.7% of participants demonstrated significant bronchodilator responsiveness suggestive of possible asthma. Most patients seen in ED presented with a respiratory condition or fever/viral illness, but spirometry was not available. Only four outpatients were prescribed salbutamol and two patients inhaled corticosteroid.Conclusion: There appears to be a high burden of obstructive lung disease in the Solomon Islands with high smoking rates, indoor smoke exposure and bronchodilator responsiveness. Respiratory symptoms are common amongst hospital ED presentations; however, inhaled asthma treatments are infrequently prescribed to outpatients.Keywords: obstructive lung diseases, COPD, asthma, inhalational exposure, Pacific Islands

Keywords

• obstructive lung diseases
• copd
• asthma
• inhalational exposure
• pacific islands.