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Himamoni Deka, 1 Putul Mahanta, 2 Sultana Jesmin Ahmed, 3 Madhab Ch Rajbangshi, 4 Ranjumoni Konwar, 5 Bharati Basumatari51 Department of Anatomy, Guwahati Medical College, Assam, India, 2 Dib, Assam, India Department of Forensic Medicine and Toxicology, Assam Medical College , Rugar; 3 Department of Public Medicine, Assam Medical College, Dibrugarh, Assam, India; 4 Tezpur College of Medicine and Hospital Surgery, Tezpur, Assam, India; 5 Department of Radiology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India Corresponding author: Putul Mahanta, Department of Forensic Medicine and Toxicology, Assam Medical College and Hospital, Dibrugarh, Assam, 786002, India, tel. +919435017802, email [email protected] airway obstruction. Both genetic and environmental factors contribute to higher rates of asthma. The aim of this study was to evaluate various socio-demographic and environmental factors influencing the etiology of childhood asthma in patients presenting to the pediatric department of the Gauhati Medical College and Hospital (GMCH) in Assam. Materials and methods. A total of 150 patients with clinically diagnosed asthma were selected in a 1:1 ratio between cases aged 3-12 years and patients of the same age group without respiratory disease and a history of asthma as controls. Data was collected using a pre-designed and pre-tested format, and written informed consent was obtained from all legal guardians of the participants. Data were analyzed by chi-square test and binary logistic regression using SPSS V20 adjusted for p-values. Results: Urban and male children were found to be at higher risk of developing asthma. Children in urban areas (OR = 4, 53; 95% CI: 1.57-13.09; ppppppp Conclusions: Children are susceptible to environmentally induced asthma Awareness-raising and preventive measures are needed to control and reduce the burden of asthma in children Key words: asthma, environmental factors, children, allergies, atopic
Asthma is a chronic lung disease characterized by reversible airway obstruction caused by inflammation of the airways in the lungs and surrounding muscle tension. Recent guidelines from the Global Initiative on Asthma (GINA) define asthma as “a heterogeneous disease often characterized by chronic inflammation of the airways”. Respiratory symptoms such as wheezing, shortness of breath, chest tightness and coughing, as well as fluctuating expiratory flow limitation, are hallmarks of asthma. one
In people with asthma, severe symptoms can occur due to a variety of triggers, such as cigarettes and other types of smoking, mold, pollen, dust, animal dander, exercise, cold air, household and industrial products, air pollution, and infections. 2 A combination of genetic and environmental factors explains the higher incidence of asthma in some communities. Often, these other factors can contribute to differences, with race or ethnicity being the more easily identified factors between different groups of people. 3
The diagnosis of asthma is clinical because there is no standardized definition for the type, severity, or frequency of symptoms. Bronchial asthma is a common disease that imposes a huge burden on general medical practice and hospitalization. 4 Although the diagnosis of asthma in children and adults has many similarities, the differential diagnosis, the natural course of wheezing, the ability to provide specific treatment, and its diagnostic value depend on age.
Worldwide, more than 300 million people suffer from asthma. In children, asthma is among the top 20 chronic diseases in the global disability-adjusted life years, with a mortality rate of 0.0-0.7 per 100,000.5 people. The prevalence of asthma in India has been reported to range from 2% to 23%, likely due to the country’s vast geographic and environmental disparities. 6 In a recent study, this figure was found to be 10.4% in Assam. 7
Asthma in children causes recurring respiratory symptoms such as wheezing, coughing, labored breathing, and chest tightness, which, if not properly treated, can lead to chronic asthma. Childhood asthma can significantly impair the quality of life of sick children by increasing absenteeism and reducing active participation in work.
Despite advanced knowledge and treatment strategies, there has been a dramatic increase in the prevalence, morbidity and mortality of asthma in children in recent years8,9, and further understanding of the pathogenesis of asthma is needed to effectively treat asthma. While much research is being done in various parts of India, very little has been done in this less developed region of northeast India.
This study was conducted in the northeastern state of Assam, India. The population of Assam is made up of various ethnic groups, of which 12.45% belong to tribal communities such as Bodo, Khachari, Karbi, Miri, Mishimi, Rabah, etc. Rural areas are scattered throughout most of the region. The state is known for its biodiversity. Agriculture, mainly rice, tea and pulses, accounts for more than one-third of Assam’s income and employs about 69 percent of the workforce. The state produces 50% of India’s tea production. Other profitable agricultural enterprises include pig farming, dairy farming and fishing with the participation of the rural population. Agriculture, tea, oil and gas, coal and limestone are the main industries. The vast racial and geographic disparities in the state are largely due to the varying dynamics and pathogenesis of the disease.
GMCH is the leading tertiary referral center in the region, treating patients from all over the northeast of India, including both rural and urban populations. Most of the patients had a low socioeconomic status and a low level of education. Bronchial asthma in children is a common problem in inpatient pediatrics.
This study aimed to evaluate various socio-demographic and environmental factors influencing the etiology of childhood asthma in patients aged 3-12 years presenting to a GMCH pediatrician.
From April 2013 to March 2017, a retrospective case-control study was conducted at the Department of Anatomy in collaboration with Pediatrics Assam GMCH to investigate the socio-demographic and environmental factors of childhood asthma in children aged 3-12 years.
In an unprecedented case-control study, 150 cases and 150 controls were selected in a 1:1 ratio to study various factors in childhood asthma. Patients with clinically diagnosed asthma aged 3 to 12 years presenting to pediatric outdoor and indoor clinics were selected as cases, while the controls were patients of the same age group, preferably living in similar conditions without respiratory problems. history of disease and asthma.
The sample size was determined using WinPepi version 11.65. Data from the original study show that the prevalence of asthma among Indian children ranges from 1% to 4%. Therefore, assuming a 1% proportion of children with asthma and equal patient and control group sizes, the study requires a total sample size of 274 people to achieve 80% power to detect a 4% two-tailed difference between two . . Both groups have a significance level of 5%.
In addition, assuming that approximately 10% of non-responders are due to subsequent loss or non-adherence, it is reasonable to draw a sample of 300 people (comprising 150 cases and 150 controls).
Use pre-designed and tested data collection formats. Written informed consent was obtained from all legal guardians of study participants. Data was collected on various socio-demographic and environmental variables. House type is defined as
Pucca house, if the walls and roof are made of brick, cement and stone; a Katcha house is made of wood, earth, straw and dry leaves if the house is made of brick walls and adobe walls with a thatched or tin roof and concrete. floors If completed, this is a Semi pucca house. Socioeconomic status was assessed using the modified Kuppuswami scale (2014).
Participants’ mode of delivery, history of birth asphyxia, type of feeding, history of food allergy, maternal history of addiction, family history of asthma, history of atopy or allergy, and family history of smoking or secondhand smoke were also recorded. Any family members living in the same dwelling were considered smokers in the family history. According to the GINA Epidemiological and Clinical Trial Participant Image Guidelines, disease severity was classified according to the prescribed treatment steps, taking into account that patients assigned to stage 2 had mild asthma, and patients assigned to stage 3-4 had mild asthma. had moderate asthma and were assigned stage-5. treatment of severe asthma.
Inclusion and exclusion criteria: The literature suggests that pediatric cases should be included in the study up to 18 years of age. However, at GMCH, the majority of child referrals are under the age of 12. In addition, the incidence of childhood asthma exceeded the prevalence of the disease before and after puberty. Therefore, the age group from 3 to 12 years was chosen for the study. The study included patients with clinically diagnosed bronchial asthma aged 3 to 12 years who agreed to participate in the study. Children aged 3 to 12 years who agreed to participate in the study without respiratory disease, preferably living in similar conditions, were selected as the control group.
Children aged 0-3 years were excluded from the study because wheezing in this age group was not sufficient to diagnose asthma. In addition, children of the appropriate age groups and their guardians who did not consent to participate in the study were excluded.
Statistical analysis. Differences in proportions were analyzed using the χ test. Binary logistic regression was used for the significance parameters in the univariate analysis, and Wald’s χ 2 test was used to measure the independent contribution of the treatment.
Ethical Approval: Prior to data collection, ethical approval was obtained from the Institutional Ethics Committees of the Institute, i.e. the Institutional Ethics Committees of GMCH, Guwahati, Assam and India, Ref: No: 233/2018/215.
Of the 112,323 patients attending the pediatric unit during the study period, 18.88% were respiratory patients. Among children in the age group of 3-12 years, 2.96% suffered from bronchial asthma. Most cases of childhood asthma occurred in the fall of September and October (Fig. 1).
This case-control study included 150 children with asthma and 150 controls. The mean (± SD) age of study participants was 8.38 (± 2.69) years. Cough and shortness of breath were the most common clinical symptoms in the cases. The majority (77.3%) of cases had episodic asthma attacks and only 8.7% of cases had severe asthma. The prevalence of cases was noted in autumn (30%). In almost 38% of cases, symptoms were reported at night (Table 1).
According to respondents, cold drinks (82.7%), ice cream (71.6%) and dust exposure (35%) are common asthma triggers. Nearly 19.3% of cases reported absenteeism due to sickness.
The mean age (standard deviation) of participants was 8.34 (2.69) years. Most of the cases were in the 7-12 age group and were male. The study participants were predominantly Hindu and non-tribal.
Children and men aged 7-12 years had higher incidence rates, although the association was not statistically significant. Also, childhood asthma was significantly associated with BMI (p-value<0.05). Also, childhood asthma was significantly associated with BMI (p-value<0.05). Кроме того, детская астма была значительно связана с ИМТ (значение р<0,05). In addition, childhood asthma was significantly associated with BMI (p value<0.05).此外，儿童哮喘与BMI 显着相关（p 值<0.05）。此外，儿童哮喘与BMI 显着相关（p 值<0.05）。 Кроме того, детская астма была значительно связана с ИМТ (значение p <0,05). In addition, childhood asthma was significantly associated with BMI (p value <0.05). The odds of being overweight (OR = 2.22, 95% CI: 1.17–4.18) and obese (OR = 2.72, 95% CI: 1.46–5.09) were more than twice as high compared with children of normal weight. Urban children living in shared families, junkyards, and damp, inadequately ventilated dwellings have a much higher risk of developing the disease. In attached kitchens, smoke-producing fuels other than LPG, mosquito repellents, Dhuna, etc., are also significantly associated with childhood asthma (p-value<0.05). In attached kitchens, smoke-producing fuels other than LPG, mosquito repellents, Dhuna, etc., are also significantly associated with childhood asthma (p-value<0.05). В примыкающих кухнях использование значительно выделяющего дым топлива, кроме сжиженного нефтяного газа, репеллентов от комаров, Дхуна и т. д., также связано с детской астмой (значение p<0,05). In adjoining kitchens, the use of highly smoke-producing fuels other than LPG, mosquito repellants, Dhuna, etc., is also associated with childhood asthma (p value < 0.05).在附属厨房中，除LPG、驱蚊剂、Dhuna 等以外的产生烟雾的燃料也与儿童哮喘显着相关（p 值<0.05）。 Dhuna 等以外的产生与儿童哮喘显着相关（p 值<0.05）、 Дымообразующие виды топлива, кроме сжиженного нефтяного газа, средства от комаров, Dhuna и т. д., также были в значительной степени связаны с детской астмой на примыкающих кухнях (значение p <0,05). Smoke generating fuels other than LPG, mosquito repellent, Dhuna, etc. were also significantly associated with childhood asthma in adjoining kitchens (p value <0.05). It was also observed that children with pets were 8 times more likely to develop asthma (Table 2).
As shown in Table 3, 46.7% of cases belonged to families of lower socioeconomic status. Maternal education was also lower among the cases (p-value<0.05). Maternal education was also lower among the cases (p-value<0.05). Материнское образование также было ниже среди случаев (значение p<0,05). Maternal education was also lower among cases (p value<0.05).病例中的母亲教育程度也较低（p 值<0.05）。病例中的母亲教育程度也较低（p 值<0.05）。 Матери в этих случаях также были менее образованными (значение p <0,05). Mothers in these cases were also less educated (p value <0.05).
Children born by caesarean section (CS) or other methods of delivery, as well as children with a history of birth asphyxia, are at increased risk of the disease. In addition, top/mixed-fed children were almost five times more likely to develop the disease than breast-fed children (Table 4).
The history of childhood food allergy and atopy has been largely linked to childhood asthma. Also, children from families with a history of allergy and asthma (p-value<0.05) were highly prone to getting the disease. Also, children from families with a history of allergy and asthma (p-value<0.05) were highly prone to getting the disease. Также высокой склонностью к заболеванию отличались дети из семей с анамнезом аллергии и астмы (значение p<0,05). Also, children from families with a history of allergies and asthma had a high propensity to the disease (p<0.05).此外，来自有过敏和哮喘病史的家庭（p 值<0.05）的儿童极易患病。此外，来自有过敏和哮喘病史的家庭（p 值<0.05）的儿童极易患病。 Кроме того, дети из семей с аллергией и астмой в анамнезе (р-значение <0,05) были высоко восприимчивы. In addition, children from families with a history of allergies and asthma (p-value <0.05) were highly susceptible. Passive smoking through other family members also increased almost eight times the risk of asthma among children (p-value<0.05). Passive smoking through other family members also increased almost eight times the risk of asthma among children (p-value<0.05). Пассивное курение через других членов семьи также увеличивает риск развития астмы у детей почти в восемь раз (значение p<0,05). Passive smoking through other family members also increases the risk of developing asthma in children by almost eight times (p value <0.05).通过其他家庭成员被动吸烟也使儿童患哮喘的风险增加了近8 倍（p 值<0.05）。通过其他家庭成员被动吸烟也使儿童患哮喘的风险增加了近8 Пассивное курение через других членов семьи также увеличивало риск развития астмы у детей почти в 8 раз (p-значение <0,05). Passive smoking through other family members also increased the risk of developing asthma in children by almost 8 times (p-value <0.05). (table 5)
Multiple binary logistic regression showed that children in urban areas, humid environments, lower socioeconomic status, pets, family history of atopy/allergies, family history of smoking/passive smoking, and mixed diets were significant contributors. Risk factors for childhood asthma (Table 6).
Table 6 Multivariate logistic regression analysis to evaluate important factors influencing childhood asthma
Over the past two to three decades, the number of atopic diseases has increased, prompting much discussion about environmental change, pollution, and immune responses to infectious pathogens. Both environmental exposure and underlying biological and genetic vulnerabilities play a role in the development of asthma.
In this study, 2.96% of patients in the 3 to 12 age group reported childhood asthma. However, some previous studies have reported various forms of childhood asthma in Indian children. 6,10-12 Geographical and environmental differences in India directly influence and affect the risk factors associated with asthma incidence. 6 Thus, for proper and timely prevention of the disease, a regional assessment of the main factors of childhood asthma is necessary.
Children aged 7-12 years, men and children living in urban areas are at higher risk of childhood asthma. Urban and male dominance in asthma prevalence was observed in a study in India,10 similar to our findings. However, this association was only statistically significant in the context of home location.
Studies have shown that gender-specific hormonal changes may influence asthma, as boys are more likely to develop asthma during childhood. However, this picture changes after puberty, and women develop the disease more often than men. 13-15 In addition, boys under 10 years of age have smaller airways than girls of the same age, and height is also thought to be a factor in childhood asthma in boys. 16.17
Metro Kamstrup, the capital of Assam, has shown rapid urbanization in recent years. Many studies report that urbanization is a factor influencing the incidence of asthma, which is consistent with our study. 18,19 In the present study, unadjusted logistic regression showed that overweight and obese children were significantly more than twice as likely to develop asthma than children with normal BMI, consistent with a recent review. 20 In addition, lower socioeconomic status is a potential risk factor for childhood asthma. Children from families of low socioeconomic status are at higher risk of developing asthma due to a lower immune response and lower health care resources. 21-23
Children living in a joint family, kaccha houses, damp dwellings, inadequate ventilation, attached kitchens, smoke-producing fuels, mosquito repellents and Dhuna, etc., were significantly associated with childhood asthma (p-value<0.05). Children living in a joint family, kaccha houses, damp dwellings, inadequate ventilation, attached kitchens, smoke-producing fuels, mosquito repellents and Dhuna, etc., were significantly associated with childhood asthma (p-value<0.05). Children living in a joint family, running away from home, damp housing, inadequate ventilation, attached kitchens, smoke-producing fuel, mosquito repellents and Dhuna etc. д., были достоверно связаны с детской астмой (значение р<0,05). e., were significantly associated with childhood asthma (value p<0.05).共同家庭的儿童、kaccha 房屋、潮湿的住宅、通风不足、附属厨房、产生烟雾的燃料、驱蚊剂和Dhuna 等与儿童哮喘显着相关（p 值<0.05）。 Children in shared households, kaccha houses, damp housing, inadequate ventilation, attached kitchen, smoke-producing fuel, mosquito repellents, and Dhuna are significantly related to children’s asthma (p value<0.05). Дети в общих домохозяйствах, домах качча, сырых жилищах, неадекватной вентиляции, пристроенных кухнях, задымленном топливе, репеллентах от комаров и Дхуна были в значительной степени связаны с детской астмой (значение p <0,05). Children living in shared households, house running, damp housing, inadequate ventilation, fitted kitchens, smoky fuel, mosquito repellents and dhuna were significantly associated with childhood asthma (p value < 0.05). Previous research has also shown that various indoor environmental factors can trigger asthma in children. 24-27 The association of indoor pet allergens with childhood asthma is controversial, as few researchers believe that early exposure to allergens may contribute to the development of tolerance. 28
Numerous studies have shown that children born by caesarean section have an increased risk of childhood asthma compared to conventional births. This is consistent with our findings. 29-32 Children with a history of birth asphyxia also have a higher risk of developing asthma. Maternal asthma is an important contributor to pregnancy complications such as respiratory distress syndrome and neonatal asphyxia. 33
As with other studies, current findings indicate that a childhood history of food allergy or atopy or a family history of allergies and asthma significantly increases the risk of childhood asthma. 34,35 In line with our study, earlier multi-generational studies have shown that intergenerational smoking habits can lead to genetic changes in the epigenome that increase the risk of asthma in offspring. 36
In recent days, rapid urbanization has affected all sectors of society. Due to different sources of income and occupations, people prefer to settle in cities and are thus exposed to various environmental pollutants. Family members of susceptible children are advised to pay more attention to avoiding humidity, smoking, keeping pets in a family with allergies/allergies, and avoiding allergies/allergic triggers in children with a family history of allergies/allergies. There should be increased awareness of exclusive breastfeeding due to the benefits of breastfeeding in asthma prevention.
Most of the patients who come to Guwahati Medical College are from all over North East India as Guwahati Medical College is the leading top level specialist center in the region. Most of the patients had a low socioeconomic status and a low level of education. Bronchial asthma in children is a common problem in the pediatric department of our hospital. Appropriate preventive strategies for these high-risk patients will help reduce morbidity and reduce the frequency of exacerbations.
Despite all available asthma treatments, many patients remain poorly controlled, but identification of specific patient populations, including phenotypes and endotypes, can optimize their management. Thus, regional studies of childhood asthma prevalence and risk factors will help in the effective management of these cases.
In this study, some patients did not return for further examination and follow-up. This may be due to a lack of awareness of the causes and consequences of the disease. Due to poor communication systems, we were unable to track all of the patients.
Children are susceptible to environmental asthma, and a proper understanding of environmental asthma triggers and allergens can help control and reduce the disease burden. In families with a history of allergies or asthma, appropriate care should be taken to protect susceptible children from predisposing factors.
All data were kept confidential and the study was conducted in accordance with the Declaration of Helsinki.
Thanks to all pediatricians who helped collect data and evaluate the content of their knowledge. All department colleagues who helped us gain access to the department’s libraries and environment during the study were also acknowledged.
All authors have made significant contributions to the work of the report, whether in concept, study design, execution, data collection, analysis and interpretation, or all of these areas; they participated in the drafting, revision or critical review of the article. Finalize the version for publication, agree on the journal to which the article will be submitted, and agree to be responsible for all aspects of the work.
1. Global strategy for the treatment and prevention of asthma. Global Asthma Initiative. 2018. Available at: https://ginasthma.org/wp-content/uploads/2019/01/2018-GINA.pdf. As of December 2, 2021