Nigerian Thoracic Society at the forefront of advocacy for better asthma care in Nigeria

The Nigerian Thoracic Society is an organization established in 1980 with the largest gathering of adult respiratory physicians, pediatric respiratory physicians, cardiothoracic surgeons, anesthetists, pulmonary radiologists, respiratory physiotherapists, and respiratory nurses in Nigeria with about 190 registered members.^[1,2] It is concerned with the management of respiratory diseases and promoting lung health in Nigeria through public education, research, training of medical personnel, and advocacy for cleaner, fresher air for Nigerians.^[2] The society has specific objectives which include encouraging and stimulating basic research and clinical investigations in the field of thoracic medicine and surgery to improve the quality and practice of pulmonary care in Nigeria.^[2] Furthermore, the association provides a forum for the exchange and dissemination of scientific ideas and research work among its members and the medical profession, to promote the advancement of training of medical doctors and allied professions related to thoracic medicine in Nigeria, etc.^[2]

As a way of advocating for better lung care in Nigeria, the Nigerian Thoracic Society uses the avenue of different international health events to organize training programs and create awareness about respiratory diseases such as asthma. One such international health event is the World Asthma Day (WAD) which is celebrated every year by the society. The WAD is an annual event organized by the Global Initiative for Asthma (GINA), a World Health Organization collaborative organization founded in 1993. WAD is held every first Tuesday in May of every year to raise awareness of Asthma worldwide.^[3] Every year, GINA chooses a theme which is usually the focus of the event worldwide. The theme for the 2022 WAD is “Closing Gaps in Asthma Care.”^[4] There are several gaps in asthma care that require intervention to reduce preventable sufferings as well as the costs incurred by treating uncontrolled asthma. Different countries organized different events to mark the WAD to create awareness and advocacy for better asthma care and Nigerian is not an exception. The 2022 celebration was exceptional due to the wider participation of members across all the six geopolitical zones to address the gaps in asthma management in Nigeria through seminars, webinars, workshops, public enlightenment, and also media engagements by the National Executives. Asthma is a respiratory disease affecting the airways and studies have shown that about 15 million Nigerians suffer from this disease hence the need for advocacy for better care.

The Nigerian Thoracic Society seized this opportunity to enlighten patients and the general public on asthma through press releases and publications from the National secretariat. The 2022 WAD took place across all the six geopolitical zones with active participation of members in asthma advocacy events. However, activities in some of the states of the federation including Lagos, Edo, Enugu, Osun, Rivers, and Ebonyi were highlighted in this report.

In Lagos, the WAD 2022 was celebrated on 4^th and 9^th of May which were held onsite and virtually, respectively. The onsite event was held at the Medical Outpatient Department, Lagos State University Teaching Hospital, Ikeja. Specific objectives of these events included addressing issues in between prescribing inhalers and monitoring adherence as well as improving the ability to use the devices for delivery of asthma medications, etc. The targeted audience was medical doctors, patients attending asthma clinics, pharmacists, and nurses. The highlight of this event was the practical session which saw in-depth teaching on inhaler techniques and patients were allowed to physically demonstrate what they were taught. The event recorded a notable outcome as participants showed improved knowledge of inhaler techniques and were able to do a physical demonstration on how to properly use inhalers and other devices for delivery of asthma medications such as metered dose inhalers (MDIs). Peak flow devices were given as gifts to all the patients who participated. On May 9, 2022, the Nigerian Thoracic Society took advantage of Twitter space to educate many of its followers about asthma to create awareness and advocacy for better asthma care. The event was hosted by @doctoora, Lung Health Improvement Initiative, Achieving Control of Asthma in Children in Africa (ACACIA), and Nigerian Thoracic Society.

Similarly, the Respiratory Unit of the University of Benin Teaching Hospital in collaboration with the Nigerian Thoracic Society hosted WAD on May 8, 2022. Activities carried out included health enlightenment campaigns at the media station. The program was carried out in Pidgin English to reach a wider audience. Various listeners/participants called in and were enlightened on the commons triggers including but not limited to dust, symptoms such as shortness of breath, wheezing, cough and chest tightness, as well as management with preventer and controller medications, particularly the use of inhalers.

At the University of Nigeria Teaching Hospital, the WAD 2022 was held virtually on 3^rd of May, taking advantage of virtual platform (Google meeting) and a radio show which was held on 4^th of May on FRCN 92.9 FM. Participants were consultants and residents in adult and pediatric pulmonology units, residents, and patients from other specialties. The outcomes of these events were better understanding of asthma and its triggers, improved inhaler techniques, and better knowledge of asthma action plans.

In Abakaliki Ebonyi State, members attempted to close the gap by training peer educators from schools. In attendance for the training were 51 students from ten different secondary schools with 18 teachers in charge of the health clubs in the schools. Selected trained facilitators were used to deliver the various lectures to the participants. A total of seven lectures were given. At the end of the program, participants (students and teachers) outlined their plans to share their learned experiences with other students at their respective schools.

In Ile- Ife Osun State, the Asthma and Chest Care Foundation in collaboration with Asthma and Chest Care Research and Training Institute and Respiratory Unit, Obafemi Awolowo University Teaching Hospital Complex organized a symposium targeting the health-care practitioners and the general public on GINA guidelines to educate on the principles of managing and controlling asthma symptoms.

Similarly, an interactive teaching and practical training on asthma care sponsored by GlaxoSmithKline (GSK) were held by the pediatric pulmonology Unit of Rivers State University Teaching Hospital and the University of Portharcourt Teaching Hospital on a radio-program to address the theme for the 2022 WAD.

In FMC Asaba, a similar program was held to discuss gaps in asthma care and solutions among health-care professionals.

In conclusion, education of asthma patients and carers is an integral part of asthma care to achieve optimal control of symptoms and exacerbation. This involves an emphasis on self-management, which can significantly reduce the suffering and costs associated with asthma. Nigerian Thoracic Society through its members was able to work together on the theme for the 2022 WAD celebration to identify and close the gaps in asthma care in Nigeria through seminars, symposia, workshops, and webinars to educate asthma patients, relatives, and carers involved in asthma care across the six geopolitical zones in Nigeria. The association also hopes to continue to engage the public and also reach out to and train other health workers in the management of asthma through collaborations with major stakeholders including government and private sector particularly pharmaceutical companies. This is hoped to have some positive impact on the burden of asthma care in Nigeria.