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Prevalence and associated factors of bronchial asthma among adult patients in Debre Berhan Referral Hospital, Ethiopia 2018: a cross-sectional study

• Sisay Shine 1 ,
• Sindew Muhamud 2 &
• Alebachew Demelash 2  

BMC Research Notes volume  12 , Article number:  608 ( 2019 ) Cite this article

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Bronchial asthma is one of the major public health challenges throughout the world that negatively impact patients, families and community. The objective of this study was to assess the prevalence and associated risk factors of bronchial asthma among patients in adult emergency department of Debre Berhan Referral Hospital. A hospital based cross-sectional study design was used among 257 study participants. A systematic sampling technique was used to select the study participants. Data was collected by using pretested and structured questionnaire and analyzed by using SPSS version 20.0. Both bivariate and multivariate logistic regression model was used to identify the predictors of asthma.

Prevalence of bronchial asthma among adult patients was 29.6%. Being an urban resident (AOR: 1.5: 95% CI 1.3–3.9), income of household less than 1000 EBr/month (AOR: 1.7: 95% CI 1.6–4.1), having family history of asthma (AOR: 2.7: 95% CI 1.3–5.8), and presence of vermin in the house (AOR: 2.4: 95% CI 1.2–4.7) were significantly associated with bronchial asthma. The authors concluded that the prevalence of bronchial asthma among adult patients was high. Therefore, educational program about the risk factors and preventive measures of asthma is highly recommended.

Introduction

Bronchial asthma is one of the most prevalent chronic inflammatory disorders of the airway, which subsequently results an increased contractibility of the surrounding smooth muscles and worsened pulmonary function [ 1 ]. It is the major public health challenge throughout the world that negatively affect patients, their families and the community by inducing work and school loss, poor quality of life, frequent emergency visits, hospitalizations and deaths that occur at any age. It also represents a major economic and social burden both in developed and developing countries [ 2 , 3 , 4 ].

According to the Center of Disease Control and Prevention report, an estimated 235 million people which include 6 million children have bronchial asthma worldwide [ 5 ]. The prevalence of asthma in developing countries increased in 50% per decade for the last 40 years and approximately 250,000 deaths occur in each year. It was the common conditions that affect 5–10% of the population during the past 20 years [ 6 , 7 ].

Bronchial asthma is one of the most common public health problems in Ethiopia. Its prevalence increased over the last few decades with different contributing factors such cigarette smoking [ 8 , 9 ], household economic status [ 10 ], occupational condition of the patients [ 9 ], residence of the patients [ 11 ], presence of vermin at household [ 9 ] and family history of asthma [ 12 ].

Bronchial asthma is being common from year to year; however, it is not having the level of attention it deserves for its proper management. Although its risk factors could be avoided to prevent the occurrence or even the exacerbation in Ethiopia, many health professionals and even the health sectors have done an inefficient effort. The level of awareness of the community toward the prevention of the disorder is suggested to be inadequate. Therefore, this study aims to contribute to filling information gaps on the existing bronchial asthma magnitude and associated risk factors. The data obtained from this study will have its own contribution for policymakers and clinicians to plan and evaluate the management of bronchial asthma.

Study design, setting and population

A hospital based cross-sectional study design was carried out from March 01 to April 30, 2018, among adult patients in an adult emergency department of Debre Berhan Referral Hospital. The hospital is located in Debre Berhan town, 130 km north of Addis Ababa. It is the only governmental referral hospital in the town. It provides both curative and preventive services for 3 million people in its catchment area. All adult patients who visited adult emergency department were our source population.

Sample size and sampling strategies

A total of 257 adult patients had participated in the study. Each study participant was selected through systematic sampling technique with an interval of every fourth adult patients who visited the adult emergency department.

Operational definition

Bronchial asthma: a study subject was labeled as bronchial asthmatic if he/she has the symptoms of shortness of breath with wheezing and having normal breathing in between episodes of shortness of breath that lasts for 3 months in the past 12 months. Those asthmatic patients whose age < 13 years and critically ill who can’t able to respond were excluded from the study.

Chronic disease: course of the disease that lasts for more than 3 months.

Drug discontinuation: a study participant withdraws drugs in an attempt to improve outcomes for any disease.

Exercise habit: a study participant who has an experience of physical exercise once per a day for more than 30 min for relaxation or health.

Frequent utilization of perfume: a study participant utilizes perfume at their home more than twice per a day.

Data collection tool and methods

The structured questionnaire adapted from reviewing different literature of similar studies was used for the collection of quantitative data [ 2 , 12 ]. Data on bronchial asthma, demographic characteristics, environmental and housing conditions, individual behavior and health-related factors were collected via interview. Data was collected immediately after stabilizing from emergency department. A team of three experienced data collectors were trained in conducting an interview. Interviewer were available to collect data at the daytime only. English version questionnaire was translated into Amharic language and again translated back to English by experts who were fluent in both languages to check consistency. This study was carried out after getting ethical clearance from Debre Berhan University research ethics review committee. Verbal informed consent was taken from the study participants after briefed about the study. Omitting name of the study participants from the questionnaire help to assure confidentiality of the information.

Statistical analysis

The data was entered by using Epi-Info 7.0.9.7 version computer software package for editing, cleaning, coding, and checking completeness and consistency and exported to SPSS window version 20.0 for analysis. Descriptive analysis was done to describe the characteristics of our study population. Both bivariate and multivariate logistic regression analysis were used to identify the predictors of asthma. Variables with 95% confidence interval and P value < 0.05 during the bivariate analysis were included in the multivariate logistic regression analysis to see the relative effect of confounding variables. Adjusted odds ratios with 95% confidence interval were calculated and P-value less than 0.05 were considered as statistically significant. Finally, data was displayed by tables, graphs and statements.

Socio-demographic characteristics of the study participants

Two hundred fifty-seven (n = 257) adult patients were enrolled in the study. They made a response rate of 100%. One hundred twenty-four (48.2%) males and 133 (51.8%) females were participated in the study. The mean age of the participants was 38.58 (SD ± 12.81) years old. About 44.7% were living in urban and 66.9% were married by their marital status.

Environmental and housing characteristics of the study participants

From the total participants, 38.5% their kitchen attached to the main house. The larger proportion of participants, 91.8% their house have window. About 50.6% households used charcoal as source of energy, followed by electricity 46.7%. Of the total participants, 48.7% have their own house followed by rented from private owner 31.1%. About 43.6% of the participants live with pets.

Individual behavior and health-related condition

About 10.5% of the study participants were cigarette smokers. Among the participants, 37.7% had family history of asthma. Fifty-six (21.8%) of the study participants had an experience of pneumonia in the last 12 months. Among the participants, 12.5% had habit of frequent utilization of perfume and 86.4% had no habit of exercise (Table  1 ).

The magnitude of bronchial asthma among adult patients

The prevalence of bronchial asthma among the study participants was 29.6%. Among participants who have bronchial asthma 17.9% were male and 8.2% at the age range of 35–44 years old (Fig.  1 ). Majority, 16.3% of participants who have bronchial asthma were from urban residence.

Prevalence of bronchial asthma with age categories among adult in Debre Berhan Referral Hospital, Ethiopia 2018

Factors associated with bronchial asthma

In the bivariate logistic regression analysis, sex of patients, the residence of the patients, monthly income of the households, the house ownership, the presence of vermin in the house, family history of asthma, and habits of bronchodilators drug utilization were found to be significantly associated with bronchial asthma. The result from multivariate logistic regression analysis revealed that being urban resident (AOR: 1.5: 95% CI 1.3–3.9), income of household less than 1000 EBr/month (AOR: 1.7: 95% CI 1.6–4.1), having family history of asthma (AOR: 2.7: 95% CI 1.3–5.8), and presence of vermin in the house (AOR: 2.4: 95% CI 1.2–4.7) were significant predictors of bronchial asthma. But sex, house ownership and habits of bronchodilators drug utilization among patients didn’t show significant association with bronchial asthma (Table  2 ).

This institution-based cross-sectional study attempted to assess the magnitude and associated risk factors of asthma among adult patients in an adult emergency department of Debre Berhan Referral Hospital.

In the present study, the prevalence of bronchial asthma among adult patients in the referral hospital was 29.6%. This prevalence was higher compared to the study done in Uganda, Nigeria, Egypt and Ethiopia [ 13 , 14 ]. A possible explanation for this difference could be due to the effect of climatic conditions. This study had been conducted on participants living in highland area which is elevated 2810 m (9219 fts) above sea level and having very cold climate in almost all months of the year. Furthermore, growing population size and radical urbanization contributes to the increment of the prevalence of asthma by changing the pattern of environmental condition and lifestyle of the community. However, variables that hadn’t been included in the above studies, such as the level of air pollution, level of exposure to allergens, and climatic conditions, may have contributions for the difference of prevalence in different areas. This can be the concern of future researches.

This study revealed that urban residents (AOR: 1.5; 95% CI 1.3–3.90) were more likely to develop bronchial asthma than rural residents. It was consistent with the report in Brazil and Ethiopia [ 15 , 16 ]. This might be explained outdoor air of urban area is highly polluted due to high levels of traffic and industry related emissions that could increase the risk of asthma. In contrast, study done in India [ 17 ] showed that being a rural resident was significantly higher the odds of having asthma. Research conducted in Ethiopia [ 18 ] revealed that no association between asthma and residence of the patients. These variations might be due to the difference in the characteristics of the study population, geographical distribution and case definitions used to ascertain asthma.

As of this study, adult patient who come from low income status were more likely to develop bronchial asthma than counterpart. It was congruent with the study conducted in Australia [ 19 ]. This could be due to the fact that, low income levels of the households limited to apply appropriate prevention and control mechanisms of bronchial asthma.

This study indicated that patients who come from the family history of asthma (AOR: 2.7: 95% CI 1.3–5.8) were more likely to develop bronchial asthma than from non-asthmatic family. Similar findings have been reported by other studies in developed and developing countries that showed a significant association between family history of asthma and asthma occurrence among adult patients [ 20 , 21 ]. This association could be either due to genetic factors or a shared environment by the family members.

In this study, present of vermin at household level increased the probability of developing asthma among adult patients. The world health organization report in 2008 report also showed that evidence for a relationship between asthma and domestic exposure to cockroaches, mice and dust mites is strong [ 22 ]. This could be explained by house which have vermin’s concerns with the use of insecticides prays at home, with more frequent use being associated with bronchial asthma. Similar results can be found in the literature regarding the link between the use of home aerosolized cleaning products and asthma [ 23 , 24 ].

Prevalence of bronchial asthma among adult patient who visited adult emergency department in the study area was high. Being an urban resident, presence of vermin at house and adults from the family of having a history of asthma were the risk to develop bronchial asthma. So, health education program for educating people especially for urban residents and people live in a house which have vermin’s about the risk factors and preventive measures were highly recommended. Further, longitudinal studies are required to investigate possible risk factors of bronchial asthma.

Limitation of the study

In this study, we have limitations that should be noted. Use of cross-sectional study may not create a true causal relationship between bronchial asthma and its risk factors. Using self-reported data and collecting data at the daytime only might increase or decrease the prevalence of asthma.

Availability of data and materials

All data supporting the findings are contained in the manuscript. Anyway, datasets are available from the corresponding author on reasonable request.

Abbreviations

adjusted odd ratio

Ethiopian Birr

outpatient department

standard deviation

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Acknowledgements

We would like to thank town administrative Health Office heads for their collaboration during conducting this research. Our gratitude also goes to our data collectors and study participants for their willingness to participate in the study. At last but not least, we would like to forward our special thank and sincere appreciations to our friends who gave advice and comment throughout the whole research project activities.

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Shine, S., Muhamud, S. & Demelash, A. Prevalence and associated factors of bronchial asthma among adult patients in Debre Berhan Referral Hospital, Ethiopia 2018: a cross-sectional study. BMC Res Notes 12 , 608 (2019). https://doi.org/10.1186/s13104-019-4670-9

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DOI : https://doi.org/10.1186/s13104-019-4670-9

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Evidence-based approach of biologic therapy in bronchial asthma.

1. Introduction

2. pathophysiology of asthma, 3. selecting biologic therapy in bronchial asthma, 4. various biologic agents, 4.1. omalizumab (anti-ige), 4.2. reslizumab (anti-il5), 4.3. benralizumab (anti-il5), 4.4. mepolizumab (anti-il5), 4.5. dupilumab (anti-il4/il13), 4.6. tezepelumab (anti-thymic stromal lymphopoietin).

Drug	Mechanism of Action	Route of Administration	Indication	Contraindication
Omalizumab	Binds IgE to prevent binding to high-affinity IgE receptors (FcεRI) on dendritic, basophils, and mast cells	Subcutaneous	Treatment of moderate to severe persistent allergic asthma for patients aged ≥6 years with positive skin test or in vitro reactivity to a perennial aeroallergen and uncontrolled on inhaled corticosteroids	Known hypersensitivity reaction
Reslizumab	Binds to IL-5	Intravenous	Add on maintenance treatment of patients with severe asthma aged ≥18 with an eosinophilic subtype	Known hypersensitivity reaction
Benralizumab	Binds IL-5R on eosinophils inducing natural killer cell-mediated eosinophil apoptosis	Subcutaneous	Add on maintenance treatment of patients with severe asthma aged ≥12 and with an eosinophilic phenotype	Known hypersensitivity reaction
Mepolizumab	Binds to IL-5	Subcutaneous	Add on maintenance treatment of patients with severe asthma aged ≥6 with an eosinophilic phenotype	Known hypersensitivity reaction
Dupilumab	Binds to IL-4R alpha inhibiting IL-4 and IL-13 signaling	Subcutaneous	Add on maintenance treatment of patients aged ≥6 with moderate to severe asthma characterized by an eosinophilic phenotype or with oral corticosteroid-dependent asthma	Known hypersensitivity reaction
Tezepelumab	Binds to thymic stromal lymphopoietin (TSLP)	Subcutaneous	Add on maintenance treatment of adult and pediatric patients ≥ 12 with severe asthma	Known hypersensitivity reaction

5. Conclusions

Author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Liaqat, A.; Mason, M.; Foster, B.; Gregory, G.; Patel, A.; Barlas, A.; Kulkarni, S.; Basso, R.; Patak, P.; Liaqat, H.; et al. Evidence-Based Approach of Biologic Therapy in Bronchial Asthma. J. Clin. Med. 2023 , 12 , 4321. https://doi.org/10.3390/jcm12134321

Liaqat A, Mason M, Foster B, Gregory G, Patel A, Barlas A, Kulkarni S, Basso R, Patak P, Liaqat H, et al. Evidence-Based Approach of Biologic Therapy in Bronchial Asthma. Journal of Clinical Medicine . 2023; 12(13):4321. https://doi.org/10.3390/jcm12134321

Liaqat, Adnan, Mathew Mason, Brian Foster, Grant Gregory, Avani Patel, Aisha Barlas, Sagar Kulkarni, Rafaela Basso, Pooja Patak, Hamza Liaqat, and et al. 2023. "Evidence-Based Approach of Biologic Therapy in Bronchial Asthma" Journal of Clinical Medicine 12, no. 13: 4321. https://doi.org/10.3390/jcm12134321

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173 Asthma Essay Topic Ideas & Examples

🏆 best asthma topic ideas & essay examples, 💡 interesting topics to write about asthma, 📑 good research topics about asthma, 📌 simple & easy asthma essay titles, 👍 good essay topics on asthma, ❓ research questions about asthma.

• SOAP Note for an Asthmatic Patient Today, asthma is known as one of the most common respiratory diseases in the United States, as well as in the whole world.
• Living with a Chronic Disease: Diabetes and Asthma This paper will look at the main effects of chronic diseases in the lifestyle of the individuals and analyze the causes and the preventive measures of diabetes as a chronic disease.
• Social Determinants of Health: Asthma Among Old People in Ballarat On the other hand, Melbourne is the capital city of the State of Victoria with a population of 4 million people, making it the second most populated city in Australia. This is a great challenge […]
• Asthma: Pathophysiology, Symptoms, and Manifestations The primary organ affected by asthma is the lungs, as the disease is caused by airway narrowing and the inability to breathe.
• Application: Asthma The features of the air passage include the bronchi, alveoli and the bronchioles. The pathophysiology of chronic and acute asthma exacerbation describes the process and stages that lead to airway obstruction.
• Asthma in Pediatric and Occupational Therapy Treatment The flow peak is more than 80% of the child’s personal best, and less than 30% variability in the day-to-day flow of the peak measurements.
• Chronic Asthma and Acute Asthma Exacerbation The consequences of the smooth muscles’ tightening can be aggravated by the thickening of the bronchial wall due to acute edema, cellular infiltration, and remodeling of the airways chronic hyperplasia of smooth muscles, vessels, and […]
• Asthma Exacerbation in Pregnancy The patient has a history of childhood asthma diagnosis, and she is presently exhibiting typical asthma symptoms like wheezing and a nonproductive cough.
• Asthma: Epidemiological Analysis and Care Plan Asthma has a variety of symptoms and pathogenesis, including acute, subacute, or chronic inflammation of the airways, intermittent blockage of airflow, and hyperresponsiveness of the bronchi.
• Asthma Diagnosis in Pregnant Women It may be essential to modify the type and dose of medication to compensate for the alterations in the female’s metabolism and the severity of her health condition.
• Healthy Lifestyle Interventions in Comorbid Asthma and Diabetes In most research, the weight loss in cases of comorbid asthma and obesity is reached through a combination of dietary interventions and physical exercise programs.
• Clinical Case of Asthma in African American Boy By combining the use of corticosteroids and exercises into the treatment plan, as well as educating the patient and his parents about the prevention and management of asthma attacks, a healthcare practitioner will be able […]
• Asthma From a Clinic Perspective And the prevalence of asthma in the European Union is 9. In UK and Ireland experience some of the greatest rates of asthma in the globe.
• Corticosteroids and Inhalants in Asthma As well as the causes of fatigue and physiological events during an asthma attack, and how the body compensates for an increase in CO2, with a focus on the effects of hypercapnia on the central […]
• The Treatment Modalities of Asthma However, in order to limit susceptibility to the triggers, the patient is advised to take long-term asthma medications on a daily basis.
• Asthma Diagnostics and Treatment According to the Asthma and Allergy Foundation of America, some of the most common symptoms of asthma include cough, wheezing, shortness of breath, chest tightness, and fainting.
• Asthma: Description, Diagnosis and Treatment First of all, before discussing measures to prevent an increase in the case of the disease, it is necessary to understand the nature of the disease.
• Inflammation’s Role in Asthma Development This work is written in order to study the role of inflammation plays in the development of asthma on the basis of research papers.
• The Use of Tezspire: The Management of Asthma The brochure describes the use of Tezspire, which is a drug used for the management of asthma. The brochure’s target audience is patients with a long history of asthma and their family and caregivers.
• Asthma Treatment in Pediatric Patients: Spacer vs. Conventional Inhaler Computers and the Internet connection have become available to a considerable portion of the population, which equally serves as a facilitator of the new solution implementation.
• Physical Assessment Report for an 18-Years-Old Asthma Patient The boy and his family suspect that he is suffering frequent asthma attacks due to allergies to cold and dust, however none of his members of the family suffer from asthma.
• Asthma: Pathophysiology, Etiology, Diagnosis, and Complications The pathobiology of asthma remains greatly indeterminate, and its pathophysiology involves abnormalities of the respiratory system organs, including the lungs and the bronchial tree.
• Use of Scientific Method in Asthma and Allergic Reactions Study As in the case of asthma and allergic reactions investigations, descriptive studies can be used to describe the nature of the relationship between asthma and asthma attack, therefore explaining the cause and effect.
• COVID-19 Susceptibility in Bronchial Asthma by Green et al. The research reflected in the article aims to trace the susceptibility of patients with bronchial asthma to coronavirus disease. It is noted that the receptors that respond to those occurring in the environment are the […]
• Exercise-Induced Asthma in Children The onset of an EIA attack follows a constriction of the airways of the patient after physical exercise. When water shifts from the cells of the epithelium to the airway surface, it causes a release […]
• Child Asthma Emergency Department Visits: Plan for the Reduction The population of Central Harlem will be the target of this intervention that aims to decrease the rate of children’s asthma-related ED visits.
• The Child Asthma Emergency Department Visits The program makes it easy for medical caregivers to carry accurate assessments to pediatric patients. The program is easily scalable, and it is also sustainable, making 5A’s the best solution to Child Asthma Emergency Department […]
• Asthma Among Children of Color in New York City On the other hand, the conditioning of the matter to a particular scope hinders the determination of a rational scientific solution to the core issue.
• Asthma in Relation to Inability to Breathe: A Case Study The shortness of breath is known to be a primary cause of Asthma, whereas the asthmatic state of an individual also has the capabilities of influencing shortness of breath as a result of the lung […]
• Asthma Treatment Options, Long-Term Control, and Complications Speaking of the patient profile, the first aspects that should be mentioned are the peculiarities of asthma disease history and other health conditions that might affect the treatment pattern.
• Occupational Asthma: Case Discussion The primary diagnosis is occupational asthma; the causative agents of the indicated type of the disease are located directly at the person’s workplace.
• The Relationship Between Vitamin D Deficiency and Asthma Disease in Children The reaction of the host on the respiratory infections is closely correlated with the deficiency of the vitamin D [1]. This is because of the suggestion that providing vitamin D supplements to patients with low […]
• Asthma: Culture and Disease Analysis The cause of this condition is thought to be the narrowing of the person’s airways. This, as the experts explain, is a result of the inflammation of the airways in the lungs.
• Relationship Between Asthma and the Body Mass Index The optimal design of the study is the use of questionnaires, since the nature of the research requires the consent of individual respondents in form of writing.
• The Connection Between Asthma and Dust Emissions This is attributed to an increased rise of annual sandstorms and continued constructions that create a huge amount of dust in the air.
• Prevalence of Asthma Due to Climatic Conditions Newhouse and Levetin also conducted a study to find the correlation between the airborne fungal spores, the concentration of pollen, meteorological factors and other pollutants, and the occurrence of rhinitis and asthma.
• Helping African American Children Self-Manage Asthma The purpose of this critique is to analyze the weaknesses of the study. The title of the report Helping African American Children Self-Manage Asthma: The Importance of Self-Efficacy adequately identified the population of interest, namely […]
• Asthma Among the Japanese Population In a report by Nakazawa in which the author sought to determine the trend of asthma mortality among the Japanese population, emotional stress and fatigue emerged as the leading factors for the causation of asthma.
• Informed Consent – Ellen Roche, Asthma Study People interested in taking part in research trials have the right to know risks, benefits, procedures, the aim of the study, and protection of identity. This violation of subjects’ right led to the formation of […]
• Asthma Prevalence: Sampling and Confidence Intervals In the study which was carried out in United States in 2009 amongst the children and adults to show the prevalence of Asthma, a sample of 38,815 and confidence interval of 95% was used.
• Osteopathic Manipulation in Patients With Chronic Asthma This article seeks to criticise the application of osteopathic manipulation in the treatment of asthma patients. The focus is on the intervention of osteopathic manipulation therapy in restoring normal functioning and compliance to the thoracic […]
• 5-Year-Old With Asthma: Developmental Milestones & Care According to his mother, he also regularly grinds his teeth at night.G.J.was delivered normally and the mother had no complications. He could listen to instructions and get whatever he is being asked by his mother.
• Asthma Respiratory Disorder Treatment Asthma etiology is the classification of various risk factors responsible for causing asthma in children and adults. Asthma etiology is the scientific classification of risk factors that cause Asthma in children and adult.
• Childhood Bronchial Asthma: Process & Outcome Measures The evidence that is used to support the adoption of this measure is the guideline on clinical practice, as well as the procedure of formal consensus.
• Biological Basis of Asthma and Allergic Disease The immunological response in asthmatic people fails in the regulation of the production of the Th2 cells and the anti-inflammatory cells.
• Asthma and Medications: The Ethical Dilemma in Treating Children One of the major causes of dilemma, however, is the inability to manage and treat the condition in children under the age of 7 years due to ethical dilemma.
• Understanding Asthma in the Elderly: Triggers, Treatment, and Challenges The main objective of the given paper is to analyze the reasons of emergence of asthma among the elderly population, as well as research peculiarities of this group’s reaction to this condition as compared to […]
• Exercise-Related Asthma in the 21st Century The study has also reported that almost 48 % of parents recognize the fact that children suffering from asthma have higher probability of the emergence of the typical symptoms of IEB.
• The Nature and Control of Non-Communicable Disease – Asthma Asthma is caused due to the inflammation of the airways which in turn induces cough, wheezing, breathlessness and a feeling of tightness in the chest.
• Asthma in School Going Youth: Effects and Management The control and prevention of adverse effects of asthma are goals of managing asthma as stated in the National Asthma Education and Preventive Program asthma treatment guidelines.
• Asthma in the African American Community The paper will also highlight the effects that the treatment options used by African Americans have on the prevalence of the disease.
• Asthma Definition and Its Diagnostics The geographical area plays a major role in the distribution of the prevalence of asthma and its predisposing factors. There is scientific evidence that the presence of a history of asthma in parents is a […]
• Foot Orthosis, Asthma & Benign Tumor It is a chronic inflammatory disorder of the airways, associated with the following symptoms: variable airflow obstruction and enhanced bronchial responsiveness to a variety of irritants.
• Asthma in School Children in Saudi Arabia The purpose of this paper is to review the current literature on asthmatic disease in Saudi Arabia to accurately determine the epidemiology nature of the condition through community assessment for purposes of compiling a health […]
• Usefulness of Acupuncture in Asthma Treatment The case for the effectiveness of acupuncture in the treatment of asthma is to be further supported by more research studies, since current and past research has been affected by a number of limitations or […]
• Hypertension, Asthma and Glaucoma The assignment of duties is also a difficult task since the victim is forgetful and disoriented, which in this case may lead to delays or failures within the working system.
• The Management of Asthma According to the Australian Bureau of Statistics, the country has the highest prevalence of Asthma in the world. Quick-relief medications are used to manage symptoms that come with acute attacks of asthma-like coughing, tightening of […]
• Treatment of Asthma in Australia The rapid-acting treatments are taken to quicken the process of reversing acute asthmatic attacks by causing the relaxation of the smooth muscles of the bronchial system. These preventers reduce the sensitivity of airways hence swelling […]
• The Asthma and Emphysema Analysis According to Kinsella and others, etiology of emphysema is often associated with smocking, and this led to the hypothesis that emphysema develops with age whereas asthma is mostly prevalent in children.
• Asthma: Causes and Treatment Effects of asthma are more pronounced mostly at night and early in the morning and this results in lack of sleep.
• Acute Asthma: Home and Community-Based Care For Patients It refers to the continuum of care extended to patients from the health facility to the community and homes. An asthma attack is fatal and patients should be encouraged to perform self-administration of medication.
• How Emotions Spark Asthma Attack Although stress and emotions are known to start in a patient’s mind, asthma in itself is a physical disease that affects the patient’s lungs, and stress can create strong physiological reactions which may lead to […]
• Asthma Is a Chronic Inflammatory Disorder Hence the main purpose of the study is to investigate the association of smoking and secondhand smoke with level of asthma control, severity, and quality of life among adult asthmatics.
• Asthma: Leading Chronic Illness Among Children in the US Ample communication was to be provided to the family, Head Start personnel and the Child’s physician in relation to the asthma. A great reduction was seen in the asthma symptoms and emergency.
• Dealing With Asthma: Controversial Methods Because of the enormous speed of the illness spread, dealing with asthma is becoming a burning issue of the modern medicine. This is due to the fact that the muscles of the broche lack the […]
• Asthma Investigation: Symptoms and Treatment In patients with asthma, the condition causes the inflammation of air passages that is followed by the significant narrowing of airways.
• Severe Asthma: The Alair Bronchial Thermoplasty System The article focuses on asthma and the treatment that could alleviate the condition. Most of asthma patients are used to having an inhaler with them and this way, there is not much new technology, except […]
• Public & Community Health: Asthma in Staten Island There is borough of Bronx, which is considered to be the poorest, and the case with it has been stated here that asthma is the fate of the residents.
• Health, Culture, and Identity as Asthma Treatment Factors She is the guardian of Lanesha and, despite raising another grandson and caring for her elderly mother, she is responsible for the health of the girl.
• The Anti-Inflammatory Role of IL-26 in Uncontrolled Asthma Research findings suggest that the suppression of IL-26 secretion in the lungs would alleviate the anti-inflammatory response associated with uncontrolled asthma.
• Asthma Pathophysiology and Genetic Predisposition The pathophysiology of this disorder involves one’s response to an antigen and a subsequent reaction of the body in the form of inflammation, bronchospasm, and airway obstruction.
• Asthma: Pathopharmacological Foundations for Advanced Nursing Practice Because of the high prevalence of asthma in the USA, mortality and morbidity rates in the country are also excessive. Asthma is one of the most common diseases in the USA, with high prevalence and […]
• Asthma as Community Health Issue in the Bronx The rate of people, especially children, with asthma in this area is among the highest ones in the city. The issue of asthma in New York and the Bronx, in particular, is connected to multiple […]
• Environmental Factors of Asthma in Abu Dhabi City A countrywide evaluation of the demises related to environmental pollution that takes a significant role in the rising cases of asthma shows UAE as the most affected nations since the discovery of oil in 1958 […]
• Occupational Asthma: Michelle’s Case The first test is not prohibitively expensive, and the patient should be able to afford it if she can pay for the medications.
• Asthma Patient’s Examination and Care Plan HPI: Being discharged from the facility ten weeks ago, the patient reports having shortness of breath, severe wheezing, and coughing. To control symptoms, the patient takes HTCZ and Enalapril.
• Asthma and Stepwise Management The stepwise approach to asthma treatment and management is a six-step approach, according to which the number and the dose of medications and frequency of management are increased as necessary when symptoms persist and then […]
• Asthma, Its Diagnostics, Treatment and Prevention Hippocrates was the one who labeled the disease as asthma, a Greek word that was used to denote the idea of “wind or to blow”, perhaps an attempt to describe the wheezing sound produced by […]
• Asthma: Evidence-Based Pharmacological Treatment For instance, in children under 6, the development of the disease is typically preceded by the asthma-like symptoms that manifest themselves roughly at the age of three.
• The Evaluation of Evidence Linking Asthma With Occupation Overall, the results of this study supported the initial argument of the authors in regard to the need for frequent updates and modifications of JEMs in order for them to reflect the most relevant and […]
• Pregnant Woman’s Asthma Case The case mentions the decreased effectiveness of the fluticasone MDI that she uses which can also be a clue to her condition. Her patterns of MDI use in the last two months and the bronchospasm […]
• Asthma: Causes and Mechanisms The enlargement of the dense oesinophilic line near the bronchus/airways causes the individual to wheeze and gasp for air. The drugs are mainly used in the rapid opening of the bronchus to enable airflow into […]
• Healthcare: Childhood Asthma and the Risk Factors in Australia From the findings presented above, it is evident that childhood asthma remains a considerable burden in Australia due to socioeconomic, geographic, and health-related issues such as deprived neighbourhoods, decreasing sun exposure and increasing latitude, and […]
• Intubation and Mechanical Ventilation of the Asthmatic Patient in Respiratory The title of the article gives a clear idea of the research question to be investigated. The authors have detailed the processes of intubation and mechanical ventilation in patients with acute asthma.
• Asthma Environmental Causes This essay discusses the measures that can be taken to mitigate environmental causes of asthma. In the US, the government has developed a comprehensive strategy to mitigate environmental causes of asthmatic conditions in children.
• Asthma’s Diagnosis and Treatment The complete occlusion of the airway can lead to growth of a distal at the atelectasis in the lung parenchyma. The level of AHR is connected to the signs of asthma and the urgency of […]
• The Effects Of Asthma On Pregnant African Americans
• Urban Children and Asthma Care Barriers
• Asthma: Asthma and Nocturnal Asthma
• The Health Problem of Asthma in the United States of America
• Asthma: Chronic Inflamatory Obstructive Lung Disease
• Asthma and Food-Allergy Reactions
• Asthma And Exercise Asthmatic Asthmatics Breathing
• Automobile Emissions, Co And Asthma
• Asthma Control and Treatment in Racial and Ethnic Minorities
• Asthma Is The Most Common Chronic Disease Of The Airways
• Inflammatory Mediators Of Asthma And Histamines Biology
• The Impact of Asthma on the Respiratory System, Its Causes, and Treatment
• How Asthma Affects The Airway And Lungs
• Diet and Nutrition for Asthma in a Child
• Urban Asthma And The Neighborhood Environment
• Asthma And Its Pathophysiological Structure
• The Effects of Medication on the Increased Performance of Asthma Patients
• What Parents Need To Know About Asthma
• Employment Behaviors of Mothers Who have a Child with Asthma
• The Genetic and Environmental Components of Asthma
• The Influence of Asthma on the Lives of Students
• Children’s Elevated Risk of Asthma in Unmarried Families: Underlying Structural and Behavioral Mechanisms
• The Effects Of Environmental Tobacco Smoke Among Children With Asthma
• The Effects Of Air Pollution On Children ‘s Asthma Emergency
• Is Improper Use Of The Inhaler Related To Poor Asthma Control
• Asthma Symptoms, Diagnosis, Management & Treatment
• Limitations From Suffering Chronic Asthma
• Causes And Effect Of Allergies And Asthma
• Describe The Main Limitations Suffered By Those With Chronic Asthma
• The Symptoms, Causes and Diagnosis of Asthma
• Negligent: Asthma and Nursing Interventions
• The Signs, Causes and What Triggers Asthma
• The Routine Care for Patients with Coronary Heart Disease, Asthma, Stroke, Irritable Bowel Syndrome, Urinary Tract Infections, Diabetes, and Cervical Cancer
• The Role Of Nurse Management Asthma And School Health Program
• The Scope of Asthma in the General Population and on the Health Care System
• The Most Effective Treatment for an Asthma Exacerbation
• Pathophysiology Of Chronic Asthma And Acute Asthma
• The Use Of Vitamin D Asthmatic Children Effectiveness Of Vitamin Supplements In Childhood Asthma
• The Ways in Which the Symptoms of Asthma Can Be Reduced
• Measures to Minimize Environmental Causes of Asthma
• Inner City Adult Asthma Patients and Risk Factors
• Raising Awareness to Prevent the Rise of Asthma
• Planning and Intervention in the Disease Process of Childhood Asthma
• The Anatomy And Physiology Of Respiratory System And The Diagnosis Of Asthma
• The Causes and Effects of Asthma Sufferers
• The Application of Corticosteroids in the Management of Bronchial Asthma
• Salbutamol: History of Development in Asthma Drug Compounds
• Sensitization To Plant Food Allergens In Patients With Asthma
• The Diagnosis and Treatment of Otitis Media and Asthma
• The Discrepancy between Asthma Cases in Minority and White Communities
• The Chronic Illness in Children Known as Asthma
• Does Childhood Asthma Improve With Age?
• What Are the First Warning Signs of Asthma?
• Which Child Is at Greatest Risk for Asthma?
• What Is the Genetic Predisposition of Asthma?
• Can Occupational Therapy Help With Asthma?
• How to Ventilate Obstructive and Asthmatic Patients?
• What Is a Risk Factor Associated With Childhood Asthma?
• What Type of Approach Is Used in Asthma Management?
• What Is the Difference Between Asthma and Acute Asthma?
• What Are the Pharmacological Treatment of Asthma?
• How Is Asthma Diagnosed?
• Can Asthma During Pregnancy Affect Baby?
• What Are the Three Mechanisms Involved in Asthma?
• How Does Genetics and Environment Affect Asthma?
• How Long Does It Take To Recover From Asthma Exacerbation?
• What Factors Influence the Development of Asthma?
• What Is the Physiological Cause of Asthma?
• What Are the Statistics on Asthma in Australia?
• What Is the Most Serious Type of Asthma?
• What Ethnic Group Is Especially Likely to Have Childhood Asthma?
• What Is a Nursing Care Plan of an Asthmatic Patient?
• Does Asthma Cause Smooth Muscle Hypertrophy?
• Should People With Asthma Use a Humidifier?
• What Is Mechanical Ventilation Asthma?
• What Is the Most Common Allergen to Trigger Asthma?
• What Is the Main Physiological Cause of Asthma?
• What Percent of Asthma Is Caused by Smoking?
• How Long Does the Average Person With Asthma Live?
• Which Drug Is Safe for Asthma in Pregnancy?
• How Many People With Asthma Still Smoke?
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A Quasi Experimental study to Evaluate the Effectiveness of Respiratory Care Bundle on Dyspnea among patients with Bronchial Asthma at Selected Hospitals, Pudukkottai

Bronchial asthma is a chronic inflammatory disease of the airways that cause airway hyper responsiveness, mucosal edema, and mucus production. Patients with bronchial asthma may experiences difficulty in breathing, which needs the respiratory interventions such as bronchodilators, inhaler therapy and alternative therapies like breathing exercises, yoga and meditation. Respiratory care bundle comprises oral care, deep breathing exercises and incentive spirometry which will reduce the level of dyspnea among patients with bronchial asthma and it can be utilized as a non- pharmacological management in respiratory rehabilitation. STATEMENT OF THE PROBLEM: “A Quasi Experimental study to Evaluate the Effectiveness of Respiratory Care Bundle on Dyspnea among Patients with Bronchial Asthma at Selected Hospitals, Pudukkottai” OBJECTIVES: 1. To assess the pre test and post test level of dyspnea among the patients with bronchial asthma in experimental group and control group. 2. To evaluate the...

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Background: Bronchial asthma (BA) is a chronic disease characterized by inflammation of the airway that triggers frequent cough, wheezing, dyspnea, and chest tightness. Bronchial asthma may be caused by exposure to multiple irritants and pollutants which include: pollen, dust mites, mold spores, pet dander, smoke, respiratory allergens.Treatment for bronchial asthma patients along with the medication for relieving the symptoms of asthma. Various alternative therapies alleviating the rate of wheezing, aiming to minimize asthma triggers. Aim: The study aim is to assess the effectiveness of selected relaxation technique on the breathing outcome among patients diagnosed with bronchial asthma. Methodology: It is an interventional evaluatory approach; time-series design will be used to conduct the bronchial asthma patients. A Non-Probability purposive sampling technique will be used to select the samples. This research study included 40 patients of AVBRH Rural hospital Sawangi (M) Wardha....

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Background: Bronchial asthma is a respiratory disorder characterized by an inflamed and constricted airway which produces mucus more than normal. Symptoms lead to breathlessness, chest discomfort and severe asthmatic attack. Asthma has been shown one of the measures that cause of severe burden of total death worldwide. With a standard pharmaceutical approach, nonpharmaceutical adjuvant therapy like yoga has shown a significant role to manage asthmatic attacks. Aim and Objective: The aim of this study is to measure the effect of yoga therapy on the level of peak Expiratory Flow Rate among bronchial asthmatic patients. Materials and Methods: The pre test post test quasi experimental research design with one control group was used in this study. A total of 60 adults with mild to moderate persistent bronchial asthmatic patients were selected from the hospital among 30 were divided into an experimental group and 30 were divided into a control group. Peak Expiratory Rate was measured using a mini wright standard peak flow meter. Measurements were taken before and after the intervention. A total of twelve weeks, five days in a week, during one hour of yoga intervention was given to the experimental group while no kind of intervention was given to the control group participants. Data were analyzed through paired sample t test using IBM SPSS statistics 22.0 version. Result: After the twelve weeks, yoga intervention has shown a significant role to improve the level of the level of Peak Expiratory Flow (P<0.01 level) among the experimental group, while no kind of significant difference was found in the control group. Discussion: Yoga, as practiced combined with asana, pranayama and meditation helps to improve peak expiratory flow rate and gives maximum ventilation to the bronchial asthmatics. Conclusion: Yoga should be practiced regularly as an alternative or adjuvant therapy to enhance the pulmonary function and overall well-being of bronchial asthmatic patients.

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ferry fratama

Igor Grygus , Yurii Pelekh

This article deals with psychophysical rehabilitation of patients with mild persistent bronchial asthma. Results of such patients’ rehabilitation depend on personal peculiarities of patients: some of them need only medical (including physical) rehabilitation, others – medical and psychological. The paper describes implementation of complex physical rehabilitation programme (therapeutic exercise, massage, physiotherapy) in the treatment of patients suffering from mild persistent bronchial asthma. The research was held at the Rivne Regional Hospital. The accumulation of the results of the experiment was performed progressively along the admission of patients to Pulmonology Department. There were 70 persistent bronchial asthma patients under the supervision. Efficiency assessment of the psychophysical rehabilitation programme was held according to the Clinical indicators, Changes in functional condition of cardior espiratory system and externa breathing. The research showed that the efficiency of psychophysical rehabilitation of patients with mild persistent bronchial asthma is proved. It is very important that asthma became controlled which is proved by significant improvement of the average functional condition of cardiorespiratory system and external breathing in comparison.

Hoda Jazayeri

since most of the asthmatic patients do not use the proper medicine to control their persistent symptoms, we decided to accomplish a study to find out the relation between the treatment, clinical symptoms and spirometric indices in asthmatic patient s . this study is a cross - sectional study on 150 patients suffering from persistent moderate asthma admitted to naghavi and beheshti hospital. They have less than three attacks weekly. After record ing of their clinical symptoms (dyspenea, cough, wheezing and nocturnal) and spirometric indices (FEV1, FEV1/FVC, FVC) twice with intervals of 3 - 6 months , they were divided into three groups. The first group was treated with salbutamol inhaler, the second with s albutamol and floxitide and the third one with salmeterol and floxitide. Then all the data was evaluated through SPSS program. the group treated with salmeterol and floxitide inhaler showed the greatest remission in coughing (%80.4), Dyspnea (%77.8), Wheezi ng (%77.8) and nocturna...

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Thesis Topics

• Patient Education Materials
• Cardiorespiratory responses to exercise in patients with mild to moderate bronchial asthma.
• Gender differences in perception of dyspnoea, quality of life and pattern of lung function abnormalities in asthma.
• A study of sleep-related breathing disorders in chronoc obstructive pulmonary disease patients with or eithout cor-pulmonale.
• A study to monitor adverse drug reactions in patients of chronic obstructive pulmonary disease.
• Breath carbon monoxide levels as a marker of clinical severity and control of asthma.
• The occurrence of rhinosinusitis in patients with bronchial asthma and/or allergic rhinitis.
• Characterisation of lower respiratory tract inflammation and its relationship with changes in pulmonary patho-physiology and thoracic imaging in bronchial asthma.
• A Comparative Study Of Inhaled and Intravenous Magnesium Sulphate As An Adjunct To Standard Treatment Protocol For Management Of Severe Exacerbation Of Bronchial Asthma.
• Predictors Of Emergency Department Use In Asthmatics.
• Diagnostic Yield Of Induced Sputum And Various Bronchoscopic Samples in Sputum Smear Negative Tuberculosis.
• A Study to Monitor Adverse Drug Reactions in Patients of Bronchial Asthma.
• Drug Resistance Profiling and Molecular Typing of Mycobacterium tuberculosis Isolates from a DOTS center and a Private Hospital in Delhi.
• Biochemical Studies on Protein Kinase C In Peripheral Blood Lymphocytes Of COPD Patients.
• Evaluation of systemic inflammatory markers, oxidant-antioxidant status and sputum cytology in stages of chronic obstructive pulmonary and diseases.
• Obstructive sleep apnoea, oxidative stress and renal function.
• Acute effects of tiotropium alone and in combination with formoterol in patients with COPD: comparision of three regimens.
• Evaluation of the effect of inhaled ciclesonide on the allergic and inflammatory markers in and bronchial asthma.
• Effect of glycemic control on outcome of acute exacerbation of COPD.
• Factors affecting attainment of control in asthma.
• Occurrence of upper airway symptoms and their impact on quality of life (QoL) in patients with COPD.
• Airway obstruction, bronchial hyper-reactivity and sensitivity to commonaeroallergen in allergic rhinitis.
• A comparative study of the efficacy and safety of theophylline and doxofylline in patients of obstructive lung disease.
• A study of species spectrum of fungi causing systemic mycoses in HIV patients in a New-Delhi Hospital and their antifungal susceptibility pattern.
• Studies on the role of lipids of lipid raft of erythrocyte membrane in COPD patients.
• A comparative evaluation of quality of life, dyspnoea, and lung function abnormalities in asthma and COPD.
• Assessment of severity of disease in patients with allergic rhinitis when categorized as ‘sneezers and runners’ and ‘blockers’.
• The impact of smoking on treatment outcome in patients of bronchial asthma.
• Obstructive sleep apnoea, oxidative stress and liver function.
• Epidemiological study and genetic diversity of PB1-F2 gene in influenza and A virus isolates from Delhi and Kolkata. Factors associated with poor asthma control and poor adherence to asthma treatment: self report by patients in emergency room.
• Effect of acetoxycoumarins and calcium channel blocking dihydropyrimidone derivatives on protein kinase C activity of and lymphocytes in COPD patients.
• A study to evaluate the occurrence of metabolic syndrome in chronic obstructive pulmonary disease.
• Effect of pulmonary rehabilitation on systemic inflammation, oxidative stress and functional status in chronic obstructive and pulmonary disease.
• Comparison of mometasone furoate and ciclesonide aqueous nasal spray in adult and allergic rhinitis patients.
• To compare the inflammatory mediator profiles, pulmonary function tests and skin and reactivity in obese and non-obese bronchial asthma patients.
• Study of cardiac autonomic dysfunction.
• Assessment of health related quality of life and work productivity in school going children with allergic rhinitis and/or asthma.
• Effect of pulmonary rehabilitation on, systemic inflammation, muscle mass and function status in interstitial lung diseases.
• Assessment of nutritional status in COPD and asthma
• Pattern of respiratory diseases and associated co-morbidities in patients attending Vallabhbhai Patel Chest Institute.
• Correlation of the partial pressure of arterial carbon dioxide, End-Tidal carbon dioxide and transcutaneous carbon dioxide in patients with respiratory diseases

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Prevalence of bronchial asthma and its associated factors among school children in urban Puducherry, India

Ganesh s. kumar.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Swaroop Kumar Sahu

Background:.

Bronchial asthma is an important public health problem at the global level. There is paucity of studies on bronchial asthma among school children in Urban India.

To assess the prevalence and associated factors of bronchial asthma among school children.

Materials and Methods:

A cross-sectional study was conducted among 263 children studying in the 8 th , 9 th , and 10 th standard using the modified International Study on Allergy and Asthma in Childhood questionnaire in Urban Puducherry. Data on associated factors that include family history of asthma, type of fuel used for cooking, placement of kitchen in the house, number of windows in sleeping room, pet animals, smoking among family members, birth order, and smoke outlet were collected. Data were analyzed by univariate analysis and expressed in proportion or percentages.

Prevalence of ever bronchial asthma was found to be 5.3%, of which 4.2% had current episode of asthma during the last 1-year period. About 72.7% of the current asthmatics had cold or rhinitis and 54.5% each had itching or rashes and nocturnal dry cough. Prevalence is more among the 12-13 years age group (6.5%) compared to the 14-16 years age group (3.6%). Boys (5.4%) and girls (5.2%) had comparable prevalence rates. The prevalence was significantly more among those with a family history of asthma, having smoking habits in any of the family members, and the absence of smoke outlet in the house ( P < 0.05).

Conclusion:

Bronchial asthma is an important health problem among children in urban Puducherry. Intervention on exposure to passive smoking and provision of smoke outlets may help to reduce the burden of disease at the community level.

INTRODUCTION

Bronchial asthma is an important health issue, especially in developing countries like India. In the year 2004, India accounted for 277 Disability Adjusted Life Years lost per 1,00,000 population and 57,000 deaths.[ 1 ] During the childhood period, bronchial asthma is often underdiagnosed and undertreated, which may lead to severe psychosocial disturbances in the family.[ 2 ] National Family Health Survey-3 showed that the prevalence of bronchial asthma among school children of the age group 15-19 years in India is as little as 0.9%, whereas other studies showed varied results ranging from 1.9% to 16.6% in different age groups.[ 1 ] In urban areas, this problem is increasing due to increase in environmental smoke and air pollution resulting from urbanization and industrialization. A study conducted in Bangalore city among less than 18 years of age showed that asthma prevalence increased to quite a great extent from the year 1979 (9%) to 1999 (29.5%).[ 3 ]

There is paucity of information on the epidemiology of asthma in Urban India.[ 4 ] Contribution of each risk factor may vary in different settings and understanding the risk factors associated with asthma such as family history, type of fuel used, pet animals, indoor air pollution, birth order, smoking among family members, and others will help in adopting appropriate preventive strategies. With this background, this cross-sectional study was conducted to assess the prevalence and associated factors of bronchial asthma among school children in Urban Puducherry, India.

MATERIALS AND METHODS

Setting and sample size.

This cross-sectional study was conducted during July-August 2012 in three schools of urban field practice area of a Medical Institution in Puducherry. The schools included two Government Schools, namely Calve College and Government Middle School, Kuruchikuppam, and one aided private society school. Since both government and private schools were included, we assume that it represents all the socio-economic strata from the population. Minimum sample size was found to be 250 subjects based on 22% prevalence rate, precision of 25%, and non-response rate of 10%. All 271 students studying in the 8 th to 10 th standard from the three schools were included as study subjects.

Method of data collection

Prior written permission was obtained from the principals of schools to allow the students to participate in the study. A pretested and validated questionnaire was designed on the lines of the International Study on Allergy and Asthma in childhood questionnaire.[ 5 ] This was translated to the local language Tamil and translated back into English to ensure reliability and validity. A pilot test was conducted before initiating the study to consider the feasibility of administration of the questionnaire and accordingly minor modifications were carried out. After obtaining the informed consent, the designated respondent was interviewed as per the questionnaire. A child with symptom of wheezing or whistling in the chest in the past was considered as criteria for defining asthma. Other symptoms associated with asthma, which included numbers of attacks of wheezing, sleep and speech disturbance, and nocturnal cough, were collected.

A semi-structured proforma containing data regarding age and associated factors that include family history of asthma, type of fuel used, placement of kitchen in the house, number of windows in sleeping room, pet animals, smoking among family members, birth order, and smoke outlet were collected.

Statistical analysis

The collected data was entered and analyzed using SPSS (Statistical Package for Social Sciences) version 11.0 for Windows. The findings were expressed in terms of proportions or percentages. Univariate analysis was carried out for associated factors to test the differences between proportions. P < 0.05 was considered as significant.

A total of 263 subjects in the age group of 12-16 years age group were analyzed with a response rate of 97.1%. The study found that most of the children belonged to the 12-13 years age group (58.2%) and were males (63.5%). Prevalence of ever bronchial asthma was found to be 5.3% and 4.2% had a current episode of asthma during the last 1-year period. About 72.7% of current asthmatics had cold or rhinitis. Nearly half (45.5%) of the current asthmatics had >3 episodes of wheezing and 54.5% of them had itching or rashes and nocturnal dry cough. About 18.2% of them were not diagnosed or treated for it [ Table 1 ].

Distribution of symptoms of asthma in the past year, N =11

Prevalence of asthma was more among the 12-13 years age group (6.5%) compared to the 14-16 years age group (3.6%); however, this difference was not found to be significant. Boys (5.4%) and girls (5.2%) had comparable prevalence rates of asthma. It was found that prevalence was significantly more among those with a family history of asthma, having smoking habits in any of family members, and the absence of smoke outlet in the house ( P < 0.05) [ Table 2 ].

Associated factors of asthma among school children in Urban Puducherry

Bronchial asthma among children is an important health issue for the concerned authorities in developing countries like India. A recent review analysis of 15 epidemiological studies showed that the mean prevalence of asthma among children was 7.24%. Urban and male predominance was observed with wide interregional variation.[ 4 ] Recent studies in India showed varied prevalence rates in different age groups and locations ranging from 0.9% to 15.7%.[ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ] The low level of prevalence found in National Family Health Survey-3 (2005-06) may be because of the lesser sensitivity of the questionnaire and self-reporting or lack of uniformity in the data collection process.

Studies have shown that prevalence is more in urban areas compared to rural areas.[ 4 , 9 ] A study conducted in Shimla city among school children aged 6-13 years showed the prevalence as 2.3%.[ 12 ] Another study from Jaipur conducted among urban school children aged 5-15 years showed the prevalence of asthma as 7.59%.[ 13 ] A study conducted in Bangalore among school children aged 6-15 years in heavy traffic area showed prevalence as high as 19.34%.[ 3 ] The prevalence of ever asthma was reported as 2.4% in a population study on 73,605 individuals of all age groups conducted simultaneously at four major centers in India.[ 14 ] Prevalence of asthma and wheeze reported were 3.3% and 7.8%, respectively, in a study conducted at Lucknow, in the age group 13-14 years.[ 8 ]

Studies from rural areas also show different prevalence rates. A recent study from rural Puducherry showed the prevalence as 8.6%, which is higher than that found in the present study.[ 15 ] A rural study from Karnataka showed the prevalence of bronchial asthma among the 6-15 years age group as 10.3%.[ 6 ] The prevalence of ever wheezers in a study among 10-18 years age group from rural Karnataka was 8.4% and current wheezers was 5.2%.[ 11 ] However, in general it was found that prevalence rate is more in the United Kingdom, Canada, Australia, New Zealand, Brazil, and other developed countries, ranging from 15% to 20%.[ 1 , 16 , 17 ] A very high prevalence of history of wheezing was found in three studies in Costa Rica with 46.8%, 42.9%, and 45.1% in different age groups conducted among school children.[ 18 ] In contrast to this, it was shown by an Indian study that prevalence of asthma among adults aged ≥15 years is 2.05%.[ 19 ] This variation may be because of the difference in the exposure status of different risk factors in different geographical locations. Moreover, the definition of asthma, instrument used to define it, age group studied, methodology adopted, and urban – rural difference – all were responsible for this varied observation.

The prevalence of asthma was similar in both sexes in contrast to other studies.[ 4 , 6 ] It was comparatively more among younger age groups similar to other studies.[ 4 ] It was observed in our study that prevalence is significantly more among those with a family history of bronchial asthma similar to other studies.[ 6 , 15 ] Indoor air pollution due to biomass or solid fuel combustion is an important risk factor in the Indian setting.[ 3 , 20 ] Although the prevalence is more among those using firewood, we could not find any association with it. Our study has shown that the proportion of cases was significantly less among those who live in houses with smoke outlets. Exposure to passive tobacco smoke was shown to be an important risk factor in our study, similar to that in other studies.[ 14 , 21 , 22 ] A study has shown interactions between genotypes at specific loci or genome regions and environmental tobacco smoke exposure with risk for development of asthma.[ 23 ]

We could not find any association between bronchial asthma and factors like pets at home, birth order, and absence of windows in living rooms in contrast to other studies.[ 1 , 7 , 15 ] The study findings may not be generalized due to the different socio-demographic characteristics and the associated risk factors in the different settings. In addition, quantification of some of the risk factors could not be ascertained and diagnostic tests could not be conducted due to feasibility constraints.

Asthma among school children is a public health problem in urban Puducherry. Our study provides valuable information on the magnitude of the problem and certain risk factors, which can be utilized for preventive measures to be taken in the future. Intervention on exposure to passive smoking and provision of smoke outlets may help in the reduction of burden of disease at the community level. Further studies are required to explore the risk factors of bronchial asthma among children in different geographical regions.

Source of Support: Nil

Conflict of Interest: None declared.

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Stanford University School of Medicine blog

Breathing: A reflection on living with asthma

We played cards sometimes, my mother and I, during my childhood asthma attacks in the middle of the night. I would creep past the bathroom door and to my parents' bedroom door. Mom , I would whisper. Mom .

That's all I needed to say. She came to the living room, where I waited for her, and stayed up the rest of the night to watch me breathe.

Watching me breathe meant making decisions about whether to call the doctor in the middle of the night or take me into his office in the morning.

Sometimes I put my hands on my head, fingers clasped together because latching them and pressing down on my head created more energy to suck in the next breath. As I grew older, I avoided placing my hands on my head, afraid to tip my mother off about how bad the attack was.

For a long and harrowing attack, she woke my father to drive me out into the night air, which we thought helped with the breathing. We meandered through the neighborhoods bordering the hospitals, looping repeatedly down certain streets, our leisurely pace a sham, because really, he remained close to those hospital entrances in case my breathing worsened, propelling us both into the light and warmth of the busy Emergency Departments.

Sometimes watching me meant making honey, lemon and whiskey toddies, or, if we had no whiskey, just honey and lemon, so the hot liquid could break up the phlegm in my chest. But often, as I sipped on my honey and lemon, my mother rubbed my back and shoulders, which were always hunched down with the effort of breathing. Or pounded between my shoulder blades, another strategy to break up the phlegm.

If the breathing became easier, either on its own or because I'd had some of the medicine stockpiled in our cupboard, and the rattling and wheezing diminished, my mother would pull out the cards. She still needed to watch my progress; neither one of us could rest yet. We would play two-handed Euchre. Or double solitaire.

I don't know how my mother's level of anxiety fluctuated when she watched me breathe through the night, but she never smoked in the house during my asthma attacks. For intense attacks, after waking my father, she might take a break from watching me and go into the backyard with a cigarette to look at the sky. She never fretted in front of me. She remained calm and positive.

During my senior year of high school, after a stressful week of classes, a swine flu shot, and a complicated AP chemistry experiment, I suffered an asthma attack, the worst I'd had in years. My pediatrician instructed the hospital to admit me straight to a floor. Some bureaucratic glitch delayed the delivery of one of those injections I needed to open my airways and help me breathe. My mother, summoned from work, told me to keep going, just a bit longer. Later, I told her, "I think you kept me alive." She told me that she'd never been so worried. She'd thought for sure I was dying.

Years later, when she died, her own breathing remained silent until near the end. Small puffs of sound emerged from her lips, like the snore puffs she'd made on those nights I'd returned from college for a visit and lay awake with the hums and creaks of my childhood home. In the hospital, as she lay dying, her brain stem already dead, I couldn't encourage her as she exhaled her last puffs. I just listened.

"Living is about the breathing," I might have said to my mother on one of those nights I clambered through an attack. We both knew that. But sometimes it helped to hear things aloud.

This piece, originally in  longer form , is part of an ongoing collaboration with Months to Years, a nonprofit quarterly publication that showcases nonfiction, poetry and art exploring mortality and terminal illness.

Dawn Newton, a writer in East Lansing, Michigan, was diagnosed with stage IV lung cancer in November 2012 and has lived with asthma all her life. Her memoir, Winded: A Memoir in Four Stages, will be published in October by Apprentice House Press at Loyola University Maryland. Her blog is at www.dawnmarienewton.com .

Photo by Alfonso Cerezo  

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