• Users Online: 120
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 1  |  Page : 77-82

Prevalence of bronchial asthma in primary school students in Assiut


Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt

Date of Submission03-Jan-2019
Date of Acceptance15-Feb-2019
Date of Web Publication16-May-2019

Correspondence Address:
Medhat M Boshra
Department of Pediatrics, Bachelor of Medicine and Surgery, Faculty of Medicine, Assiut University, Assiut
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCMRP.JCMRP_142_18

Rights and Permissions
  Abstract 

Objective
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheezing, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation.
Patients and methods
This study was conducted on primary school students of Assiut Governorate and some villages connected with Assiut Pediatric Hospital from April 1, 2017, to October 1, 2017; students aged 9–12 years were eligible for the study. On the basis of the International Study of Allergy and Asthma in Childhood, a modified questionnaire was formulated to fulfill the aims of the study. We distributed the questionnaire (in Arabic) to be answered by students and their caregivers after explaining the questions.
Results
This was a study carried out on the prevalence of bronchial asthma in Assiut district among primary school children, and it shows that Assiut children have a prevalence of asthma of 7.6%.

Keywords: bronchial asthma, epidemiology, questionnaire


How to cite this article:
Boshra MM, Ahmed MM, Raafat DM. Prevalence of bronchial asthma in primary school students in Assiut. J Curr Med Res Pract 2019;4:77-82

How to cite this URL:
Boshra MM, Ahmed MM, Raafat DM. Prevalence of bronchial asthma in primary school students in Assiut. J Curr Med Res Pract [serial online] 2019 [cited 2022 Sep 27];4:77-82. Available from: http://www.jcmrp.eg.net/text.asp?2019/4/1/77/258373


  Introduction Top


Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation[1]. It is defined by the history of respiratory symptoms such as wheezing, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation[2].

According to WHO[3] between 100 and 150 million people around the globe suffer from asthma, and this number is rising. Worldwide, deaths from this condition have reached over 180 000 annually.

Risk factors for asthma can be classified into the following (and they are):

  1. Host factors involved in the development of asthma.
  2. Environmental factors that may influence the susceptibility to the development of asthma in predisposed individuals cause exacerbations of asthma and/or cause symptoms to persist[4].


Diagnosis of asthma is based on identifying both a characteristic pattern of respiratory symptoms such as wheezing, shortness of breath (dyspnea), chest tightness or cough, and variable expiratory airflow limitation[5].

If possible, the evidence supporting a diagnosis of asthma should be documented when the patient first presents, as the features that are characteristic of asthma may improve spontaneously or with treatment; as a result, it is often more difficult to confirm a diagnosis of asthma once the patient has been started on controller treatment[5].

The aims of this study were as follows:

  1. Identify the prevalence of bronchial asthma among primary school students in Assiut Governorate.
  2. Trial to identify possible risk factors and triggering factors of childhood asthma in Assiut.



  Patients and Methods Top


Research design: this was a retrospective descriptive study conducted on primary school students of Assiut Governorate and some villages.

Duration of the study: 6 months for collecting data from students in primary schools in Assiut Governorate.

Inclusion criteria

All primary school students aged 9–12 years were eligible for the study.

Exclusion criteria

If there was an accentuated second heart sound, the patient was referred for echocardiography to exclude pulmonary hypertension.

The questionnaire consisted of three papers [Figure 1]:
Figure 1: Questionnaire (in Arabic) to diagnose asthma.

Click here to view


Paper I included sociodemographic characteristics [name, age, sex, the residence of school child, family size, number of rooms in the house, degree of parent's education, parent's occupation (working or not), source of water, sewage disposal, and household pets or animals].

Paper II included questions for history related to asthma (whether the father or mother was a smoker or not, whether the child was suffering from nasal allergy, dermal allergy, eye allergy or allergy to a specific type of food, and the presence of allergic manifestations in any family member, including asthma, nasal allergy, dermal allergy, or conjunctiva allergy and nocturnal exacerbation of symptoms).

Paper III was with regard to whether the child had a physician-diagnosed asthma (symptoms that the child suffers with, such as cough, wheezing, and dyspnea; what the allergen is that induces an attack of asthma, such as viral respiratory infection, smoking, exercise, and house dust; whether the child receives controlling medication or not and, if yes, what are these drugs; and whether the child was admitted in hospital suffering from an asthmatic attack and for how long).


  Results Top


This study was conducted on primary school students of Assiut Governorate and some villages in 2016/2017.

The total sample included 1100 children representing 30 classes from 10 schools.

The schools were selected randomly for the study, with proportionate representation from both government and private schools, as well as from urban and rural areas.

The study showed that children in Assiut have a prevalence of asthma of 7.6%.

More than half (55.3%) of screened children had a wheezing chest in the past, but the majority of them were suffering from a wheezy chest in the last 12 months. The majority of them had two to three attacks of wheezy chest in the last 12 months, and about 80% of them were suffering from disturbed sleep in less than one night per week [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6],[Table 7],[Table 8] and [Figure 2].
Figure 2: Distribution of different types of allergen-inducing asthma.

Click here to view
Table 1: Sex and residence differences among screened students

Click here to view
Table 2: Prevalence of asthma among screened students

Click here to view
Table 3: Presence of bronchial asthma in relation to sex, residence and number of rooms in houses

Click here to view
Table 4: Association between asthmatic screened children and number of siblings

Click here to view
Table 5: Differences of parents' education level, occupation level, presence of household pets, and source of water and sewage disposal among screened asthmatic students

Click here to view
Table 6: Association between asthmatic children and parental smoking

Click here to view
Table 7: Association between presence of bronchial asthma and presence of allergy and family history of allergy

Click here to view
Table 8: Rate of hospital admission with regard to sex

Click here to view



  Discussion Top


In this current study, by using a translated and adapted version of the ISAAC questionnaire, which was distributed to a sample of 1100 students, 9–12 years' old school children in Assiut district were evaluated. It is revealed that wheezing during the last year was 45.7%, and physician-diagnosed asthma was 7.6%. This is nearly similar to the results reported by Hassan and Hagrass[6], as they revealed that the prevalence of asthma was 7.2% among primary school children in Assiut city by using a questionnaire among 1170 pupils; otherwise, this rate was less than that estimated in Cairo in 2006 by Georgy et al.[7], as they revealed asthma prevalence as 8.2%, using a questionnaire among 13 028 children aged 3–15 years. This may be due to the different geographical, social, and environmental factors between these two localities.

In contrast, in this study, the prevalence of wheezing during the last year was 55.4% (609 out of 1100) and 45.7% (503 out of 1100), respectively. These rates are more than what has been previously estimated by Georgy et al.[7] who revealed that the prevalence of wheezing was 26.5% (697 out of 2631) and that wheezing during the last year was 14.7% (379 out of 2570).

This may be due to an increase in exposure to risk factors and dust and the use of fast foods and food additives.

This work shows that the majority of asthmatic children were girls (66.7%), which is contrary to the findings of Hassan and Hagrass[6], who reported that most asthmatic children were boys (53.6%).

The increased risk for male individuals in childhood is probably related to narrower airways, increased airway tone[7] and positive higher IgE[8] in boys, which predispose them to enhanced airflow limitation in response to a variety of insults, but the difference in this recent study's results may be due to a combined contribution of environmental and epigenetic (the result of environmental insults) changes, accounting for the increased prevalence of this emerging health risk. Because childhood asthma is correlated with chronic comorbid diseases such as increased respiratory infections, bronchitis, cystic fibrosis, pneumonia, atopic dermatitis, otitis media (middle ear effusion), olfactory disorders and lung cancer[9].

In this recent study, there was a significant association between number of siblings of screened children (family size) and asthmatic students, with P value 0.001, and this may have an effect on the prevalence of asthma, as most of the asthmatic students (66.7%) had more than three siblings.

In this current study, there was a significant negative association between the number of rooms of houses where the screened children lived and their residence (urban and rural), with P value 0.003, and this was associated with about 60% of screened asthmatic students who lived in houses with only one to two rooms. That result is different from that by Hassan and Hagrass[6], which showed that there was no significant association between asthma and room number; this may be due to change in shapes of buildings in rural than those were in the past.

In this work, there was no association between education of parents and asthma of children, as most of the fathers and mothers of asthmatic students were educated (73.8 and 66.7%, respectively), similar to the study by Abdallah et al.[10] that reported no significant association between asthma and parental educational level.

Moreover, in the current study, there was no association between source of water and sewage disposal and asthma, as all of the screened children had a tap in their houses as the source of water and a bathroom for sewage disposal.

In this study, about 26, 7% of screened asthmatic students had household pets or animals in their houses, and there was a significant association between asthma and the presence of household pets or animals in the screened children's houses, with P value less than 0.001. This is similar to the study by Hassan and Hagrass[6] who revealed that there was a significant association between asthma and the presence of family pets in the home, such as birds (83.3%), dogs (7.1%), and cats (13.1%).

This work shows that about 46.4% of screened asthmatic children lived with a smoker father, and there was a significant association between suffering of screened children from asthma and passive smoking (P value ≤ 0.001), this result was contrary to the study by Zedan et al.[11], which reported no significant association between asthma and passive smoking; it is also contrary to the study by Abdallah et al.[10], which reported no significant association between asthma and father's smoking.

In this study, the allergens that induced an attack of asthma the most among screened children were house dust and common cold (26.2%), followed by house dust only (20.3%), then passive smoking and house dust and (20.3%), finally, house dust and common cold and odors (11.9%). This was in agreement with the study carried out by Abdallah et al.[10] who revealed that the most common triggering factors for asthma were exposure to house dust (84.6%), exposure to cigarette smoke (81.5%), playing and physical activity (58.5%).

In this recent study, the prominent symptoms of asthma among screened asthmatic children were cough (100%) then wheeze (98.8%) and dyspnea (46.4%); this is slightly different from that reported by Hassan and Hagrass[6] who reported that the prominent symptoms of asthma among studied children were wheezing 100%, cough 96.4%, and dyspnea 40.5%.

In this study, there was a significant association between suffering of the students from nasal allergy, dermal allergy, eye allergy, or allergy to any specific type of food and the presence of asthma with P value 0.001. Also, there was a significant association between the presence of allergic manifestations in any family member of asthmatic children with P value = 0.001.

This work shows that about 40.5% of screened asthmatic children were receiving controlling medications; the majority of them did not continue treatment.

In this recent study, there was no significant association between severity of asthma and number of times of hospital admission due to asthmatic attacks with regard to sex and residence; this is in agreement with the study carried out by Pauwels et al.[12], as severe exacerbations can occur in patients with mild or well-controlled asthma.

In this study, there were no differences between boys and girls suffering from an asthmatic attack with regard to the rate of admission to hospitals, although more girls were admitted to hospitals only once on suffering from asthmatic attacks than boys. Boys were more recurrently admitted more than three times on suffering from asthmatic attacks than girls.

Moreover, the majority of boys spent more than 3 days in hospital for recovering from asthmatic attacks in comparison with the majority of girls who spent from one to three days in hospital for recovering from asthmatic attacks.


  Conclusion Top


In this study, the prevalence of bronchial asthma among primary school students in Assiut Governorate was 7.6%. It was higher in girls compared with boys.

There were no effects on the prevalence of asthma with regard to the residence of screened children and with respect to whether their parents were educated or not.

There were associations between the prevalence of asthma and number of siblings, level of housing, presence of household pets or animals, and also with parental smoking.

There was a significant association between screened asthmatic children and presentation of any other types of allergy, and there was also a significant association with positive family history for presence of allergic manifestation.

The main allergen that induced an attack of asthma among screened children was first house dust and common cold, then house dust alone, followed by smoking and house dust and, lastly, house dust and odors.

The main symptoms that screened asthmatic children were suffering from during asthma attacks was cough (100%), followed by wheezing (98.8%) and lastly dyspnea (46.4%).

Only 34 from 84 screened asthmatic children were receiving controlling medication. About 34 asthmatic students were admitted in hospital suffering from asthmatic attack, with no differences between boys and girls in the rate of admission. Girls were admitted more to hospitals only once, but boys were more recurrently admitted.

Recommendations

This study recommends that parental smoking be prohibited or avoided inside homes, and, also, dealing with household pets or animals must be forbidden, especially among those with allergic history.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
International Study of Allergy and Asthma in Childhood (ISAAC). International Data Centre, Auckland, New Zealand, July 2000. Available at: http://isaac.auckland.ac.nz. [Last accessed on 2018 Dec 05].  Back to cited text no. 1
    
2.
Global Initiative for Asthma. Global strategy for asthma management and prevention. 26 July 2016. Available at: https://ginasthma.org/wp-content/uploads/2016/04/GINA-2016-main-report_tracked.pdf  Back to cited text no. 2
    
3.
WHO 2017. Bronchial asthma, fact sheet N°206, the scale of the problem. Available at: www.who.int/mediacentre/factsheets/fs206/en. [Last accessed on 2017 Jan 05].  Back to cited text no. 3
    
4.
Global Strategy for Asthma. Management and prevention. 2005. Available at: http://www.ginasthma.org. [Last accessed on 2018 Dec 05].  Back to cited text no. 4
    
5.
Levy ML, Quanjer PH, Booker R, Cooper BG, Holmes S, Small I, General Practice Airways Group. Diagnostic spirometry in primary care: proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations: a General Practice Airways Group (GPIAG) document, in association with the Association for Respiratory Technology and Physiology (ARTP) and Education for Health. Prim Care Respir J 2009; 18:130–147.  Back to cited text no. 5
    
6.
Hassan AA, Hagrass SA. Pediatric Department, Al-Azhar University, Assiut, Egypt and Community Health, Nursing Department, Faculty of Nursing, Zagazig University, Zagazig, Egypt. Prevalence of bronchial asthma in primary school children. Am J Med Med Sci 2017; 7:67–73.  Back to cited text no. 6
    
7.
Georgy V, Fahim HI, El-Gaafary M. Prevalence and socioeconomic associations of asthma and allergic rhinitis in northern Africa. Eur Respir J 2006; 28:756-762.  Back to cited text no. 7
    
8.
Sears MR, Greene JM, Willan AR, Wiecek EM, Taylor DR, Flannery EM, et al. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med 2003; 349:1414–1422.  Back to cited text no. 8
    
9.
Klinnert MD, Nelson HS, Price MR, Adinoff AD, Leung DY, Mrazek DA. Onset and persistence of childhood asthma: predictors from infancy. Pediatrics 2001; 108:E69.  Back to cited text no. 9
    
10.
Abdallah AM, Sanusy KA, Said WSH, Mahran DG, Mohamed-Hussien ARM. Epidemiology of bronchial asthma among preparatory school children in Assiut district. Egypt J Pediatr Allergy Immunol 2012; 10:109–117.  Back to cited text no. 10
    
11.
Zedan M, Settin A, Farag M, Ezz-Elregal M, Osman E, Fouda A. Prevalence of bronchial asthma among Egyptian school children. Egypt J Bronchol 2009; 3:124–130.  Back to cited text no. 11
    
12.
Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV, et al. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet 2003; 361:1071–1076.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1644    
    Printed110    
    Emailed0    
    PDF Downloaded138    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]