Prevalence of Comorbid Conditions in Relation to Severity of Asthma

INTRODUCTION: Childhood Asthma has emerged perhaps as the commonest chronic medical problem treated by pediatricians all over the world. what was originally thought to be a disorder affecting only adults has emerged as a very significant problem affecting the child’s life style and day to day activities including schooling, sports and recreation. The incidence of asthma is increasing alarmingly in the past few decades1. Because asthma is a complex and heterogenous disease with many phenotypic expressions through the course of childhood, it is challenging to characterize. First the clinical manifestations of asthma are non specific and many children wheeze during the first few years of life. But only a few of these children develop persistent wheezing and clinical asthma2. Approximately 60% are transient wheezes who outgrow their disease by 5 years of age. DEFINITION OF ASTHMA: The manner in which asthma has been defined has changed significantly over time. ·1.In 1950’s asthma was defined as a disease characterized by airflow obstruction that could resolve spontaneously or following therapy3. 2. In 1960’s asthma was viewed as an episodic disease in which airflow obstruction was caused by bronchial hyper responsiveness4. 3. In 1970’s the concept of preventing bronchospasm and managing disease progression was considered. 4.In 1990’s asthma was redefined as a chronic inflammatory disease characterized by reversible airflow obstruction and bronchial hyper responsiveness. AIM OF THE STUDY: 1. To assess the prevalence of specific co-morbid conditions like (a) Allergic rhinitis, (b) Sinusitis and (c) Gastroesophageal reflux disease in children with asthma 2. Association of these conditions in relation to severity of asthma. DISCUSSION: AGE AND SEX DISTRIBUTION OF ASTHMA: Most of the children with asthma were in the age group of 6-8 years, although they were more or less equally distributed. The male : female ratio is 1.22 : 1, although no statistical significance was found. FAMILY HISTORY OF ASTHMA / ATOPY: The children with asthma with family History of Asthma / Atopy were 66 out of 159. The distribution of them among first degree and second degree relatives were 35 and 31 respectively. The relationship of family History of asthma/atopy with different grades of asthma was not statistically significant. But several studies like A.Ten Brinke et al10. , have shown that patients with frequent asthma exacerbations (Severe asthma) more often had family history of asthma/atopy which was statistically significant. SEVERITY OF ASTHMA: The distribution of asthma was less in Grade IV (Severe Persistent) - 4.4 %. Several studies including Irwin et al11, that were done in adult patients with asthma have shown more or less equal distribution among different grades of asthma. CONCLUSION: 1. This study concludes that the prevalence of Allergic Rhinitis and sinusitis was greater in children with asthma. 2. There is a higher prevalence of Allergic rhinitis and sinusitis among moderate /severe asthma than mild group of children with asthma, implicating that these factors could contribute to the severity of asthma and its exacerbations. 3. So all the children diagnosed as bronchial asthma, particularly moderate persistent and severe persistent asthma should be evaluated for the presence of co-morbid conditions, which if treated simultaneously will result in less asthma exacerbations with a greater improvement in their quality of life including schooling, sports and recreation.