SOCIO-DEMOGRAPHIC AND CLINICAL PROFILE OF CHILDREN WITH ASTHMA ATTENDING CHEST CLINIC AT B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, NEPAL

1* Sa sh Yadav 1426 ISSN: 2542-2758 (Print) 2542-2804 (Online) Birat Journal of Health Sciences Vol.6/No.2/Issue 15/May-Aug., 2021 ORA 244 DOI: h ps://doi.org/10.3126/bjhs.v6i2.40304 Received : 02 May, 2020 Accepted : 05 August, 2021 Published : 04 November, 2021 Original Research Ar cle


Results
Of the 200 children, there were 142 (71%) males. The median age of presenta on was 3 years and 139 (69.5%) from the age group 1-5years One third had poorly controlled asthma. Comorbidity was present in 59(29.5%) and allergic rhini s (7%) was the most common. 90.5% had onset of wheezing before 5 years of age. Family history of asthma and/or atopy and smoking was present in 24% and 31%, respec vely. 22% had exposure to pet animals. Upper respiratory tract infec on (URTI) (37%) was the most common trigger for exacerba on. Cough (99%) and fast breathing (98%) were the most common symptoms.

Conclusion
The majori es were males of young age with rhini s as most common co-morbidity and many of them had a history of parental smoking at home. One third of them had poorly controlled asthma which shows the need for proper management of asthma including its comorbidity in younger children and changing certain habits like parental smoking at home.

INTRODUCTION
Asthma is one of the most common chronic diseases in the world. The prevalence of asthma has been reported from different parts of the world, with figures ranging from 1% to 20 % for both children and adults. It is es mated that around 300 million people in the world currently have asthma with 250,000 annual deaths a ributed to the disease. Almost all of these deaths are avoidable. The Interna onal Study on Asthma and Allergies in Childhood (ISAAC) showed a significant worldwide varia on in the prevalence of symptoms of asthma, with the highest prevalence in English speaking Western countries and the lowest prevalence in Eastern Europe and Asia. Most asthma-related deaths occur in low and lower-middle income countries. There are limited reports regarding prevalence of asthma in children from Nepal. The report from neighboring country India shows wide varia on (4-19%) in the prevalence of asthma in school going children from different geographic areas. There is evidence that over the last 20 years its prevalence has considerably increased, especially among children.
Many children with asthma are under-diagnosed and undertreated in our region which may be due to lack of proper treatment and follow up with a knowledge gap among the caretaker and pediatrician. In addi on, there are various environmental and gene c risk factors which are different from one region to another. Hence, we need to iden fy regional socio-demographic and clinical profiles in order to have efficient preven on of acute asthma and its management. Therefore, the aim of this study is to find out the socio-demographic, clinical profile and various factors associated with asthma exacerba on in children.

METHODOLOGY
This was a retrospec ve study which was carried out at the Department of Pediatric and Adolescent Medicine of B. P. Koirala Ins tute of Health Sciences (B.P.K.I.H.S) between July 2014 and March 2016. It is a ter ary center in eastern region of Nepal which has a well equipped Pediatric department. The study popula on included all the pa ents of age group 1 to 14 years with asthma a ending the pediatric chest clinic in this ins tute. The diagnosis and level of control of asthma were established using the Global Strategy for Asthma Management and Preven on, Global Ini a ve for Asthma (GINA-2014). The diagnosis of asthma is defined by the history of respiratory symptoms such as recurrent wheeze, shortness of breath, chest ghtness, and cough that vary over me and in intensity. Level of control was divided into: well controlled, par al controlled, or uncontrolled. Tables 1 summarize the levels of asthma control. The children who have congenital heart disease, tuberculosis, anatomical anomalies and other diseases with involvement of respiratory systems were excluded from the study. The diagnosis was made on the basis of detailed history and clinical examina on of each pa ent. Informa on was collected concerning details of demographic profile including detailed history, age of first episode of wheeze, exposure of smoke and pet animals, family history of asthma and atopy and factors responsible for exacerba on were evaluated in the outpa ent department. Level of control was divided into: full control, par al control, or uncontrolled. The data regarding the variables was collected through a pre semi-structured ques onnaire. The present study was approved by the Research Ethics Commi ee at BPKIHS.
All data were collected in a pre designed data sheet and analysis was done using the Sta s cal Program for Social Sciences (SPSS) 11.5 version. The sta s cal analysis was done by propor ons and percentages.

DISCUSSION
In the present study, the prevalence in males was found higher than females which was also reported by other [8][9][10] studies.
et al. explained that male sex is a risk factor T se for wheeze in children. As children get older, the difference narrows and by adulthood the prevalence of asthma is greater in women than in men. The reasons for these sex-related 12 differences are not clear. In contrast, a study by Ali et al. in Egypt stated that, there was no significant difference in the prevalence of asthma among male and female pa ents below 15 years of age.
In this study more than 90% of the children had their first episode of wheeze before 5 years of age. These results are consistent with the study conducted by DSY Lam et al and concluded that more than 90% of the children had their 13 onset of asthma symptoms before 6 years of age. Wheezing is most o en related to viral infec ons of the respiratory tract in the first year of life. Respiratory syncy al virus is the most important agent, affec ng up to 70% of 14 children in the first year of life. Some studies have shown that hospitaliza ons for bronchioli s is an independent risk factor 15,16 for developing asthma.
Urban-specific lifestyle and environmental factors modify immune development in early life, and the subsequent risk 17 of asthma. Urban dwelling children were more likely to develop asthma compared with rural children in our results, 18,19 which is similar in other studies.
Among previously diagnosed asthma cases 37 % had inadequate control of symptoms showing poor awareness [20][21][22][23][24] of asthma management, as supported by others. Several factors may be involved in asthma control. Adherence to treatment, iden fica on and treatment of co-morbidi es and triggering factors, availability of medica ons, and educa on of pa ents and their families may play a 25,26 fundamental role in this goal.
Asthma is a disease that may be related to other atopic disorders. Allergic rhini s is the disease most o en associated with asthma. Some authors consider the two diseases as a single inflammatory process of the airway, sharing the same pathophysiology, triggering factors, and [27][28] environmental risk factors. In the present study, rhini s was associated with asthma in 14% of pa ents. The control of symptoms of rhini s in asthma c pa ents is essen al, as this combina on may lead to an increased need for medica on to control asthma, worsening the quality of lives of pa ents and increasing costs and demand for health care 29 services.
In our study, 48 (24%) pa ents were having family history of asthma which is inconsistent with the findings of Wylie Burke et al who stated that a family history of asthma was a significant predictor of physician diagnosed asthma in children regardless of race/ethnicity and socioeconomic status. Findings support the collec on of family history, including grandparent asthma status. Similarly, Mahdi B et al stated that family history of asthma is important determinants in the development of asthma in the [30][31] offspring.
Out of 200 pa ents 62(31%) pa ents were having a history of parental smoking at home and this finding is slightly more 32,33 as compared to other studies.
Study has shown that interac ons between genotypes at specific loci or genome regions and environmental tobacco smoke exposure with 34 risk for the development of asthma.   36,37 currently is inversely associated with childhood asthma. Linneberg et al. found that previous or con nuing exposure to a cat at home increased the risk of developing a sensi za on to cat in adulthood, while having a dog at home did not increase the risk of developing a sensi za on to 38 dog. Similarly, Oberle et al. observed a significant associa on between con nuous exposure to cats from early life on and asthma in childhood, whereas exposure to dogs 39 was not related to the prevalence of asthma. URTI was the most common trigger for asthma exacerba on in our study. Viral respiratory tract infec ons are frequent and usually self-limited illnesses. For pa ents at risk for asthma, or with exis ng asthma, viral respiratory tract infec ons can have a profound effect on the expression of 40 disease or loss of control. In a study of children aged 9-11 years, 80-85% of asthma exacerba ons that resulted in reduced peak expiratory flow and wheezing were due to viral upper respiratory infec ons. Various other studies also found that viral respiratory infec ons are associated with asthma exacerba ons in nearly 80% of these episodes.,

CONCLUSION
Very few studies have been conducted in Nepal on pediatric asthma. We found that bronchial asthma is a disease of young age from urban areas with rhini s as most commonly associated co-morbidity. The most common trigger for asthma exacerba on was URTI and onset of the first episode of wheezing before five years of age. Despite some limita ons, this study shows that one third of them have poorly controlled asthma which is very high and can be u lized for the improvement of health care measures for its control in our region.

ACKNOWLEDGEMENTS
My sincere thanks to the department of pediatrics (BPKIHS) for their effort in data collec on and entry of the medical records. I would also like to thank to Dharni Dhar Baral for his help in data analysis.

RECOMMENDATION
We recommend to conduct more research to clearly define the prevalence, sociodemographic profile and factors associated with uncontrolled asthma in our region. We also recommend finding out the causes of such a large propor on of uncontrolled asthma in small children so that the government can develop the policies and programs for pediatric asthma.

LIMITATION OF THE STUDY
The sample size is small and not focused on the cause of uncontrolled asthma. We need large scale study to understand the factors associated with poorly controlled asthma in the pediatric age group.