|Year : 2021 | Volume
| Issue : 1 | Page : 10-18
Prevalence of bronchial asthma among students of 16–20 years' age group in a South Indian City
Irfan A Sheik, M Vishnu Sharma
Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India
|Date of Submission||03-Oct-2020|
|Date of Decision||10-Nov-2020|
|Date of Acceptance||19-Nov-2020|
|Date of Web Publication||28-Jan-2021|
Dr. M Vishnu Sharma
Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Background: The prevalence of asthma has been increasing worldwide in recent years. There is a wide variation in the prevalence of asthma in various countries, varying between 1.2% and 6.3% among adults in most countries. There is a scarcity of data on the prevalence of asthma in the age group 16–20 years in India. Objective: The aim is to study the prevalence of asthma among students of 16–20 years' age group in our city. Methodology: This was a questionnaire-based cross-sectional study. A standardized questionnaire was prepared and distributed to 4600 college students. Among the students who had symptoms suggestive of asthma by the questionnaire method, 10% of them were selected for spirometry to confirm the diagnosis by a systemic random sampling method. Statistical analysis was performed using frequency and percentage method to calculate the prevalence. Chi-square test, odds ratio, and 95% confidence interval were used to measure the association between the variables, and a value of P < 0.05 was considered to be significant. Results: Out of 4600 students, 1539 (33.5%) were boys and 3061 (66.5%) were girls. 230 (5.0%) students had symptoms suggestive of bronchial asthma, of which 115 (7.5%) were boys and 115 (3.8%) were girls. 336 (7.3%) students had a family history of asthma. Out of 230 students having symptoms suggestive of asthma, only 57 (24.78%) students were taking regular medications, in which 34 (59.64%) students had symptomatic relief. The prevalence of bronchial asthma among college students (16–20) years of age was 5.0%. A family history of asthma was associated with significantly higher odds of having bronchial asthma. Conclusions: The prevalence of asthma among students of 16–20 years ago was 5.0%. A family history of asthma was associated with significantly higher odds of having bronchial asthma.
Keywords: Bronchial asthma, prevalence, South India, students
|How to cite this article:|
Sheik IA, Sharma M V. Prevalence of bronchial asthma among students of 16–20 years' age group in a South Indian City. J Adv Lung Health 2021;1:10-8
|How to cite this URL:|
Sheik IA, Sharma M V. Prevalence of bronchial asthma among students of 16–20 years' age group in a South Indian City. J Adv Lung Health [serial online] 2021 [cited 2021 Feb 24];1:10-8. Available from: http://www.jalh.com/text.asp?2021/1/1/10/308269
| Introduction|| |
Bronchial asthma is a chronic lung disease. It is one of the common causes for breathlessness and morbidity. In recent years' prevalence of bronchial asthma is increasing. It has been noticed that there is a similar increase in other allergic disorders such as allergic rhinitis, urticaria, and eczema. This increase in allergic disorders in recent years may due to an increase in atopic sensitization and also due to tobacco smoking and air pollution.
Bronchial asthma usually starts in the first three decades of life. Early diagnosis and proper treatment improve long-term outcomes in asthma. Untreated or improperly treated asthma may worsen over a period of time.
In most countries, the prevalence of asthma is reported to be 1.2%–6.3% among adults. In recent years there has been an increase in the incidence of emergency room visits, hospital admission, and primary care visits for asthma in many countries. The majority of asthmatics develop symptoms in the first three decades of life. Early diagnosis and management improve the long-term outcome in asthmatics. It is important to know the burden of the disease for effective long-term management and formulate preventive measures to tackle the disease. There is a scarcity of data on the prevalence of asthma among students in India.
Objectives of the study
To study the prevalence of asthma among students of 16–20 years' age group in Mangaluru city.
| Methodology|| |
Source of data
College students of age group 16–20 years of age, including girls and boys, in Mangaluru city. Institutional ethical committee approval was taken.
Method of data collection
This was a questionnaire-based study Annexure 1. A standardized questionnaire adopted from? The International Study of Asthma and Allergies in Childhood (ISAAC) was prepared and administered to students of 12 different colleges in the age group of 16–20 years.
Period: November 2014–October 2015.
Study design: Cross-sectional study.
College students of age group 16–20 years of age, including both girls and boys.
- Students with respiratory symptoms attributed to other lung diseases.
- Students with known heart diseases
- Students diagnosed with systemic illnesses such as collagen vascular diseases and autoimmune disorders.
Purposive sampling, among various colleges of Mangaluru city. Considering an 8% prevalence rate, and 10% allowable error, the sample size was estimated as n = 4600. The students were considered as having bronchial asthma if the student had a history of doctor-diagnosed asthma or a history of chest congestion, wheezing, and waking up at night with the tightness of the chest ever or in the past 12 months (>3 symptoms or doctor diagnosis). Out of these students who were considered to have asthma, 10% were selected for spirometry to confirm the diagnosis by a systematic random sampling method.
Pre- and post-bronchodilator spirometry was done by giving short-acting beta-agonist nebulization (Salbutamol). An increase in postbronchodilator forced expiratory volume in 1 s values more than 200 ml and 12% were considered bronchial asthma.
Sample size – 4600.
The statistical analysis was performed by Frequency and percentage method to calculate the prevalence. Chi-square test, odds ratio (OR), and 95% confidence interval were used to measure the association between the variables, and a P < 0.05 is considered to be significant.
| Results and Observations|| |
In our study group, the age distribution was from 16 to 20 years. 961 (20.8%) students were 16 years of age, 1196 (26.0%) students were 17 years of age, 905 (19.7) were 18 years of age, 697 (15.2%) 19 years of age and 841 (18.3%) students were 20 years of age [Table 1]. Out of 4600 students, 1539 (33.5%) were boys and 3061 (66.5%) were girls [Table 2]. Out of 4600 students, 112 (2.4%) students have a history of smoking cigarettes or beedis, more among boys (99.1%) compared to girls (0.8%) [Table 3]. Out of 4600 students, only 31 (0.7%) students have a history of chewing one or other forms of tobacco products, all were boys (100%) [Table 4]. Out of 4600 students, 34 (0.7%) students have a history of consumption of alcohol in their lifetime, more among boys (76.47%) compared to girls (23.52%) [Table 5].
Out of 4600 students, 230 (5%) students had symptoms suggestive of asthma in their lifetime or within the past 12 months [Table 6]. Out of these, 72 (31.3%) were 16 years of age, 48 (20.9%) of 17 years of age, 40 (17.4%) of 18 years of age, 22 (9.6%) were 19 years of age, and 48 (20.9%) belongs to 20 years of age [Table 7]. The highest number of students who had symptoms of asthma belonged to 16 years of age. The prevalence of asthma was more among boys (7.5%) compared to girls (3.8%) [Table 8]. In our study, there was no association found between the prevalence of bronchial asthma and habits like tobacco chewing or smoking.
There was a positive correlation between the students with asthma and with a history of asthma in one or more of their family members. About 21.4% of students who had a history of asthma in the family had symptoms suggestive of bronchial asthma and 31.3% of asthmatic students had a history of bronchial asthma among their family members [Table 9].
|Table 9: Correlation between prevalence of asthma and family history of asthma|
Click here to view
Out of 4600 students, 336 (7.3%) of students have a history of asthma among their family members [Table 10]. Out of 230 (5%) students having symptoms suggestive of asthma, 173 (75.2%) students were not taking any medications for the same [Table 11]. Out of 57 students who are taking regular medications for asthma, 41 (71.92%) students were on oral medications and 16 (28.07%) were on inhalational medications [Table 12]. Out of 57 students who are taking regular medications for bronchial asthma, 34 (59.64%) students have symptomatic relief of symptoms and 23 students do not have any kind of symptomatic relief of symptoms after taking medications [Table 13].
|Table 12: Types of medications students taking who diagnosed to have bronchial asthma|
Click here to view
| Discussion|| |
Bronchial asthma usually starts in the first three decades of life. Untreated or improperly treated asthma can worsen over some time. Determining the prevalence of asthma in the various age groups will help to formulate effective interventions to prevent or control the disease and reduce the incidence.
Evaluation of children and adults has shown a low prevalence rate of asthma (2%–4%) in Asian countries compared to western countries (15%–20%). Our study among college students of age group 16–20 years showed the prevalence of bronchial asthma 5.0%, which is almost similar to those among US adults (4.5%) according to the analysis of the National Health and Nutrition Examination Study ??? data. A study was done by Stojanovic-Ristic et al. in 2006 among the student population (aged 19–23 years) of Belgrade University concluded that the prevalence of asthma was 3.68%. This study also showed an increase in the prevalence of asthma over the last several years (from 2.96% to 4.05%). In our study, the prevalence of asthma was 5%; this difference may be due to differences in the age structure of the study population, geographical variation, and methodological differences in study design.
A study was done by Bruce et al. at the Queens University Belfast among the first-year university students (from 1972 to 1989), found that a 1-year prevalence of asthma raised from 1.3% to 2.84%. There was a more than two-fold rise in the prevalence of asthma in this population from 1972 to 1989. As this study concluded, there was a two-fold increase in the prevalence of diagnosed asthma among their study population, which is close to our study prevalence of 5%.
Community-based studies in India reported the prevalence of asthma among adults is 3.5% in Mumbai, 3.47% in Bangalore, and 2.28% in Chandigarh. The study population in these community-based studies varied from 15 to 85 years of age; moreover, the study design was different compared to our study.
Indian studies done on school-going children reported the prevalence of asthma varies from 7.0% to 29.5%. Rajkumar et al. reported a prevalence of 8.78% among school-going girls in Delhi. Chhabra et al. in 1999 reported a 15.7% prevalence of bronchial asthma. The high prevalence rate was also reported by Paramesh, who showed a prevalence of 29.5%. The wide variation in these studies may be attributed to the difference in geographic distribution, study population, study design, and industrialization, and air pollution in different parts of the country.
A study done by Pradeepa et al. among school children in Subramanya, a rural area 75 kilometers from our city reported a prevalence of current wheezers of 5.2% among the 10–12 years' age group, which was suggestive of bronchial asthma, which was similar to our study result (5.0%). Our study was also done based on a similar study design using the ISAAC questionnaire; moreover, the study population was from the same geographical area. In Kerala, Ravindran et al. reported a similar prevalence of 5.2%, which may be attributed to the similar geographical conditions compared to Kerala and adjoining Dakshina Kannada district.
A study done by Erhabor et al. showed a higher prevalence of asthma in female students aged 15–35 years. A study by Uthaisangsook et al. showed a higher prevalence of asthma in males compared to females. In our study, the prevalence of asthma was more among males (7.5%) compared to females (3.8%). Chhabra et al. in 1999reported a higher prevalence among male children of Delhi. According to Anuradha and Kalpana, in 2011, males outnumbered females. These are the studies done on school-going Children, which is similar to our study results. Before the age of 14 years, the prevalence of asthma is nearly two times more in boys than in girls. As the age progresses, the gap narrows. In adults, the prevalence of asthma is more in women than in males. As our study population included 16–20 years' students, results are following the previous hypothesis.
In our study, higher prevalence of asthma was seen in students of 16 years of age. There was no association found between the prevalence of bronchial asthma and smoking, alcohol consumption, and tobacco chewing. An overall improvement in asthma during adolescence may be due to diminished immunological responsiveness due to hormonal changes that occur during this age. The effect of age on the prevalence of asthma in each sex may be due to differences in hormonal status, which may influence the airway size, airway inflammation, airway smooth muscles, and vascular endothelial functions. The size of the airways increases with age from childhood to adolescence. This may be the reason for the higher prevalence of asthma in 16 years' age group compared to 17–20 years in our study.
Out of 4600 students, 336 (7.3%) of students have a history of asthma among their family members. 31.3% of asthmatic students had a history of bronchial asthma among their family members, which is much higher than the study population. A family history of asthma in one or more first-degree relatives is a risk factor for asthma.
Our study found that out of 230 students having symptoms suggestive of asthma, 173 (75.2%) students were not taking any medications for the same. This may be because the asthma symptoms were not troublesome or they ignored the symptoms. Some of these may be under-diagnosed as well. Untreated or improperly treated asthma may worsen over some time, may lead to increased severity of symptoms, emergency hospital visits, increased morbidity, and even mortality. Hence it is important to diagnose asthma early and treat asthma properly. Educating the public regarding the symptoms of asthma, the provision of proper health care facilities, educating and treating the patients with proper inhaled medication is the key to prevent the progression of asthma.
Out of 57 students who were taking regular medications for asthma, 41 (71.92%) students were on oral medications and only 16 (28.07%) were on inhalational medications. A study by Adams et al. showed that even in the United States, there was inadequate use of appropriate medications for asthma. Our study indicates the use of inhaled medication is very low. This indicates that there is an urgent need to educate the patients as well as the health care authorities to use appropriate inhaled medications to treat asthma in our geographical area.
Out of 57 students who were taking regular medications for bronchial asthma 34 (59.64%) students have symptomatic relief of symptoms and 23 students did not have any kind of symptomatic relief of symptoms after taking medications. This may be due to inappropriate medications or poor adherence to medications. Further studies are required regarding medication adherence and prescription pattern in asthma.
| Conclusions|| |
The prevalence of asthma among students of 16–20 years ago was 5.0%. A family history of asthma was associated with significantly higher odds of having bronchial asthma.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Annexure 1|| |
| Questionnaire|| |
- Place (native);
- Sex a. boy b. girl;
- Height . Weight
- Do you Smoke: (yes/no). no of cigarettes/beedis per day: years:
11. Do you chew tobacco; (yes/no).
12. Do you consume alcohol: (yes/no)
Questionnaire on Rhinitis
1. Did you ever had a problem with sneezing or a runny or blocked nose, when you DID NOT had a cold or the flu?
2. In the past 12 months did you had a problem with sneezing or a runny or blocked nose when you had no cold or flu?
3. In which of the past 12 months has this nose problem occurred?
(Please tick any which apply)
4. Do you have ear itching/blocked ear/pain in the ear when you had the nose problem?
5. Do you need to clear your throat often?
Questionnaire on eczema
1. Did you ever had any itchy rash which was coming and going for at least six months?
2. Did you have this itchy rash at any time in the last 12 months?
3. Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the angles under the buttock or around the neck Eyes or ears?
4. Has this rash cleared completely at any time during the last 12 months?
| Respiratory questions|| |
Cough and phlegm
1. In the last 12 months, have you ever felt like congestion in the chest or coughed up phlegm (mucus) with colds?
2. In the last 12 months have you ever felt like congestion in the chest or coughed up phlegm (mucus) when you did not have a cold?
3. Have you ever felt like congestion in the chest or cough up phlegm (mucus) on most days (4 or more days a week) for as much as 3 months of the year?
4. In the last 12 months did your chest sounded wheezy during or after exercise?
5. In the last 12 months did your chest sounded wheezy when you had not recently exercised?
6. In the last 12 months did you had wheezing or whistling in the chest when you had a cold or the flu?
7. In the last 12 months, did you had wheezing or whistling in the chest when you did not had cold or the flu ?
7. Have you ever woken up with tightness of the chest at any time in your life?
8. Have you woke up at night with tightness of the chest in the last 12 months?
10. In the last 12 months did your chest sounded wheezy during or after exercise?
11. Did you ever felt like difficulty in breathing/tightness of chest after exposure to dust?
12. Did you ever had a dry cough at night apart from a cough associated with a cold or chest infection?
13. Did you ever had an asthma attack?
14. If yes, do u take any regular asthma medications (yes/no).
15. Which medications: oral medications/inhalational medications (DPI/MDI).
16. Does the symptoms gets subsided after medications:
17. Does any of your family members have asthma/known allergic conditions.:
Specify: (how you are related to them)
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13]