Clinical and epidemiological evaluation of Tuberculosis in Albania during the period 2009-2018

Aim: To estimate the clinical and epidemiological pattern of Tuberculosis (TB) in Albania over the period 2009-2018. Methods: A retrospective analysis of clinical and epidemiological data based on TB individual notification forms during the period 2009-2018. Results: During the 10-years period, TB incidence increased from 14 to 15.5, but without a significant increasing trend. The total number of TB cases increased from 440 to 447. The proportion of extra-pulmonary TB decreased from 32% to 25% in 2018 (p=0.015), with and average mean change of 29 cases. Males prevail among TB cases and male-to-female ratio ranges from 2:1 to 3:1. Drug susceptibility testing (DST) was carried out depending on the availability of the reagents and there were 54%, 18% and 96% culture cases confirmed positive in 2009, 2014 and 2019, respectively. The overall treatment completion rate was 85% and 88.2% in 2009 and 2018, respectively. However, there was a significant drop in cured cases from 26% in 9.3%, whereas the percentage of deaths has increased from 0.5% in 4.1%. All treatment outcomes exhibited a significant change (p<0.001).   Conclusion: TB continues to be a public health challenge in Albania regardless of the seemingly generally stable epidemiological situation

Clinical and epidemiological evaluation of Tuberculosis in Albania during the period 2009-2018

Aim: To estimate the clinical and epidemiological pattern of Tuberculosis (TB) in Albania over the period 2009-2018. Methods: A retrospective analysis of clinical and epidemiological data based on TB individual notification forms during the period 2009-2018. Results: During the 10-years period, TB incidence increased from 14 to 15.5, but without a significant increasing trend. The total number of TB cases increased from 440 to 447. The proportion of extra-pulmonary TB decreased from 32% to 25% in 2018 (p=0.015), with and average mean change of 29 cases. Males prevail among TB cases and male-to-female ratio ranges from 2:1 to 3:1. Drug susceptibility testing (DST) was carried out depending on the availability of the reagents and there were 54%, 18% and 96% culture cases confirmed positive in 2009, 2014 and 2019, respectively. The overall treatment completion rate was 85% and 88.2% in 2009 and 2018, respectively. However, there was a significant drop in cured cases from 26% in 9.3%, whereas the percentage of deaths has increased from 0.5% in 4.1%. All treatment outcomes exhibited a significant change (p<0.001).   Conclusion: TB continues to be a public health challenge in Albania regardless of the seemingly generally stable epidemiological situation.     Conflicts of interest: None declared

Prevalence of chronic obstructive pulmonary disease (COPD) in Albania

Aim: The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Albania. Methods: This was a cross-sectional study conducted in Albania in 2013-14. A nation-wide representative sample of 1200 adults aged ≥40 years was selected using multistage cluster sampling technique. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC ratio <70% predicted. Results: Of the 1200 adults invited to participate, 939 adults or 78% (467 men and 472 women) were eligible for the study. The overall COPD prevalence (GOLD stage 1 or higher) was 12.4%; it was higher in men (17.4%) than in women (7.7%). Using Lower Limit of Normal (LLN), the prevalence of COPD was 9.9%, again higher in men (13.2%) than women (6.6%). The prevalence of doctor-diagnosed COPD was 1.3% (1.9% in men, 0.6 % in women). Male sex, smoking and increasing age were significantly associated with COPD diagnosis. Conclusion: The overall prevalence of COPD in Albania was 9.9% using BOLD standards. Smoking and increasing age were the main risk factors for COPD. The study highlights the importance of raising awareness of COPD among health professionals

Prevalence of chronic obstructive pulmonary disease (COPD) in Albania

Aim: The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Albania. Methods: This was a cross-sectional study conducted in Albania in 2013-14. A nation-wide representative sample of 1200 adults aged ≥40 years was selected using multistage cluster sampling technique. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC ratio <70% predicted. Results: Of the 1200 adults invited to participate, 939 adults or 78% (467 men and 472 women) were eligible for the study. The overall COPD prevalence (GOLD stage 1 or higher) was 12.4%; it was higher in men (17.4%) than in women (7.7%). Using Lower Limit of Normal (LLN), the prevalence of COPD was 9.9%, again higher in men (13.2%) than women (6.6%). The prevalence of doctor-diagnosed COPD was 1.3% (1.9% in men, 0.6 % in women). Male sex, smoking and increasing age were significantly associated with COPD diagnosis. Conclusion: The overall prevalence of COPD in Albania was 9.9% using BOLD standards. Smoking and increasing age were the main risk factors for COPD. The study highlights the importance of raising awareness of COPD among health professionals.   Conflicts of interest: None declared

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

Gender Related Differences in Reported Respiratory Symptoms.

Background: Physiological research on dyspnea has provided some information on how sex differences in lung and airway size can influence the experience of dyspnea during exercise; however, there is still a knowledge gap with regard to sex-related differences in other respiratory symptoms, including cough and sputum production. Objective: The objective of this analysis was to assess sex related differences in reported objective symptoms using data from the population-based Burden of Obstructive Lung Disease (BOLD) study in Albania. Method: Males and females with impaired lung function may experience the same symptoms but per-ceive and/or report them differently. In this analysis were included 997 responders who had completed the core questionnaire, which included data on respiratory symptoms using the following questions: “Do you usually cough when you don’t have a cold?” and “Do you usually bring up phlegm from your chest, or do you usually have phlegm in your chest that is difficult to bring up when you don’t have a cold. Chronic was defined as three months or more per year. Data used were drawn from the final report for Albania provided by BOLD team. Results: Overall, male gender was associated with increased odds for reported chronic cough at any group age [Total: 14.7 (2.3) vs. 6.6 (0.9)]. This difference is very much reduced in the group age 70+ years old [25.8 (8.2) vs. 21.3 (6.8)]. In the contrary when we used the estimated population preva-lence of chronic cough by pack-years and gender, female gender was associated with increased odds for reported chronic cough especially in the 10+ pack-years groups [50.4 (11.0) vs. 12.2 (8.3) in 10-20 pack-years and 29.0 (5.5) vs. 26.0 (3.3) 20+ pack-years] indicating a increased smoking susceptibility of female gender. In contrast, female gender was associated with decreased odds for reported phlegm. Even for the same pack-years of smoking, female gender is associated with decreased odds for report-ed chronic phlegm [0 vs. 7.1 (8.6) in 10-20 pack-years group; 0 vs. 15.4 (3.0) in 20+ pack-years group]. Conclusions: Physicians need to recognize that although a female may not report chronic sputum or phlegm production and a male may not report chronic cough, a diagnosis of Chronic Obstructive Pulmonary Disease should still be considered as symptoms often are the first step to a diagnosis of under-lying airway disease