Indian Council of Medical Research, Indian Study on Epidemiology of Asthma, Respiratory Symptoms, and Chronic Bronchitis (INSEARCH). By Dr. S.K. Jindal. Ansar Nagi: New Dehli: India. Postgraduate Institute of Medical Education and Research, Chandigarh, 2010.
This study aimed to find the prevalence of asthma, COPD, and other respiratory diseases and symptoms in India based on data collected from multiple areas of India, including Chennai. The study also aimed to determine the influences of external factors on the prevalence of asthma, such as smoking or the burning of solid fuels. At each of the twelve centers, approximately 15000 people from the rural and urban areas of the city were given a questionnaire about asthma and symptoms. They found that 8.5% of the people surveyed had at least one respiratory symptom associated with asthma, and that 2.05% met the study's definition of asthma. Some factors they found associated with an increased prevalence of asthma were: advancing age, asthma in first degree relative, exposure to first- or second-hand tobacco smoke, and the use of coal, liquefied petroleum, wood, or dung cake.
The author is a professor at the Postgraduate Institute of Medical Education and Research, Chandigarh, and he is the head of the Department of Pulmonary Medicine at the school. In 2011, he received the Outstanding Educator Award from the American Thoracic Society for his contributions to the study of pulmonary health. He is also the Editor-in-Chief of the journal Chest India, and has published may articles for it.
The main findings of the article refer to environmental factors and whether or not they increase the prevalence of asthma. The study found that certain factors, like exposure to tobacco smoke and the use of solid fuels, increased the risk of asthma. The study also found that males had a higher prevalence of asthma, as do people living in rural areas and people of a lower socioeconomic status.
These findings are in line with others conducted elsewhere in the world. The Asthma and Allergy Foundation of America agrees that exposure to tobacco, whether through first or second-hand smoke, increases asthma prevalence (http://www.aafa.org/display.cfm?id=8&cont=6 ). Also, studies conducted by the CDC show that families living below the poverty line have an increased prevalence of asthma (http://www.cdc.gov/nchs/data/databriefs/db94.htm ). Finally, studies listed by the National Library of Medicine confirm that burning coal as a heat source poses a special threat to families and leads to an increased incidence of asthma and associated symptoms (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760246/ ).
“Chronic Respiratory Disease (CRD), which includes asthma and chronic obstructive pulmonary disease (COPD), may account for an estimated burden of about 100 million individuals in India. There are only few studies from India about the field epidemiology of asthma.”
“Asthma was diagnosed if the respondent answered in 'yes' to one of items 14 and 15, AND to one of the item nos. 25, 26, 27.
14. Wheezing or whistling sound from chest or
15. Chest tightness or breathlessness in morning
AND
25. Having suffered from asthma or
26. Having an attack of asthma in past 12 months or
27. Using inhaled or oral bronchodilators”.
“More than 70% of asthmatics were residents of rural areas, compared to 64% of the remaining study population”.
The study used data collected from twelve cities. A questionnaire was provided that asked questions about asthma, COPD, respiratory symptoms, medical history, economic status, and the living conditions of the respondent. The questionnaire was provided in English, Hindi, or the regional dialect of the city, depending on the respondent's preference. Data from four cities was collected earlier in a previous phase and analyzed already.
Social disparities are addressed by having an interview with each patient, so as to avoid keeping the illiterate at a disadvantage in the study. Social disparities are also addressed by having the survey translated into the regional dialect of the city, since many people learn the regional dialect as a first language in India, as opposed to learning Hindi or English first. Health disparities are addressed by taking into account medical history, such as asthma in the family and a patient's history of smoking. Heath disparities are also addressed by taking respondents from both rural and urban settings, since many of the rural respondents are of a lower socioeconomic standing.
This publication has been cited by at least 15 other articles. Most of the articles that cite this one relate to asthma or COPD guidelines and epidemiology. Some of the articles that cite this one relate to respiratory or COPD. Most of these articles are centered on India. Some examples are included here:
Of the 65 references listed in the article, the author of this publication, S.K. Jindal, was an author in at least ten of them. This could mean that he's drawing from a limited view of information to satisfy himself or because he distrusts other authors, or that there is so little information on the epidemiology of chronic respiratory, as he mentioned earlier, that many of them have his fingerprints on them because he is one of the few people in India researching this topic.
First, I looked at the questionnaire used to collect information in this study, which is provided at the end of the paper, to see what sort of questions it asked. One thing that struck me about it was that it leaves the question about socioeconomic status up to the perception of the interviewer, as opposed to using income statistics. Rely on the interviewer to determine economic standing could lead to an unreliable and varied reporting for that figure.
Next, I looked at the specific statistics for Chennai gathered in this article, since that is the city I am focusing on for this article. Of the 9000 rural respondents, 2.1% of the males and 1.6% of the females had asthma at some point, while out of the 6000 urban respondents, 2.6% of the males and 2.7% of the females had asthma at some point. The urban percentages being higher than the rural percentages conflicts with the average data gathered by the paper, which states that rural respondents had higher incidences of asthma. However, this may be because only 1000 out of the 9000 rural respondents were labeled as lower income, which may account for this difference, since a higher percentage of the rural population in the other sites were considered to be low income.
Finally, I looked at the International Union Against Tuberculosis and Lung Disease(IUATLD)'s 1984 Bronchial Symptoms Questionnaire, since the paper cited that as an influence on the survey used in this study. While I was not able to find the original questionnaire, I was able to find a scholarly article that has been cited by over 500 articles that talks about the validity of the questionnaire. The paper stated that the questionnaire provided reliable information and good repeatability, especially with regards to the questions on asthma. This is a good sign, since it means that the questionnaire used here took inspiration from reputable sources.
http://icmr.nic.in/final/INSEARCH_Full%20_Report.pdf
This study aimed to find the prevalence of asthma, COPD, and other respiratory diseases and symptoms in India based on data collected from multiple areas of India, including Chennai. The study also aimed to determine the influences of external factors on the prevalence of asthma, such as smoking or the burning of solid fuels. At each of the twelve centers, approximately 15000 people from the rural and urban areas of the city were given a questionnaire about asthma and symptoms. They found that 8.5% of the people surveyed had at least one respiratory symptom associated with asthma, and that 2.05% met the study's definition of asthma. Some factors they found associated with an increased prevalence of asthma were: advancing age, asthma in first degree relative, exposure to first- or second-hand tobacco smoke, and the use of coal, liquefied petroleum, wood, or dung cake.
“Asthma was diagnosed if the respondent answered in 'yes' to one of items 14 and 15, AND to one of the item nos. 25, 26, 27.
14. Wheezing or whistling sound from chest or
15. Chest tightness or breathlessness in morning
AND
25. Having suffered from asthma or
26. Having an attack of asthma in past 12 months or
27. Using inhaled or oral bronchodilators”.
“More than 70% of asthmatics were residents of rural areas, compared to 64% of the remaining study population”.
(Chronic cough: an Asian perspective. Part 1: Epidemiology. http://www.ncbi.nlm.nih.gov/pubmed/26240790
Regulatory Considerations for Approval of Generic Inhalation Drug Products in the US, EU, Brazil, China, and India. http://www.ncbi.nlm.nih.gov/pubmed/26002510 )
Next, I looked at the specific statistics for Chennai gathered in this article, since that is the city I am focusing on for this article. Of the 9000 rural respondents, 2.1% of the males and 1.6% of the females had asthma at some point, while out of the 6000 urban respondents, 2.6% of the males and 2.7% of the females had asthma at some point. The urban percentages being higher than the rural percentages conflicts with the average data gathered by the paper, which states that rural respondents had higher incidences of asthma. However, this may be because only 1000 out of the 9000 rural respondents were labeled as lower income, which may account for this difference, since a higher percentage of the rural population in the other sites were considered to be low income.
Finally, I looked at the International Union Against Tuberculosis and Lung Disease(IUATLD)'s 1984 Bronchial Symptoms Questionnaire, since the paper cited that as an influence on the survey used in this study. While I was not able to find the original questionnaire, I was able to find a scholarly article that has been cited by over 500 articles that talks about the validity of the questionnaire. The paper stated that the questionnaire provided reliable information and good repeatability, especially with regards to the questions on asthma. This is a good sign, since it means that the questionnaire used here took inspiration from reputable sources.