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2
Laboratory Biossafety Manual
Position statement for adult and paediatric spirometry in South Africa: 2022 update
Maree, D.M.; Swanepoel, R.A.; Swart, F. et al.
African Journal of Thoracic and Critical Care Medicine
(2022)
CC
Spirometry is required as part of the comprehensive evaluation of both adult and paediatric individuals with suspected or confirmed respiratory diseases and occupational assessments. It is used in the categorisation of impairment, grading of severity, assessment of potential progression and response
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to interventions. Guidelines for spirometry in South Africa are required to improve the quality, standardisation and usefulness in local respiratory practice. The broad principles of spirometry have remained largely unchanged from previous versions of the South African Spirometry Guidelines; however, minor adjustments have been incorporated from more comprehensive international guidelines, including adoption of the Global Lung Function Initiative 2012 (GLI 2012) spirometry reference equations for the South African population.
All equipment should have proof of validation regarding resolution and consistency of the system. Daily calibration must be performed, and equipment quality control processes adhered to. It is important to have standard operating procedures to ensure consistency and quality and, additionally, strict infection control as highlighted during the COVID-19 pandemic.
Adequate spirometry relies on a competent, trained operator, accurate equipment, standardised operating procedures, quality control and patient co-operation. All manoeuvres must be performed strictly according to guidelines, and strict quality assurance methods should be in place, including acceptability criteria (for any given effort) and repeatability (between efforts).
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This American Thoracic Society Statement was prepared by a Committee of the Scientific Assembly on Environmental and Occupational Health at the request of the American Lung Association Occupational Health
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Expert Advisory Group to emphasize the continuing importance of silicosis as a major lung disease worldwide and the need for increasing efforts in prevention. Emphasis is placed on public health issues of silicosis rather than on important current research in pathologic mechanisms.
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Al afrontar la amenaza común que supuso el coronavirus del síndrome respiratorio agudo severo de tipo 2 (SARS CoV 2), los países y las instituciones de todo el mundo se vieron rápidamente desbordados por la monumental tarea de responder a un problema que avanzaba rápidamente y que les obligó a
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idear estructuras y alianzas ad hoc para ampliar las medidas de respuesta. En este sentido, el Grupo Independiente de Preparación y Respuesta frente a las Pandemias señaló:
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The key actions, activities, and approaches in this document are organized within each of the 5Cs (see Table 1 in the PDF) and those of the Strategic preparedness and response plan (SPRP) pillars as follows:
National action plan key activities, prioritized for the current context and the current
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understanding of the threat of SARS-CoV-2
A. Transition from emergency response to longer term COVID-19 disease management.
B. Integrate activities into routine systems.
C. Strengthen global health security.
Special considerations for fragile, conflict-affected and vulnerable (including humanitarian) settings
WHO global and regional support to Member States to implement their national action plans
Key guidance documents for reference
This is a living document that will be updated to incorporate new technical guidance in response to the evolving epidemiological situation. National plans should be implemented in accordance with the principles of inclusiveness, respect for human rights, and equity.
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The Malaria Care Toolkit. Tools for maintaining high-quality malaria
case management services. Développé par MalariaCare, ce module aide les superviseurs de santé à améliorer la prise en charge du paludisme grave en leur proposant un apprentis
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sage et un mentorat ciblés et basés sur des cas. Il leur fournit les outils nécessaires pour guider les prestataires de soins de santé lors des visites de formation et de supervision de proximité (OTSS). Conçu pour renforcer les compétences en matière de diagnostic et de traitement, il se concentre notamment sur les domaines souvent négligés, comme le paludisme grave. Il utilise des études de cas réels et des discussions guidées pour évaluer et améliorer la compréhension clinique.
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The objective of this course is to provide high-level information and contextual understanding of WHO Standard Operating Procedures (SOPs) for Emergencies.
We will explore a range of topics, ranging from the Emergency Response Framework (ERF), to planning, grants and finance, procurement, risk mana
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gement, rosters and deployment, and ethics.
Each module within this course is standalone. Therefore, you can take the modules in any order – with the exception of the Course Review. The Course Review is a question-based revision module that recaps the content covered in modules 1 to 10.
The target audience for this course is personnel who will be assigned by WHO to go on deployment in response to health emergencies.
The course is available in English and French
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The Our World in Data webpage on air pollution provides an extensive overview of the global impact of air pollution on health and the environment. It presents data on sources of pollution, such as industry, vehicles, and domestic energy use, and hig
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hlights the associated health risks, including respiratory and cardiovascular diseases. The site emphasizes that air pollution is one of the leading environmental risk factors for premature deaths worldwide, particularly affecting low- and middle-income countries. It also discusses trends in air pollution levels over time and the effectiveness of policy interventions in reducing pollution and improving public health.
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Pollution (dirty air) is a big trigger for asthma as it makes it difficult to breathe and affects the health of humans, animals, and plants. Avoiding pollution helps prevent asthma symptoms!
The document titled "Early Warning Signs of COPD" from the American Lung Association outlines what COPD is, its risk factors, and the importance of recognizing early symptoms such as persistent cough, breathlessness, and frequent chest infections. It emphasizes the need for early consultation with a
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healthcare provider and diagnostic testing like spirometry to confirm COPD. Early diagnosis and treatment can help slow disease progression and improve quality of life.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of li
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fe. The aim of this journal is to provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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Secondhand smoke can infiltrate into other units through hallways and stairwells. Don’t be shy when it comes to your health. Talk to your building manager about making your apartment smokefree.
The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa.
The guidelines were developed by updating the Canadian
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Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment
and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts.
The recommendations in these guidelines are:
1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5%
(conditional recommendation: moderate-quality evidence).
2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence).
3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence).
4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence).
Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities.
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There is paucity of data on the burden and specific drivers operative in the pathogenesis of chronic obstructive pulmonary disease (COPD) in the African setting and populations. Lack of awareness and inadequate knowledge on the aetio-pathogenesis of the disease together with inadequate capacity for
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COPD care contributes to preventive and management challenges. Thus, the majority of patients with COPD are misdiagnosed, misclassified and mismanaged or undertreated. With the struggling improvement in the quality of healthcare in Africa, studies conducted over the last 10 years indicates the rising trends in both the risk factors and the burden of COPD. The role of new risk factors such as indoor pollution, infections with human immunodeficiency virus (HIV) and pulmonary tuberculosis (TB), in the pathogenesis of COPD in Africa is increasingly being recognized. This literature review attempts to collect and synthesize information that could be useful in improving COPD care and informing the governments to take appropriate actions for prevention, diagnosis and management of COPD in Africa.
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A worldwide increase in the prevalence of asthma has been reported in recent years. With an increase in prevalence comes an increased burden of disease in terms of morbidity, mortality and compromised quality of life. The economic burden in terms of
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utilisation of healthcare resources and limitation of the earning capacity of the individuals and families is an added problem. Various indicators such as disability-adjusted life years and healthy life years have been used to define the economic burden. The data from Asian countries regarding these parameters is scarce, underlining the need for systematic studies in these countries, especially those that are resource poor. The purpose of this review is to highlight the varying prevalence of asthma in Asia and to assess the likely economic burden for the future.
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Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. A task force supported by the European Respiratory Society has developed these evidence
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-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
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Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still nee
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ds substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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The publication "Aligning national drought plans with global and national policy frameworks" provides governments and practitioners with practical guidance on how to align national drought plans (NDPs) with existing policy, legal and institutional frameworks to enable effective implementation. It po
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sitions policy alignment as a core requirement for moving from reactive drought response to proactive, risk-based drought management, in line with national development priorities and international commitments.The report presents two complementary methodologies that support alignment across both the planning and implementation phases of NDPs. A multicriteria assessment framework is used to review the quality, readiness and internal coherence of drought plans, while a policy alignment approach examines how drought is recognized and addressed across sectoral policies, institutional mandates and coordination mechanisms.
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This document assembles these best practices and provides a resource for the proper management of equipment in the laboratory to ensure accurate, reliable and timely testing, and maintain a high level of laboratory performance. Improved equipment management also lowers repair costs, lengthens instru
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ment life, reduces interruption of services due to breakdowns and failures, and enables laboratory accreditation and the achievement of high-quality and accessible laboratory services at all levels of healthcare service delivery.
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COPD Wheel - International Primary Care - Respiratory Group
International Primary Care Respiratory Group (IPCRG)
International Primary Care Respiratory Group (IPCRG)
(2024)
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The document is a visual guide created by the IPCRG for managing COPD, focusing on self-management, treatment options (such as inhaler use, pulmonary rehabilitation, and medications), and addressing comorbidities. It highlights the importance of personalized care plans, patient education, risk reduc
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tion, vaccinations, and the correct use of therapies to improve quality of life and manage COPD effectively.
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