|Year : 2015 | Volume
| Issue : 1 | Page : 3-6
Clinical profile of bronchial asthma patients reporting at respiratory medicine outpatient department of teaching hospital
AK Singh1, Vikram Kumar Jain2, M Mishra2
1 Department of Chest and TB, SMS Medical College, Sitapura, Jaipur, Rajasthan, India
2 Department of Respiratory Medicine, Mahatma Gandhi Medical College, Sitapura, Jaipur, Rajasthan, India
|Date of Web Publication||17-Aug-2015|
Vikram Kumar Jain
KTR 3 and 4, Mahatma Gandhi Nagar, DCM, Ajmer Road, Jaipur - 302 021, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: There is limited information available on the clinical profile of asthma patients reporting at teaching hospital. Objective: The objective was to evaluate clinical profile of bronchial asthma patients reporting at teaching hospital. Materials and Methods: A prospective study of bronchial asthma patients over 15 years of age was conducted at Mahatma Gandhi Medical College and Hospital, Jaipur over a year (July 2010 to June 2011). Asthma was diagnosed on detailed history, clinical examination and spirometry having obstructive pattern with reversibility showing increase in forced expiratory volume in 1 st sec by 12% and 200 ml from prebronchodilator value. Besides demographic data, smoking habit, atopic symptoms, and family history suggestive of asthma also collected. Results: Total, 151 cases of bronchial asthma included. Maximum were male (80.8%) and urban (65%). Most cases (52.9%) were in age group of 16-30 years followed by 32.5% in 31-45 years. More than half (55.6%) belonged to the middle class in society. Majority (74.2%) were nonsmokers. Most common symptoms were cough, wheeze, and breathlessness 98.7%, 90.1%, and 88.1%, respectively. Nocturnal awakening was present in 2/3 rd cases. Rhinitis (65%) was most common associated condition. Almost equal number of cases had seasonal and perineal pattern of symptoms, with increased severity mainly in autumn (n = 53) and spring (n = 42). Family history of atopy was present in 1/3 rd patients. Nearly 3/4 th cases were newly diagnosed, and 1/4 th were previously diagnosed. More than 50% of these newly diagnosed asthma cases belonged to moderate severity grade. Among previously diagnosed cases (n = 40), spirometry was used in only 20% cases for diagnosis of asthma, and only 20% had their asthma under control at the time of reporting. Conclusion: Asthma is a disease of young age, with rhinitis as most common associated co-morbidity. Spirometry is poorly used by practitioners in diagnosing asthma with poor control of asthma among previously diagnosed cases. This reflects a lack of awareness of use of spirometry for diagnosis and inadequate advice of treatment.
Keywords: Asthma, atopic, atopy, bronchodilator, demographic, rhinitis, severity, smoking, spirometer
|How to cite this article:|
Singh A K, Jain VK, Mishra M. Clinical profile of bronchial asthma patients reporting at respiratory medicine outpatient department of teaching hospital. Indian J Allergy Asthma Immunol 2015;29:3-6
|How to cite this URL:|
Singh A K, Jain VK, Mishra M. Clinical profile of bronchial asthma patients reporting at respiratory medicine outpatient department of teaching hospital. Indian J Allergy Asthma Immunol [serial online] 2015 [cited 2019 Sep 20];29:3-6. Available from: http://www.ijaai.in/text.asp?2015/29/1/3/162970
| Introduction|| |
Asthma is a heterogenous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation (global initiative for asthma [GINA] 2014).  Asthma is currently one of the world's most common long-term noncommunicable disease; affecting about 300 million people worldwide , and number could increase further by another 100 million by year 2025.  Prevalence of asthma among developed countries is more (2.7-20%) ,,,,, than reported from India.  On intensive search of medical literature on PubMed we were unable to find studies depicting clinical profile (demographic, symptom pattern and staging etc.) of patients of bronchial asthma reporting at outpatient department (OPD) of a teaching hospital. Few studies were available on the profile of asthma patients admitting at the emergency department. ,
To best of our knowledge, studies reported from India related to the profile of asthma patients reporting at OPD of teaching hospital are lacking. In view of these facts, this study was planned to know the clinical profile of patients of bronchial asthma reporting at respiratory medicine OPD of teaching hospital.
| Materials and methods|| |
The study was conducted over 1-year period (July 2010 to June 2011) in the Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur. Patients over 15 years of age were included. Those presenting with emphysema, acute ischemic heart disease, left ventricular failure, myocardial infarction, and bleeding disorders were excluded. The patients were evaluated in OPD of the department and details of the demographic profile including socioeconomic status,  atopy, detail history, and current asthma attack were recorded. Complete blood investigations, ski gram chest, paranasal sinuses, and spirometry were done in each case. Spirometry was performed using ndd Medizintechnik AG true flow™ . Baseline forced expiratory volume in 1 st s (FEV 1s ) was determined. Two puffs of levosalbutamol (100 μg) were administered and after an interval of 15 min, spirometry was repeated to determine reversibility. Diagnosis of asthma was accepted on increase in FEV 1s by >12% and 200 ml in comparison to the baseline value, as laid by GINA earlier and also same in GINA 2014.  FEV 1s value determined by spirometry was taken as a measure of severity of asthma. Grading of asthma severity was done using GINA guideline. 
| Results|| |
The study included 151 cases, of these 111 were diagnosed at our department. Majority of the cases were male (80.8%). Urban cases (65%) were more. Most of the cases (74.2%) were nonsmokers. Maximum cases (55.6%) belonged to the middle class in society [Table 1]. 85.4% cases of bronchial asthma were below 45 years [Table 2]. Among respiratory symptoms, cough was most common symptom (98.7%), followed by wheeze (90%), breathlessness (88%), chest tightness (65.5%), nocturnal awakening (65.5%), expectoration (41%), and chest pain (21%). Among associated conditions, rhinitis was most common (65%), followed by sinusitis (34.4%), conjunctivitis (29%), urticaria (8.6%) and ear itching (7%). Diurnal variation of symptoms was present in 92% cases. Maximum patients had symptoms at early morning (81.4%) and nocturnal (68%). Seasonal and perineal presentations of symptoms by cases were 50.3% and 49.7%, respectively. Maximum cases (65.8%) of bronchial asthma were reported in the months of March and April and august to November [Table 3]. Family history of asthma and or rhinitis was in 35% cases. Among cases diagnosed at our center, 61.3% had asthma severity of moderate to severe persistent grade at the time of presentation [Table 4]. Among previously diagnosed cases (n = 40) of asthma, spirometry for diagnosis was used in only 20% cases by treating practitioners. Among cases treated by these practitioners, only 20% had their asthma symptoms under adequate control while 37.5% had partial control and 42.5% had uncontrolled asthma.
| Discussion|| |
Bronchial asthma is a chronic inflammatory disease of airways, prevalent worldwide with variable geographical and seasonal pattern. Disease is under diagnosed, under and poorly treated with poor compliance. In the present study more than 4/5 th cases were males which are also reported by others. ,, Our study showed maximum cases (65%) were from the urban area, which is also supported by one air study  conducted in Spain. In our study, maximum cases (>50%) were in age group of 16-30 years which is also supported by other studies. , More than half of the cases belonged to the middle class while Olufemi et al.  and Eisner et al.  reported maximum cases belonging to lower socioeconomic group. The higher rate of asthma cases in our study belonging to the middle class may be due to more patients coming from urban areas. Family history of asthma and or rhinitis was in more than 1/3 rd cases in our study. Our study showed cough as most common respiratory symptom, also reported by others. ,
In our study, maximum cases reported in months of August, September, and October followed by March and April. Rhinitis (65%) was most common associated condition, similar to reported in other studies. ,,, In our study, among newly diagnosed asthma cases, 12.6% were in intermittent severity grade, while remaining 87.4% were in persistent severity grade (26.1% mild, 42.3% moderate, and 19% severe), while one air study  reported 61.5% cases in persistent (29.4% mild, 27.2% moderate, and 4.9% severe) and 38.5% in intermittent severity grade. This reflects that larger percentage of asthma patients remain untreated in the community. As a result, their asthma progresses in severity. There is probably the lack of asthma knowledge among treating physicians. Progression of asthma severity can be prevented by timely diagnosis and proper management. Among previously diagnosed asthma cases only 20% had adequate control of symptoms showing poor awareness of asthma management, as supported by others. ,,,,
| Conclusion|| |
Our study concludes that bronchial asthma is a disease of young age with rhinitis as most common associated co-morbidity. Most of the cases of asthma reported in autumn and spring seasons, possibly related to high levels of pollen in the environment and are worst seasons for asthma patients. There is a need of asthma awareness program for general practitioners for timely diagnosis and proper management of asthma. Spirometry is poorly used by practitioners in diagnosing asthma with inadequate advice of treatment leading to poor control of asthma.
| References|| |
GINA. Global Strategy for Asthma Management and Prevention. [Last revised on 2014 Aug 12] web link www.ginasthma.org.
Chapman KR. Impact of ′mild′ asthma on health outcomes: Findings of a systematic search of the literature. Respir Med 2005;99:1350-62.
Ehrs PO, Nokela M, Ställberg B, Hjemdahl P, Wikström Jonsson E. Brief questionnaires for patient-reported outcomes in asthma: Validation and usefulness in a primary care setting. Chest 2006;129:925-32.
Burney P, Malmberg E, Chinn S, Jarvis D, Luczynska C, Lai E. The distribution of total and specific serum IgE in the European Community Respiratory Health Survey. J Allergy Clin Immunol 1997;99:314-22.
Chinn S, Burney P, Jarvis D, Luczynska C. Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS). Eur Respir J 1997;10:2495-501.
Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS). Eur Respir J 1996;9:687-95.
Devereux G, Ayatollahi T, Ward R, Bromly C, Bourke SJ, Stenton SC, et al.
Asthma, airways responsiveness and air pollution in two contrasting districts of northern England. Thorax 1996;51:169-74.
Peat JK, Haby M, Spijker J, Berry G, Woolcock AJ. Prevalence of asthma in adults in Busselton, Western Australia. BMJ 1992;305:1326-9.
Peat JK, Gray EJ, Mellis CM, Leeder SR, Woolcock AJ. Differences in airway responsiveness between children and adults living in the same environment: An epidemiological study in two regions of New South Wales. Eur Respir J 1994;7:1805-13.
Aggarwal AN, Chaudhry K, Chhabra SK, D′Souza GA, Gupta D, Jindal SK, et al
. Prevalence and risk factors for bronchial asthma in Indian adults: A multi-centre study. Indian J Chest Dis Allied Sci 2006;48:13-22.
Demoly P, Bousquet J. The relation between asthma and allergic rhinitis. Lancet 2006;368:711-3.
Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J, et al.
Rhinitis and onset of asthma: A longitudinal population-based study. Lancet 2008;372:1049-57.
Kumar N, Shekhar C, Kumar P, Kundu AS. Kuppuswamy′s socioeconomic status scale-updating for 2007. Indian J Pediatr 2007;74:1131-2.
Olufemi O, Alakija KS, Oluboyo PO. Self reported risk factors of asthma in a Nigerian adult population. Tur Toraks Der 2009;10:56-62.
Vijayakumar S, Sasikala M, Mohammed TS, Gauthaman K. A perspective study of asthma and its control in Assam. World Acad Sci Eng Technol 2009;55:134-36.
Navarro A, Valero A, Juliá B, Quirce S Coexistence of asthma and allergic rhinitis in adult patients attending allergy clinics: ONEAIR study. J Investig Allergol Clin Immunol 2008;18:233-8.
Eisner MD, Patricia PP, Edward HY, Stephen CS, Paul DB. Risk factors for hospitalization among adults with asthma: The influence of sociodemographic factors and asthma severity.Respir Res 2001;2:53-60.
Bugiani M. Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy. Allergy 2005;60:165-70.
Guerra S, Sherrill DL, Martinez FD, Barbee RA. Rhinitis as an independent risk factor for adult-onset asthma. J Allergy Clin Immunol 2002;109:419-25.
Baiardini I, Braido F, Giardini A, Majani G, Cacciola C, Rogaku A, et al.
Adherence to treatment: Assessment of an unmet need in asthma. J Investig Allergol Clin Immunol 2006;16:218-23.
Horne R. Compliance, adherence, and concordance: Implications for asthma treatment. Chest 2006;130 1 Suppl: 65S-72.
Jones A, Pill R, Adams S. Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ 2000;321:1507-10.
Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al.
Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med 2011;105:930-8.
Boulet LP, Vervloet D, Magar Y, Foster JM. Adherence: The goal to control asthma. Clin Chest Med 2012;33:405-17.
[Table 1], [Table 2], [Table 3], [Table 4]