Clinical Profile and the Predictors of Severity in Children with Asthma in a Tertiary Care Centre

INTRODUCTION: Asthma is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction. This condition is associated with considerable morbidity. There is a wide variation of 1.6-36.8% globally in childhood asthma prevalence among different locales. Even though there has been a considerable improvement in management of asthma, childhood asthma appears to be increasing in prevalence. The cause of childhood asthma has not been determined till date, but various studies point towards a combination of environmental exposures and inherent biological and genetic vulnerabilities. Various studies and present available literature show that asthma prevalence correlated well with reported allergic rhinoconjunctivitis and atopic eczema. Allergy has been identified as the major risk factor associated with the persistence of childhood asthma in young children. Thus repeated exposure to an allergic agent leads to episodes of asthma attacks. The surrounding environment with its allergens stimulates a genetically predisposed individual to activate his immune responses for a prolonged pathogenic inflammation and aberrant repair of injured airways tissues. The various common environmental agents leading to such aberrant inflammatory repair include inhaled allergens, respiratory viral infections, chemical and biological air pollutants such as environmental tobacco smoke and air pollution. Repeated home allergen exposure in sensitized individuals has been shown to be strongly linked to disease persistence. AIM OF THE STUDY: 1.study the risk factors among children with Asthma. 2.To analyse the various predictors of severity of Asthma. DISCUSSION AND ANALYSIS: There is a wide variation in the data analyzed. There are various parameters which show a consistent relation with severity. Most of the analyzed data show an association with asthma but do not statistically support the theory that presence of such risk factors leads to higher severity in all cases. DATA SHOWING SIGNIFICANT STATISTICAL ASSOCIATION WITH SEVERITY OF ASTHMA: The overall analysis reveals significant proportion of children having a genetic background develop severe grade of asthma. Family history of asthma leads to higher grade of asthma in the affected children. In continuation of the above genetic traits history of associated atopy, GERD, allergic rhinitis predisposes the affected children to develop a more severe grade of asthma as significant association are found in children having history of above disorders. A history of wheeze in infancy shows that there are a significant number of such children progressing to develop more severe grades of asthma. Such affected children have a significantly higher positive history of admission to the hospital for acute exacerbation of asthma. CONCLUSION: Asthma is a disease associated with various factors. These factors could be genetic or environmental or both. The environmental insult has increased the prevalence of the disease with more susceptible individuals presenting with asthmatic manifestations. In the above study, we have seen that the environmental factors are associated with all grades of disease. The conditions producing a more severe grade of asthma according to our study are family history of asthma, obesity, associated allergic conditions like atopy and allergic rhinitis, GERD, low birth weight and age of onset of less than 1 year of age. The above findings show that intrinsic factors are associated with severity and extrinsic factors are associated with disease manifestations in life