|Year : 2021 | Volume
| Issue : 1 | Page : 17-21
Estimation of prevalence of bronchial asthma in preschool and prepubertal children using international study of asthma and allergies in childhood criteria in Raipur Chhattisgarh
Renu Kale1, Raghavendra S Khachhawaha2
1 Department of Paediatrics, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Consultant Paediatrician, Ekta Institute of Child Health, Raipur, Chhattisgarh, India
|Date of Submission||06-May-2021|
|Date of Acceptance||27-Aug-2021|
|Date of Web Publication||07-Dec-2021|
Dr. Renu Kale
Nandadeep, Newshanti Nagar, Street No. 6A, Opposite SMT, Raipur - 492 001, Chattisgarh
Source of Support: None, Conflict of Interest: None
OBJECTIVE: Bronchial asthma is the most common chronic disease affecting children and young adults. The prevalence of asthma is on the rise worldwide with increasing levels of pollution. The epidemiology of asthma is a growing area of research. There is a paucity of data from central India, especially from Raipur, which has become the capital of Chattishgarh since the year 2000. This community-based study was conducted to estimate the prevalence of bronchial asthma in school going children aged between 6–7 years and 13–14 years.
MATERIALS AND METHODS: A cross-sectional study using ISSAC questionnaires was conducted across 12 schools in Raipur, selected on a random basis. The required sample size of 1000/age group was needed according to International Study of Asthma and Allergies in Childhood criteria, so a total of 2029 children were recruited in both age groups. Data were managed in Microsoft Office Excel and were analyzed using tests of proportion.
RESULT: Out of 2029 children evaluated, 153 (7.54%) had a positive history of wheezing throughout their lives and the relative number of wheezy girls was 7.56% as compared to boys 7.52%. Comparison between two age groups 6–7 and 13–14 years, wheezing incidence of 7.37% and 7.71% was similar with no significant difference. Confirmed asthma was detected in 2.32% of cases. No significant difference was noted in both age groups, i.e. 1.97% in 6–7 and 2.67% in 13–14 years. Higher incidence of exercise-induced wheeze was noted in older age group (13–14 years) children 5.04% versus 4.23%.
CONCLUSION: The prevalence of bronchial asthma was 2.32% in children in Raipur. Increasing trends in prevalence due to increasing pollution needs environmental measure to control pollution.
Keywords: Bronchial asthma, prevalence, school children
|How to cite this article:|
Kale R, Khachhawaha RS. Estimation of prevalence of bronchial asthma in preschool and prepubertal children using international study of asthma and allergies in childhood criteria in Raipur Chhattisgarh. Indian J Allergy Asthma Immunol 2021;35:17-21
|How to cite this URL:|
Kale R, Khachhawaha RS. Estimation of prevalence of bronchial asthma in preschool and prepubertal children using international study of asthma and allergies in childhood criteria in Raipur Chhattisgarh. Indian J Allergy Asthma Immunol [serial online] 2021 [cited 2022 Jan 18];35:17-21. Available from: https://www.ijaai.in/text.asp?2021/35/1/17/331800
| Introduction|| |
Bronchial asthma is a chronic disorder of the bronchial tree affecting both children and adults with 300 million individuals affected worldwide. Asthma is defined by the history of recurrent wheezing, coughing, chest tightness, shortness of breath at night time, and early morning symptoms which affects the quality of life., Asthma symptoms begin early in life and a third of children wheeze during the first 3 years of life.,, The majority of children stop wheezing by age of 6 years but 40% will continue to wheeze having developed asthma or developing asthma later in life. It impairs airway development in children and reduces maximally attained lung function. Quality of life in children is affected by asthma with exercise intolerance, poor nighttime sleep, and school absenteeism. Psychological changes in children from anger to depression are common.
Asthma is a source of a financial burden on family, with one-third of monthly per capita income spent on medication alone., Cost of asthma treatment in India is 9% of per capita annual income which puts the burden on family finances, leading to cost-cutting in quality of food partaken by children and family members.
International Study of Asthma and Allergies in Childhood (ISAAC) is a unique worldwide epidemiological research program established in 1991 to investigate asthma, rhinitis, and eczema in children. ISAAC is a questionnaire-based screening tool for epidemiological purpose to elucidate asthma prevalence in children, it is noninvasive, safe, and self-administered ISAAC is the largest collaborative research project with aims to develop environmental measures and disease monitoring to formulate strategies for future intervention, to reduce the burden of allergic and nonallergic diseases in children, especially in developing countries.
Bronchial asthma is underdiagnosed at the community level to as much as 50%., In a recent review, it has been reported that, at primary care, asthma diagnosis can vary from 54% underdiagnosis to 30% overdiagnosis.,,
India has a substantial burden of bronchial asthma. Incidence of asthma in 1.3 billion population has been reported as 6% in children and 2% in adults with wide variations among different states varying from 2% to 23%.,, There are few studies from the capital of Chhattisgarh, Raipur which has been reported as 7th most polluted city in the world by the WHO in 2016. The prevalence of asthma in Raipur in a study by Kumari and Jagzape was 5.14%. There are no other prevalence studies from Raipur. We carried out this epidemiological study to assess the prevalence of asthma in 2000 schoolchildren of Raipur using a standardized ISAAC questionnaire.
Our study reported the prevalence of asthma as 1.9% in 6–7 years and 2.17% in 13–14 years, which is lower than that reported by Kumari and Jagzape. The difference in prevalence in both studies done in Raipur may be due to different variables measured in both the studies and the number of children covered (2029 vs. 175).
| Materials and Methods|| |
A cross-sectional self-administered questionnaire-based study was conducted between August 2016 and 2017 after ethics committee approval. We have included private as well as government schools for the study wherein the school administration was briefed and permission to administer the questionnaire was obtained. All children in the eligible age range were screened from the school records. All the eligible students of either gender were enrolled after parents or guardian's written informed consent after being briefed about the purpose of the study, whereas all nonconsenting students were excluded.
The prevalidated survey protocol of ISSAC was used for two different age groups, i.e. 6–7 years and 13–14 years. A standardized written ISSAC asthma questionnaire was distributed to all the children. Questionnaires contained standard ISSAC modules about symptoms of asthma. Elder children group completed the questionnaires themselves at school, whereas younger ones took it home to be completed with the help of their parents.
A total of 1200 questionnaire were distributed for each group, of which we received 1017 and 1012 completed questionnaires for age group 6–7 years and 13–14 years, respectively, and were analyzed. The data were managed in Microsoft Office Excel and were analyzed using tests of proportion.
| Results|| |
A total of 2029 students participated in the study, consisting of 1017 in the age group 6–7 years and 1012 students between 13 and 14 years. Various symptoms observed in 2 age groups with the difference in gender are as given in [Table 1].
The prevalence of bronchial asthma in the studied population was estimated from ISAAC questions based on wheezing in the past 12 months was 2.32%, more in older children (2.67% vs. 1.9%) as compared to the younger age group. The prevalence of asthma in the male population was 2.25% and 2.38% in the female population. The prevalence of asthma was not found to vary according to age or sex [Table 2].
|Table 2: Prevalence of asthma in age group 6–7 year and 13–14-year-olds by ISSAC criteria|
Click here to view
| Discussion|| |
There has been a constant and variable increase in the prevalence of bronchial asthma worldwide in the past two decades The same is being observed in India., Globally, asthma is ranked ten among the leading causes of burden of disease as measured by disability-adjusted life years.,,, Around 300 million people have asthma worldwide and there is a likelihood of a further 100 million being added by 2025. ISAAC studies from the world over have shown that the prevalence of bronchial asthma has peaked in high-income countries, and there is an increasing trend in low- and middle-income countries, prevalence of bronchial asthma is increasing by 0.002%/year in 13–14 year olds and 0.6% in 6–7 years olds. The diagnosis of asthma is dependent on the clinical presentation of bronchospasm, variable airway narrowing, bronchial hyperresponsiveness, airway inflammation, and response to inhaled bronchodilators and corticosteroids. Spirometry in children is difficult, and results are often normal. Reversibility of symptoms to bronchodilatation is not consistently present.
ISAAC is a questionnaire-based study to estimate the prevalence of asthma and allergy in childhood which is an epidemiological noninvasive tool for the estimation of asthma. Asthma questionnaires of ISAAC consist of three groups of asthma-related symptoms first the existence of asthma symptoms, second severity of asthma symptoms, and third existence of asthma variants (night cough, exercise-induced asthma etc.).
Our study was done in Raipur, capital of Chhattisgarh covering the population of 2029 children from both private and government schools. Children from all strata of society were included.
The prevalence of asthma in our study was estimated to be around 2.5%, and wheezing was 7.54%. This compares with other studies from other parts of India.,, Awasthi et al. have reported a prevalence of 2.3% in 6–7 year olds and 3.3% in 13–14 year olds from Lucknow North India. Wheezing was found in 6.2% in the age group 6–7 years and 7%–8% in 13–14 year olds. Asthma variant such as dry night cough is a relatively sensitive indicator of airway hyperresponsiveness in children, was 7.67% in 6–7 year olds, and 6.81% in 13–14 year olds; this was more commonly reported by parents due to heightened awareness at night.,
Speech limitation suggests asthma severity in questionnaires. In our study, younger children reported 2.16%, while in older children, it was 3.16%. ISSAC studies done in reported prevalence of this symptom ranging from 1% to 13.5% in 13–14 years age group, while younger children range was 0.6%to 2.8%. Masjedi et al. showed similar results where no age or sex predominance was observed.
Kumari and Jagzape. study from Raipur has reported a higher incidence of wheezing, i.e. 11.9% in 6–9 year olds and 13.8% in 10–14 year olds. Prevalence of bronchial asthma was also significantly higher at 5.14% as compared to our study. The difference may be related to the study population covered. This study covered a population of 175 school children, whereas we covered a population of 2029 schoolchildren from all over the city.
Bhalla et al. study from Rohtak, Haryana found a 13.5% prevalence of bronchial asthma in adolescent children. This study has reported a high prevalence compared to studies from other parts of the country. This may be factored due to local prevailing conditions. Sex difference in the prevalence of bronchial asthma is seen in studies across the world and India.,,,,, Arora et al. have reported male preponderance in the incidence of wheezing in the younger age group of 6–7 year olds, we found similar results in our study from Raipur with wheezing of 8.97% in boys as compared to 5.6% girls in 6–7 year olds.
Female sex shows a higher incidence of wheezing and bronchial asthma in the age group of 13–14 years,, this is also seen in our study with the female preponderance of 9.52% as compared to 6.05% in males in 13–14 year olds. Hormonal factors play an increasing role in the incidence of wheezing and bronchial asthma in adolescent females.
Exercise-induced wheezing and bronchial asthma is more in boys as compared to females,, our study found 5.23% males versus 3.1% females affected. This could be related to boys being more physically active as compared to females, as vigorous physical activity triggers acute airway narrowing.
An increasing level of pollution in India over the past decade has shown an increased incidence of bronchial asthma as suggested from studies from various parts of the country. Study from Jaipur done in 2008 showed the prevalence of bronchial asthma of 7.59%, and in 2018, the prevalence increased significantly to 18%. This study is an indication of increased pollution in our cities over a decade.
A study of 20,000 children between 1979 and 1999 from Bengaluru had shown increasing trends in the prevalence of asthma from 9% to 25% over a decade. Children residing in higher traffic regions and those from lower socioeconomic population had the highest prevalence of 31.14%. Study from Mysore has reported a prevalence of asthma in children in the age group of 6–14 years of 17.14%. The corresponding prevalence within 1998, 2003, and 2008 prevalence was 4%, 16%, and 9%, showing a gradually increasing trend over the past decade.
Study by Behl et al. reported a prevalence of 2.7% in schoolchildren in Shimla, which is similar to our study. Gupta et al. study has shown the prevalence of 2.6% in males and 1.9% in females which compares with our report.
The prevalence of asthma differs in rural and urban areas,, with urban areas being more affected due to vehicular and industrial pollution. A study from Haryana in 2000 has reported a prevalence of 2% in rural areas, which is similar to our study. A study from Karnataka showed the prevalence of wheeze ever to be 8.4% and current wheeze of 5.2% which was similar to our study.
Prevalence of bronchial asthma has been shown to range from 2.6% to 12.3% worldwide,, with areas of heavy pollution, especially urban areas having a higher incidence of bronchial asthma.
Our study from Raipur compares well with similar studies from other parts of the country. We found a lower incidence of asthma as compared to a similar study from Raipur by Kumari and Jagzape, which may be due to the difference in the number of children covered in the study population. Our study was based on recall, so there are chances of forgetting the previous incidence was high. This may be the reason for lower incidence. Limitations of our study were noninclusion of physical examination, spirometry, family history, and household and environmental pollutants, whereas the large study population was the strength of our study.
| Conclusion|| |
The prevalence of bronchial asthma in our study was 2.3%, and the prevalence of wheeze ever was 7.73%. The difference in diagnosed asthma and wheezing may be underdiagnosis of bronchial asthma. It has been suggested that, among adolescent and young adults in any population, 50% of cases go undiagnosed. The burden of asthma is increasing with increasing industrialization, more studies with a larger population is need of the hour. The cost incurred by family and school loss days is the cause of mental health issues in children. Environmental measures at the international, national, state, and individual level are needed at war footing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ellwood P, Ellwood E, Rutter C, Fernandez VP, Morales E, Marcos LG, et al.
Global Asthma Network Phase I Surveillance: Geographical Coverage and Response rates; Global Asthma Network. J Clin.Med 2020:9:3688.
World Health Organization, Bronchial Asthma; Scope of Problem. Available from: http://www.who.int
. [Last accessed on 2005 Aug 23].
Shyamali CD, Jennifer LP, Adnan C. Epidemiology of asthma in children and adults. Front Pediatr 2019;7:246.
Gregory AM, Vander Ende J, Willis TA, Verhulist FC. Parent reported sleep problems during development and self reported anxiety/depression, attention problems and aggressive behaviour later in life. Arch Pediatr Adolesc Med 2008;162:330-5.
Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and overdiagnosis of asthma. Am J Respir Crit Care Med 2018;198:1012-20.
Barreto ML, Ribeiro-Silva Rde C, Malta DC, Oliveira-Campos M, Andreazzi MA, Cruz AA. Prevalence of asthma symptoms among adolescents in Brazil: National Adolescent School-based Health Survey (PeNSE 2012). Rev Bras Epidemiol 2014;17 Suppl 1:106-15.
To T, Stanojevic S, Moores G, Gershon AS, Bateman ED, Cruz AA, et al.
Global asthma prevalence in adults: Findings from the cross-sectional world health survey. BMC Public Health 2012;12:204.
Pal R, Dahal S, Pal S. Prevalence of bronchial asthma in Indian children. Indian J Community Med 2009;34:310-6.
] [Full text]
Sharma BS, Kumar MG, Chandel R. Prevalence of asthma in urban school children in Jaipur India. Pediatr Res 2011;70:517.
Kumari V, Jagzape TB. Bronchial asthma prevalence and risk factors among children in urban population from Raipur Chhattisgarh. Indian J Allergy Asthma Immunol 2019;33:45-50. [Full text]
Lallo UG, Walters RD, Adachi M, Guia T, Emelyanov A, Fritscher CC, et al
. Asthma programs in diverse regions of world: Challenges, Success and Lessons Learnt; Int J. Tuberc Lung Diseases 2011;15:1574-1586.
Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al.
Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet 2006;368:733-43.
Awasthi S, Kalra E, Roy S, Awasthi S. Prevalence and risk factors of asthma and wheeze in school-going children in Lucknow, North India. Indian Pediatr 2004;41:1205-10.
Sharma BS, Kumar MG, Chandel R. Prevalence of asthma in urban school children in Jaipur, Rajasthan. Indian Pediatr 2012;49:835-6.
Chakravarthy S, Singh RB, Swaminathan S, Venkatesan P. Prevalence of asthma in urban and rural children in Tamil Nadu. Natl Med J India 2002;15:260-3.
van Aalderen WM, Meijer GG, Oosterhoff Y, Bron AO. Epidemiology and the concept of underlying mechanisms of nocturnal asthma. Respir Med 1993;87 Suppl B: 37-9.
Masjedi MR, Fadaizadeh L, Najafizadeh K, Dokouhaki P. Prevalence and severity of asthma symptoms in children of Tehran- International Study of Asthma and Allergies in Childhood (ISAAC). Iran J Allergy Asthma Immunol 2004;3:25-30.
Bhalla K, Nehra D, Nanda S, Verma R, Gupta A, Mehra S. Prevalence of bronchial asthma and its associated risk factors in school-going adolescents in Tier-III North Indian City. J Family Med Prim Care 2018;7:1452-7.
] [Full text]
Arora K, Das PR, Poorvi PA, Rustogi R, Singh D. A study of prevalence and risk factors of asthma in urban school children of Ludhiana, Punjab India. Indian J Health Sci 2015;8:104-8.
DeBoer MD, Phillips BR, Mauger DT, Zein J, Erzurum SC, Fitzpatrick AM, et al.
Effects of endogenous sex hormones on lung function and symptom control in adolescents with asthma. BMC Pulm Med 2018;18:58.
Dhabadi BB, Athavale A, Meundi A, Rekha R, Suruliraman M, Shreeranga A, et al.
Prevalence of asthma and associated factors among schoolchildren in rural South India. Int J Tuberc Lung Dis 2012;16:120-5.
Sanjana JM, Maheshn PA, Jayaraj BS, Lokesh KS. Changing trends in prevalence of asthma and allergic rhinitis in children in Mysore, South India. Eur Respir J 2014;44:1187.
Behl RK, Kashyap S, Sarkar M. Prevalence of bronchial asthma in school children of 6-13 years of age in Shimla city. Indian J Chest Dis Allied Sci 2010;52:145-8.
Gupta M, Bhargav R, Sharma BS. Diagnosis and management of childhood asthma: How far we have reached? A survey of pediatricians knowledge, attitude and practices from Rajasthan. Indian J Allergy Asthma Immunol 2015;29:14-7. [Full text]
Jain A, Vinod Bhat H, Acharya D. Prevalence of bronchial asthma in rural Indian children: A cross sectional study from South India. Indian J Pediatr 2010;77:31-5.
Pokharel PK, Kabra SK, Kapoor SK, Pandey RM. Risk factors associated with bronchial asthma in school going children of rural Haryana. Indian J Pediatr 2001;68:103-6.
Paramesh H. Epidemiology of asthma in India. Indian J Pediatr 2002;69:309-12.
[Table 1], [Table 2]