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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 241-248

Study of demographic and clinical characteristics of bronchial asthma patients in Mahalla Chest Hospital during the period from March 2013 to February 2014


Chest Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission16-Mar-2016
Date of Acceptance22-May-2016
Date of Web Publication25-Jul-2017

Correspondence Address:
Dalia A Kashlana
Al-Mahallah Al-Kubra, Gharbia, 31951
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.211481

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  Abstract 


Objectives
The aim of this work was to study bronchial asthma patients in Mahalla Chest Hospital during the period from March 2013 to February 2014 as regards the epidemiology, demographic characteristics, clinical characteristics of the patients, and prescription pattern, whenever available.
Background
Bronchial asthma is a serious global health problem and arising problem in Egypt. Prevalence, morbidity, and mortality in Egypt are still lacking and have to be estimated, and hence studies are needed in all governorates to assess the global burden of bronchial asthma in Egypt.
Patients and methods
This study was conducted at Mahalla Chest Hospital, and included 212 adult patients who had bronchial asthma with a wide range of asthma severity, from those attending the outpatient clinic and those admitted in Mahalla Chest Hospital during the period from March 2013 to February 2014 to provide adequate epidemiological analysis. Data from patients were collected through a questionnaire.
Results
In this study, 28.77% of cases were severe persistent cases, 29.72% were mild persistent cases, and 41.51% were moderate persistent cases. The average age was 44.57%. Asthmatic attacks were precipitated by outdoor allergens in about 34.9% of the studied cases. An overall 18.4% of the studied cases suffered from attacks triggered by tobacco smoke, and infection trigger attacks were observed in 15.09% of cases. An overall 52.4% of asthmatic patients were exposed to passive smoking and mainly they were female.
Conclusion
The mean age of the patients was 44.57 years. The majority of them were female and were exposed to passive smoking at home. The majority of the studied cases were overweight, with an average BMI of 26.7 kg/m2. Family history of bronchial asthma was found in 60.85% of the patients. Outdoor allergens were the most common precipitating factor for bronchial asthma. Only 35.4% of the studied cases were compliant to treatment.

Keywords: asthma, demography, epidemiological study, questionnaire


How to cite this article:
Mabrouk AA, Abd El-Aziz AA, Agha MA, Kashlana DA. Study of demographic and clinical characteristics of bronchial asthma patients in Mahalla Chest Hospital during the period from March 2013 to February 2014. Menoufia Med J 2017;30:241-8

How to cite this URL:
Mabrouk AA, Abd El-Aziz AA, Agha MA, Kashlana DA. Study of demographic and clinical characteristics of bronchial asthma patients in Mahalla Chest Hospital during the period from March 2013 to February 2014. Menoufia Med J [serial online] 2017 [cited 2019 Apr 18];30:241-8. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/241/211481




  Introduction Top


Bronchial asthma is a serious global health problem. It is a chronic inflammation that is associated with airway hyper-responsiveness, which leads to recurrent episodes of wheezing breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment [1].

Bronchial asthma is also defined by its clinical, physiological, and pathological characteristics. The predominant feature of clinical history is episodic shortness of breath, often accompanied by cough, especially at night. Wheezing appreciated on auscultation of the chest is the most common physical finding. The main physiological feature of asthma is episodic airway obstruction characterized by expiratory airflow limitation. The dominant pathological feature is airway inflammation, sometimes associated with airway structural changes [1].

The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways, such as indoor allergens, outdoor allergens, and tobacco smoke [2].

Annual worldwide deaths from asthma have been estimated at 250 000 and mortality does not appear to correlate well with prevalence [3].

However, bronchial asthma is an arising problem in Egypt; prevalence, morbidity, and mortality in Egypt are still lacking and have to be estimated [4].

The epidemiology, demographic characteristics, clinical characteristics of the patients, and prescription pattern vary significantly between studied Egyptian asthmatic patients and others in different countries, which highlight individuality of each country and the necessity of national data on our health problems [4].

Studies are needed in all governorates to assess the global burden of bronchial asthma in Egypt [4].


  Patients and Methods Top


Patients

The study was conducted at Mahalla Chest Hospital and randomly included 212 adult patients who had bronchial asthma with a wide range of asthma severity, from those attending the outpatient clinic and those admitted in Mahalla Chest Hospital, during the period from March 2013 to February 2014, to provide adequate epidemiological analysis.

Inclusion criteria

  1. Having a diagnosis of asthma.
  2. Asthmatic smokers or nonsmokers.


Exclusion criteria

  1. Age younger than 18 years.
  2. Presence of other underlying chest diseases.


Methods

After obtaining informed written consent from patients and approval from the Research Ethical Committee of Faculty of Medicine, Menoufia University, the patients were subjected to the following: full history taking, including smoking history, occupational history, and drug intake history, complete physical examination, including general and local examination, chest radiograph (posteroanterior and lateral views), ECG, complete blood picture, liver and kidney function tests, sputum cytology, sputum culture and sensitivity, BMI evaluation, and pulmonary function test.

Data from patients were collected through a questionnaire [5] and included the following: age, sex, occupation, smoking habit, age of onset, family history, precipitating factors to asthma, level of asthma control, other types of allergy, compliance to treatment, prescription pattern, other forms of treatment, complications of asthma, clinical examination, BMI, and comorbidity.

Statistical methodology

The collected data were coded, tabulated, and statistically analyzed using SPSS program (Statistical Package for Social Sciences, IBM, Chicago, USA) software, version 17.0.

Descriptive statistics was performed and numerical parametric data were presented as mean ± SD and minimum and maximum of the range, whereas categorical data were presented as number and percentage.

Inferential analyses were carried out for qualitative data using the c2-test for independent variables.

The level of significance was taken at P value less than 0.050 as significant, less than 0.001 as highly significant, and otherwise as nonsignificant. The P value is a statistical measure for the probability that the results observed in a study could have occurred by chance.


  Results Top


Demographic characteristics of studied patients are outlined in [Table 1]. An overall 33.02% of the studied cases were male and 66.98% of them were female. An overall 50.5% of the patients were housewives, 16.5% were farmers, and 13.7% were workers (factories, especially textiles and workshops). It was noticed that their ages ranged from 20 to 74. Bronchial asthma in the majority of studied cases (73.6%) was of adulthood onset. Most of the studied cases (77.4%) were from rural areas. An overall 60.85% of the studied cases had a family history of bronchial asthma. The BMI of studied cases ranged from 19.5 to 36.5.
Table 1 Demographic data of the studied group

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The majority of studied patients (60.4%) had been educated about how to use inhalation therapy, and metered dose inhaler was the most frequent device used by studied asthmatic patients (53.3%). The majority of studied patients (64.6%) were taking inhalation therapy only on demand. Candidiasis was the most common complication of inhalation therapy (7.5%), whereas hoarseness of voice was found in only 3.8% of studied cases [Table 2].
Table 2 Distribution of the studied group as regards education on how to use the prescribed device, type of device used, complications, and compliance of inhalation therapy

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Female sex, increasing age, late onset, rural residence, and positive family history significantly (P < 0.001) affected the severity of bronchial asthma among studied cases [Table 3].
Table 3 Comparison between different degrees of bronchial asthma as regards demographic characteristics

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Current smoking and the presence of comorbidities were significantly (P < 0.05) related to the admission of studied patients to ICU [Table 4].
Table 4 Factors related to ICU admission

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Increasing age, late onset, rural residence, current smoking, and presence of comorbidities significantly (P < 0.05) affected the level of control of bronchial asthma among the studied cases [Table 5].
Table 5 Comparison between the level of control of bronchial asthma as regards demographic characteristics

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The presence of hypertension (HTN), liver diseases, renal diseases, gastroesophageal reflux disease (GERD), and absence of comorbidities significantly (P < 0.05) affected the level of control of bronchial asthma among the studied cases [Table 6].
Table 6 Comparison between grades of control of bronchial asthma as regards comorbidities

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All studied cases were receiving short-acting inhaled β2-agonist. All severe cases were highly significantly (P < 0.001) receiving theophylline. Most of the moderate and severe studied cases were highly significantly (P < 0.001) receiving-long acting inhaled β2-agonist, systemic steroids, and inhaled steroids. None of the mild cases were receiving antileukotrienes and the difference was highly significant (P < 0.001) [Table 7].
Table 7 Drug prescription pattern for the studied patients

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The majority of studied cases (37.7%) had a history of allergic rhinitis. Moreover, 28.3% of studied cases had more than one type of other allergies [Figure 1].
Figure 1: Other allergic conditions in the studied group.

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HTN was the most common comorbidity found in studied asthmatic patients (30.2%), followed by GERD (25.9%), whereas osteoporosis was the least common comorbidity found in studied asthmatic patients (2.4%) [Figure 2].
Figure 2: Distribution of the studied group as regards comorbidities.

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The majority of studied cases (49.5%) were partially controlled, whereas 39.6% of the cases were uncontrolled, and 10.8% of the studied cases were controlled [Figure 3].
Figure 3: Level of bronchial asthma control in the studied group.

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Bronchial asthma in most of the studied asthmatic patients (41.5%) was of moderate severity, whereas a small category of the studied asthmatic patients (28.77%) were having severe persistent asthma [Figure 4].
Figure 4: Severity of bronchial asthma in the studied group.

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  Discussion Top


In the present study, 66.98% of the studied cases were female. The majority of them were housewives. This is in agreement with the study by Ismail [6], who determined the demographic and clinical characteristics of bronchial asthma patients in Abbasia Chest Hospital, in which the incidence of asthmatic female patients was 62.7%. However, these results did not match the results of a study by Ezzat [7], who determined the prevalence of asthma among adults in Cairo in a study conducted on 140 asthma patients, revealing that the incidence of asthma was 55% among male patients, higher than that in female patients.

Sex-related differences in the prevalence of asthma was explained by Martinez et al. [8], who stated that male sex is a risk factor for asthma in children before the age of 14. As children get older, the difference narrows and by adulthood the prevalence of asthma is greater in women than in men. The reasons for these sex-related differences are not clear.

This is in agreement with the explanation given by Centre for Disease Control and Prevention [9], which stated that asthmatic women were more likely compared with men and boys were more likely compared with girls of having asthma. A study by Ali et al. [10] in Menoufia city stated that, in Egypt, there was no significant difference in the prevalence of asthma among male and female patients below 15 years of age.

As regards occupations, it was found that the majority of studied patients were housewives (50.5%), 16.5% were farmers, 13.7% were workers either in factories or workshops, and 2.8% were drivers. It was noticed that most of the patients had jobs that exposed them to dusts, gas, chemical fumes (i.e. irritants), and organic solvents. This is in agreement with the findings of Xu and Christiani [11], who declared that the incidence of asthma is greater in workers exposed to dusts, gas, chemical fumes (i.e. irritants), and organic solvents.

As regards age in the current study, the average age was 44.5 years, and these results were close to results of Emara [12], in which average age was 43.7 years, in a thesis studying the pattern of bronchial asthma patient in Ain Shams University Hospital on 100 patients.

In the present study, 60.85% of the studied cases had a positive family history of the disease, which nearly matched with the findings of Lababidi et al. [13], who conducted a study on 40 patients, in which 57.5% of them had a family history of asthma.

However, this study is not in agreement with the study by Ismail [6] and Mostafa [14], who found that 38.7 and 39%, respectively, of studied groups had a positive family history.

In the current study, most of the bronchial asthma patients were overweight, with an average BMI of 26.7 kg/m 2, and this was common mainly among moderate and severe asthma cases, showing a strong relation between obesity and asthma. These results are in agreement with the study conducted by Luder et al. [15], who explored the association between BMI and asthma in men and women of diverse ethnic and socioeconomic background. The results showed that the prevalence of asthma was 4.6% among men and 8.1% among women. In women, the prevalence of asthma was significantly increased in those with a BMI of 25 kg/m 2 or higher. In men, the prevalence of asthma was increased in those with a BMI of 30 kg/m 2 or greater.

These results were explained by Shore et al. [16], who showed that obesity is a risk factor for asthma; certain mediators such as leptin may affect airway function and increase the likelihood of asthma development.

As regards other allergic conditions, in the present study it was found that 88.2% of cases had other types of allergy or atopy. Among them, allergic rhinitis was the most common type of allergy (37.7%), and this was mainly a common association among moderate and severe cases. These results are in agreement with a study conducted by Castillo et al. [17], who conducted a study to understand the prevalence and characteristics of rhinitis in adult asthmatic patients, seen in either primary or secondary care in Spain. An overall 75% of asthmatic patients had associated rhinitis, and this association was more frequent in atopic individuals. They concluded that there is a positive correlation between the severity of rhinitis and asthma and between the number of asthma exacerbations and the presence of rhinitis. These results support the main message of ARIA recommendations as regards the integral management of the airways to improve the control of asthma.

In the study conducted by Ismail [6], allergy represented 43.6% of cases, of which 65.1% were allergic rhinitis. However, these results did not match with those obtained by Sabry [18], who found that 18% of studied cases had allergic rhinitis in a study conducted in Kasr El Eini Hospital to study physiological and clinical links between allergic rhinitis and asthma. The current study matched the results by Masuda et al. [19], who concluded that bronchial asthma was often complicated with allergic rhinitis; attention should be paid to the nasal symptoms in patients with asthma, especially those who had atopic asthma and a positive family history of perennial allergic rhinitis.

In this study, 35.8% of the studied cases were on capsule inhalation therapy, and this conclusion nearly matches with the results obtained by Gessner et al. [20], who reported the results of using budesonide 400–800 μg/day and formoterol 24–48 μg/day in cases of moderate and severe asthma previously treated insufficiently with another combination therapy. They found that lung function parameters improved significantly compared with the run-in phase before the change in medication, and the use of additional short-acting inhalative β-agonists was reduced.

As regards complications of inhalation therapy, in this study, it was recorded that the incidence of complications from inhalation therapy was 11.3% among patients using inhalation therapy and was distributed as oral candidiasis and hoarseness of voice. This is in agreement with the findings of Togood et al. [21], who concluded that the most frequent local side effects of inhaled corticosteroids were oral candidiasis and hoarseness of voice.

In this study, all of the studied cases were treated with inhalation therapy. This is similar to the finding of Ismail [6], who found that 71.1% of the patients were treated with inhalation therapy. The current study matched the study by Barthwal et al. [22], who conducted a study on 150 patients with bronchial asthma over 12 years of age referred to the chest clinic of tertiary care hospital in India for inadequate control. Their results stated that 127 (84.6%) patients were on inhalation therapy. However, their results did not match the findings of Emara [12], who found that only 55% of patients were treated with inhalation therapy. This difference may be related to the social and the psychological aspect of the Egyptian society about the concept of receiving inhalers. All these increase our attention to the importance of health education to the patient and also to the treating physician.

In this study, 59.4% of patients used inhaled corticosteroids and more than half of all patients were receiving β2-agonists (54.2%). This is in agreement with the results of a large, primary care-based audit by Neville et al. [23], which showed that nearly half of all patients were taking low-dose inhaled corticosteroids in addition to β2-agonists, as required, and that 54% of these were taking more than two puffs of a β-agonist per day, suggesting the need for a treatment step-up.

As regards comorbidities, in the current study, it was found that 76.9% of the studied cases had comorbid conditions, which nearly matched the results of Nasr [5], who found that 59.9% had comorbid conditions. Moreover, this is in agreement with another survey by Thomas. [24], who assessed the burden of asthma in Chicago, wherein comorbid conditions were present in the majority of asthma hospitalization (68%), and this showed the dangerous effect of asthma on other systems of the body.

However, in other studies by Ismail[6] and Emara [12], 32.4 and 36% of patients, respectively, had comorbid conditions.

In the current study, 30.2% of patients were hypertensive on treatment. This result is similar to the study by Nasr [5], who evaluated bronchial asthma patients in Mubarak Police Hospital. They found that 30% of asthmatic patients were hypertensive. This result is close to the prevalence of hypertension in the Egyptian population, which was 26.3% according to Ibrahim et al. [25]. Moreover, this study is in agreement with the study conducted by Salako and Ajayi [26], who assessed bronchial asthma as a risk factor for hypertension and they suspected that the similarities between these two diseases may predispose the individuals with one disease to the other. They studied the blood pressure pattern during and after acute severe asthma along with the frequency of hypertension in stable asthmatic patients and concluded that the frequency of hypertension among asthmatic patients is quite high, and that concurrent family history of hypertension and frequency of attack of acute severe asthma did not seem to determine the status of blood pressure. They recommended regular blood pressure check during follow-up visits of asthmatic patients.

Diabetic patients represented 13.2% of the patients in the current study. The data from Egypt demographic and health survey 2008 showed the crude prevalence rate of physician-diagnosed diabetes in the adult population of Egypt aged 15–59 to be 4.07% [27]. This result is similar to that of Nasr [5], who evaluated bronchial asthma patients in Mubarak Police Hospital. They found that 13.3% of asthmatic patients were diabetic.

Higher levels of diabetes in the current study in relation to the prevalence of diabetes in Egypt is against the study ofCazzola et al. [28], which declared that asthma was weakly associated with depression, diabetes mellitus, dyslipidemia, osteoporosis, and rhinosinusitis. However, this may be explained by higher mean BMI and usage of systemic corticosteroids to relieve exacerbations.

In conclusion, the present study is a descriptive study of bronchial asthma patients at Mahalla Chest Hospital.

It was found that bronchial asthma is still a common problem despite the growing awareness of the health outcomes related to the effects of bronchial asthma.


  Conclusion Top


From this survey the following results were obtained.

  1. The mean age of the patients was 44.57 years.
  2. The majority of them were female and were exposed to passive smoking at home.
  3. The majority of the studied cases were overweight, with an average BMI of 26.7 kg/m 2.
  4. Family history of bronchial asthma was found in 60.85% of the patients.
  5. Most of them were moderate and mild cases.
  6. Outdoor allergens were the most common precipitating factor to bronchial asthma.
  7. Allergic rhinitis was the most common type of allergy associated with bronchial asthma.
  8. Metered dose inhalers were the most common type of inhalation used.
  9. The most common complication of inhalation therapy was oral candidiasis.
  10. Hypertension was the most common comorbidity among the studied cases.
  11. Only 35.4% of the studied cases were compliant to treatment.


According to this study, it can be concluded that there is still unawareness about how serious bronchial asthma is as a disease that can disturb the quality of life if it was not taken seriously. The chronic condition only requires proper long-term care, active management, and adherence to an asthma action plan.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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