Childhood asthma: Bangladesh perspective
Asthma is a chronic lung disease that affects people of all ages, but it is the most prevalent chronic disease among children. Asthma causes recurring periods of wheezing (a whistling sound when the individual breathes), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning. Childhood asthma is often confused with respiratory tract infections. If undiagnosed or undertreated, childhood asthma can possibly restrict individuals activity for a life time creating a substantial burden to individuals and families.
In 2011, 235 million people around the world had been suffering from asthma. Although asthma is a global problem recent studies indicate that the problem is more intense and increasing in low and middle income countries. Over 80% of asthma deaths occur in low and lower-middle income countries. In Bangladesh few studies have been conducted to estimate the burden of childhood asthma.
A study from icddr,b reported 16.1% prevalence of wheezing in last 12 months among children of 60 to 71 months. Another study in urban and rural schools of Dhaka district showed 9.1% prevalence of wheezing among children of 6-7 years and 6.1% among children of 13-14 years.
The first national survey on asthma prevalence (NAPS-1999) in Bangladesh reported that more than 5% of the total population and 7.5% of 1-5 year old children were suffering from asthma. The report also indicated that the prevalence was higher in children of low-income, poorly educated rural and sub-urban groups compared to those from urban families. A more recent study revealed 3% greater prevalence of childhood asthma in coastal region compared to that of Dhaka city.
Center for Control of Chronic Diseases (CCCD) completed a community based study on Childhood Asthma.
The study was conducted to estimate the age and sex specific prevalence of childhood asthma by spirometry. Spirometry is a test for determining lung function and it can play an important role to diagnose and manage asthma in children . However, there is limited use of spirometry by physicians in Asian countries.
To get the estimation from both rural and urban settings of the country, the study was conducted in icddr,b surveillance sites at Matlab, a rural area in Chandpur district and Kamlapur, a semi urban slum area in Dhaka. A total of 1056 children (511 boys and 545 girls) participated in the study.
The preliminary findings showed that the prevalence of self reported wheezing in last 12 months was 7.3% in Dhaka and 5.7% in Matlab. It was observed that children with wheezing had lower weight and height compared to children without wheezing.
All three major parameters (FEV1- Forced expiratory volume in 1st second, FVC- Forced vital capacity and FEV1/FVC) of lung function were less among wheezing children compared to children without wheezing.
Actual cause of asthma is not known, but allergens, indoor air pollutants and outdoor environmental factors are recognised as precipitating factors to develop asthma. Children with history of hereditary asthma are known to the risk of subsequent allergic sensitisation and ultimately bronchial asthma. To find out the inherited linkage, the study looked at the prevalence of asthma and aczema among the parents of study children. History of asthma or eczema was more in parents of wheezing children. Overall 5.1% participants reported that their mother had asthma and 5.3% children reported their father had asthma. For both cases, the rate is higher for the children having wheezing than the children without wheezing. Mothers of 13.2% children with wheezing also suffered from eczema whereas the rate is 8.8% for the fathers.
Acute lower respiratory tract infections (ALRI) is also a risk factor and young children are mostly exposed to particulate matters in smoke of biomass fuel causing lower and upper respiratory tract infections which lead to bronchial asthma. Exposure to environmental tobacco smoke, low socio-economic condition and domestic crowding are also major
risk factors for asthma among
children.
Due to its chronic nature, childhood asthma results in a huge economic burden on families and health system.
It has also been found to be the strongest risk factor for chronic obstructive pulmonary disease which is an irreversible and progressive disease.
Further research is needed to identify the associated risk factors and prevalence of childhood asthma in Bangladesh to guide appropriate interventions to fight against the increasing rate of asthma among children. ?
Source: Chronic disease news, ICDDR,B
