Factors Influencing Control in Bronchial Asthma in Children Aged between 5 to 12 years at a Tertiary Care Teaching Hospital

INTRODUCTION: Asthma is a non-communicable chronic airway inflammatory disorder, in susceptible individuals it causes recurrent episodes of wheezing, breathlessness, chest tightness and nocturnal cough particularly at night and early morning associated with variable and widespread airway obstruction often reversed by either spontaneously or with bronchodilator therapy. The inflammation also causes increased bronchial hyper responsiveness to various stimuli. AIMS OF THE STUDY: The aim of the study is to identify the FACTORS INFLUENCING CONTROL IN BRONCHIAL ASTHMA in children aged between 5 to 12 years at a tertiary care teaching hospital in Chennai. OBJECTIVES: To Study the factors influencing control in bronchial asthma by comparing well controlled children and poorly controlled children with bronchial asthma between 5 to 12 years of age at tertiary care teaching hospital in Chennai. STUDY DESIGN: Cross Sectional study. Study Setting: Institute of Child Health & Hospital for Children, Chennai. Study Period: April 2018 to March 2019. Study Population: Children between 5 to 12 years of age with bronchial asthma being treated as outpatient or inpatient at asthma clinic &wards in ICH&HC Chennai respectively. Sample size -160 cases (poorly controlled children) and 160 controls (well controlled children). Inclusion criteria: 1. Children between 5 to 12 years of age with physician diagnosed asthma attending the asthma clinic regularly for a minimum of 3 months. 2. Children between 5 to 12 years of age with physician diagnosed asthma admitted in wards with bronchial asthma exacerbations. Exclusion criteria: 1. Patients who had other chronic illness such as primary immunodeficiency diseases, heart diseases, and neurological, genetic diseases and other chronic pulmonary diseases, children on vitamin D supplementation were excluded. 2. Children with asthma admitted for complaints other than exacerbations. 3. Parents who are not given consent for this study. 4. Children who were not accompanied by primary care giver. MATERIALS AND METHODS: After getting informed written consent from parents, Information about age, sex, Body Mass Index (BMI), residential area, socioeconomic status obtained from the caregiver and recorded in the questionnaire. Information about asthma knowledge, family history of atopy/asthma, treatment adherence, inhaler technique, associated comorbid conditions (sinusitis, allergic rhinitis, allergic dermatitis, adenotonsillitis, allergic conjunctivitis), presence of overcrowding, industrial smoke exposure, type of fuel used for cooking in home (gas stove, kerosene, wood, others), presence of tobacco smoking in the family, usage of incense sticks /camphor/ frankincense, presence of pet animal in the home, presence of trigger factors including avoidance of known trigger factors, vaccination status other than vaccination as per national immunization schedule like annual influenza vaccination were collected. Level of caregiver’s asthma knowledge was assessed by using a Pre validated 25-items Asthma knowledge questionnaire. Level of asthma control was assessed by GINA 2017 consensus based symptom control tool to avoid bias. As per GINA 2017 guidelines, Based on that children with physician diagnosed asthma were grouped into well controlled, partially controlled and uncontrolled group. For Comparison with well controlled children, Partial/uncontrolled children were grouped together as poorly controlled children. Blood samples were collected for measuring haemoglobin levels, peripheral smear study for Eosinophilia, Serum vitamin D3 levels, C - reactive protein (CRP) level from peripheral vein. RESULTS: Urban residence, low socioeconomic status, Poor asthma knowledge, Poor adherence to treatment, Improper inhaler technique, comorbid conditions like Allergic Rhinitis and allergic Rhinitis with Conjunctivitis, Usage of incense sticks/camphor/frankincense, VitaminD3 deficiency, Peripheral Eosinophilia, positive serum CRP were found as independent risk factors for poor asthma control. CONCLUSION: Cornerstone of asthma control is identification of risk factors and their removal or modification. Our study shows Urban residence, Poor parental asthma knowledge, Poor adherence to treatment, improper inhaler technique, Comorbid conditions like Allergic Rhinitis and Allergic Rhinitis with Conjunctivitis, Usage of incense sticks/camphor/frankincense, Vitamin D3 deficiency, peripheral Eosinophilia as independent risk factors for poor control. Parent education programs, Asthma support groups, written individualised action plan, Avoidance of triggers like incense sticks, vitamin D supplementation, positive reinforcement of correct inhaler technique and treatment adherence will go a long way in making asthma control an achievable goal