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SHORT COMMUNICATION
Year : 2010  |  Volume : 54  |  Issue : 3  |  Page : 165-168  

Prevalence of bronchial asthma and its association with smoking habits among adult population in rural area


1 Professor and Head, Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, India
2 Associate Professor, Department of TB and Chest Diseases, Kempegowda Institute of Medical Sciences, Bangalore, India
3 Assistant Professor, Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, India
4 Post Graduate, Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, India
5 Associate Professor of Statistics, Kempegowda Institute of Medical Sciences, Bangalore, India
6 Associate Professor, Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, India

Date of Web Publication18-Jan-2011

Correspondence Address:
B G Parasuramalu
Professor and Head, Department of Community Medicine, Kempegowda Institute of Medical Sciences, Banashankari 2nd stage, Bangalore - 560 070
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.75742

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   Abstract 

A cross-sectional study was conducted in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore. A total of 3194 adult individuals (18-70 years) were selected from 30 villages (clusters) using a cluster-sampling technique. Individuals with symptoms suggestive of asthma were subjected for clinical examination for the diagnosis of asthma. Among the 3194 respondents, 1518 (47.5%) were males and 1676 (52.5%) were females. The prevalence of bronchial asthma was 2.88%. The prevalence of asthma was higher among those reporting a history of current smoking. Among current smokers, the number of cigarettes/bidis/hookah smoked daily did not differ (P > 0.05) between individuals without asthma and with asthma, whereas the mean number of years of smoking did differ (P < 0.001). There was significant association between tobacco smoking and bronchial asthma.

Keywords: Bronchial asthma, prevalence, smoking


How to cite this article:
Parasuramalu B G, Huliraj N, Rudraprasad B M, Prashanth Kumar S P, Gangaboraiah, Ramesh Masthi N R. Prevalence of bronchial asthma and its association with smoking habits among adult population in rural area. Indian J Public Health 2010;54:165-8

How to cite this URL:
Parasuramalu B G, Huliraj N, Rudraprasad B M, Prashanth Kumar S P, Gangaboraiah, Ramesh Masthi N R. Prevalence of bronchial asthma and its association with smoking habits among adult population in rural area. Indian J Public Health [serial online] 2010 [cited 2019 Jun 27];54:165-8. Available from: http://www.ijph.in/text.asp?2010/54/3/165/75742

Bronchial asthma is a common disease and an important cause of morbidity among both children and adults. In India, the prevalence of asthma is found to be about 2.4% in adults over 15 years of age using the International Union Against Tuberculosis and Lung Disease (IUATLD) questionnaire. [1] Active tobacco smoking has got important effects on asthma. Smoking in adults causes bronchial irritation and precipitates acute episodes of bronchial asthma. It also increases bronchial responsiveness and causes airway sensitization to several occupational allergens. Smoking adds to the morbidity besides influencing the prevalence and natural history of asthma. [2]

In asthmatic patients, few studies have analyzed the role of smoking as an aggravating factor. [3] Only few studies have been conducted in rural areas of India to study the relationship of active tobacco smoking and bronchial asthma. Hence, this study was conducted with the following objectives: (i) to find out the prevalence of bronchial asthma and (ii) to determine the tobacco smoking as an associated risk factor with bronchial asthma.

After obtaining the Institutional Ethics Committee approval, a cross-sectional study was conducted among adults in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore (K. Gollahally and Sulikere Primary health centres, Bangalore Rural district, covering a population of 44,387 residing in 71 villages) from January 2008 to December 2008. The sample size was calculated using the formula n = Zα/2 2pq/L2 (at 5% level of significance and 95% CI, Zα/2 = 1.96, prevalence of 11% and precision of 10%). The sample size was found to be 3108, and it was rounded off to 3120. The study population was selected from 30 villages/clusters using a cluster-sampling technique with 104 individuals in each cluster/village. When there were more than one adult in the last house of each cluster/village, all of them were included. Hence the total was 3194.

The prevalence of asthma in relation to smoking habits was studied among all the 3194 adult individuals selected from 30 villages (clusters) using a cluster-sampling technique. The data were collected by the house surgeons who were trained for the purpose under the supervision of the principal investigator to ensure uniformity and completeness in the data collection. In each cluster, 104 individuals aged 18-70 years were interviewed with a previously validated [4],[5] and standardized translated Kannada version questionnaire. The socioeconomic status was assessed based on the standard of living index (SLI). [6] In case a house was locked or a respondent was not available, the interviewer noted it as such, and returned at a subsequent date at a time convenient to the respondent to fill the questionnaire. If three such attempts at meeting residents of a household were unsuccessful, the household was dropped from the list. All the respondents who answered affirmatively both to (a) whistling sound from chest, or chest tightness, or breathlessness in the morning, and (b) having suffered from asthma, or having an attack of asthma in the past 12 months, or using bronchodilators, were labeled as positive to questionnaire definition for diagnosis of asthma. [1],[5]

Smoking was assessed in detail and smoking was considered in three classes: current smokers, ex-smokers, and nonsmokers. Current smokers were defined as subjects who reported currently smoking cigarettes, bidis, or hookah at the time of the survey. Ex-smokers were subjects who had smoked daily and given up ≥1 month before the survey. Nonsmokers were those who had never smoked. [7] The age of starting smoking was asked and former smokers were asked at what age they had stopped and how much they had smoked before stopping. Current smokers were asked how much they currently smoked (less than five cigarettes/bidis/hookah daily, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, or 50 or more) and the type of cigarette smoked (cigarettes, bidis, hookah). [2] Statistical tests used for analysis in this study were Chi-square test, Odd's ratio (OR), and Mann-Whitney U-tests.

In this study it was observed that, out of 3194 subjects, 1518 (47.5%) were males and 1676 (52.5%) were females. The majority, i.e. 1363 (42.7%), were in the age group of 18-29 years, followed by 1275 (39.9%) were in the age group of 30-49 years. The least, i.e. 147 (4.6%), were in the age group of >65 years.

Ninety-two adult subjects reported that they had asthma as per the IUATLD asthma questionnaire. The overall prevalence of asthma was found to be 2.88%. The prevalence of asthma among males and females were found to be 3.36 and 2.45%, respectively. The difference in the prevalence of bronchial asthma among males and females was found to be statistically not significant (χ2 = 2.24, P> 0.05). The prevalence of asthma was found to be high, i.e. 8.56%, in the age group of 50-64 years and the prevalence was found to be increasing with increase in age (statistically significant, χ2 = 119.03, P < 0.001). The prevalence of asthma was found to be high among individuals from high socioeconomic status (not statistically significant, χ2 = 3.69, P > 0.05) [Table 1].
Table 1 :Distribution of asthma cases according to age, sex, and socioeconomic status

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The prevalence of tobacco smoking among asthmatic and nonasthmatic subjects according to questionnaire data is shown in [Table 2]. The prevalence of asthma was higher among those reporting a history of current smoking, for both men and women (25.0% in asthmatics vs. 12.9% in nonasthmatics; OR = 2.48, 95% CI: 1.47-4.16) and for men alone (45.1% in asthmatics vs. 26.8% in nonasthmatics; OR = 2.96, 95% CI: 1.54-5.67) [Table 2]. This difference in the prevalence of asthma was statistically significant for both men and women and for men alone. Odd's ratio could not be calculated for women as no woman smoker was asthmatic in this study. Among current smokers, the number of cigarettes/bidis/hookah smoked daily did not differ statistically (Mann-Whitney U-test, P > 0.05) between individuals without asthma (mean, 14.79 ± 14.31) and with asthma (mean, 17.81 ± 11.31). However, individuals without asthma had smoked for an average of 22.08 ± 13.22 years, compared with 35.16 ± 13.07 years for those with asthma and the mean years of smoking was found to be statistically significant (Mann-Whitney U-test, P < 0.001).
Table 2 :Distribution of tobacco smoking habits among asthmatic and nonasthmatic subjects

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In this study, it was observed that the prevalence of asthma based on IUATLD questionnaire definition was 2.88% which was in accordance with the observation made by Aggarwal et al. [1] (3.54%). The prevalence of asthma among males and females was found to be 3.36% and 2.45%, respectively. This was found to be statistically not significant (χ2 = 2.24, P > 0.05), which differs from the findings of study conducted by Chan-Yeung et al., [8] where the prevalence of asthma-like symptoms and reported asthma attacks was higher in females than in males and increased with age. Chowgule et al. [9] in their study involving 2213 subjects in the age group of 20-44 years observed that the prevalence of asthma was 3.8% and 3.1% among males and females, respectively, and the overall prevalence was 3.5%. The prevalence of asthma was observed to be increasing with age. This finding was in accordance with the observation made by Aggarwal et al. [1] and Chowgule et al. [9] The prevalence of asthma was found to be high among high socioeconomic status, which differs from the findings of Aggarwal et al. [1] where they observed that the prevalence of asthma was associated more with lower socioeconomic status. The difference in the prevalence of asthma among different socioeconomic status may be due to different scales used for assessing the socioeconomic status.

The prevalence of asthma was higher among those reporting a history of current smoking, for both men and women. This difference in the prevalence of asthma was statistically significant for men alone. This finding is in accordance with the study conducted by Vesterinen et al. [2] and many other studies. [10] The results of several studies conducted in Scandinavia support the hypothesis that smoking may be a risk factor for asthma. [10] Among current smokers, the number of cigarettes/bidis/hookah smoked daily did not differ (P > 0.05) between individuals without asthma and with asthma. Furthermore, the mean number of years of smoking did differ (P < 0.001) between those individuals without asthma and with asthma; whereas Vesterinen et al. [2] observed that there were no differences between smokers with and without asthma with respect to the amount smoked or the duration of smoking.

This study clearly suggests that tobacco smoking is a risk factor for bronchial asthma. Hence there is an urgent need (apart from the other health problems of tobacco smoking) to create awareness regarding the hazards of tobacco smoking which can help in reducing the prevalence of bronchial asthma.

 
   References Top

1.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 multicentre study. Indian J Chest Dis Allied Sci 2006;48:13-22.  Back to cited text no. 1
[PUBMED]    
2.Vesterinen E, Kaprio J, Koskenvuo M. Prospective study of asthma in relation to smoking habits among 14 729 adults. Thorax 1988;43:534-9.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Strunk RC, Nicklas RA, Milgrom H, Davis ML, IkleΒ DN. Risk factors for fatal asthma. In: Sheffer AL, editor. Fatal asthma. Basle: Marcel Dekker; 1998. p. 31-44.  Back to cited text no. 3
    
4.Burney PG, Laitinen LA, Perdrizet S, Huckauf H, Tattersfield AE, Chinn S, et al. Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison. Eur Respir J 1989;2:940-5.  Back to cited text no. 4
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5.Jindal SK, Gupta D, Aggarwal AN, Jindal RC, Singh V. Study of the Prevalence of Asthma in Adults in North India Using a Standardized Field Questionnaire. J Asthma 2000;37:345-51.  Back to cited text no. 5
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6.National Family Health Survey, India 2005-2006 (NFHS- 3).  Back to cited text no. 6
    
7.Siroux V, Pin I, Oryszczyn MP, Le Moual N, Kauffmann F. Relationship of active smoking to asthma and asthma severity in the EGEA study. Eur Respir J 2000;15:470-7.  Back to cited text no. 7
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8.Chan-Yeung M, Zhan LX, Tu DH, Li B, He GX, Kauppinen R, et al. The prevalence of asthma and asthma-like symptoms among adults in rural Beijing, China. Eur Respir J 2002;19:853-8.  Back to cited text no. 8
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9.Chowgule RV, Shetye VM, Parmar JR, Bhosale AM, Khandagale MR, Phalnitkar SV, et al. Prevalence of respiratory symptoms, bronchial hyperreactivity and asthma in a megacity - Results of the European Community Respiratory Health Survey in Mumbai (Bombay). Am J Respir Crit Care Med 1998;158:547-54.  Back to cited text no. 9
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10.Larsson L. Incidence of asthma in Swedish teenagers: relation to sex and smoking habits. Thorax 1994;50:260-4.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]


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