Retrospective cross-sectional study of asthma severity in adult patients at Jimma Medical Center, Ethiopia
Asthma is a common chronic respiratory disease that affects 300 million people worldwide and 50 million people in Africa.6. Poor asthma control is the leading cause of emergency department (ED) access, becoming the most important determinant of the economic burden of asthma management19 continues to increase, particularly in low- and middle-income countries (LMICs), posing a significant public health threat1 including Ethiopia. An early and precise diagnosis of asthma according to its severity is fundamental for its optimal management.1. Asthma severity is assessed retrospectively based on the level of treatment required to control symptoms and exacerbations.
In this study, more than a third of the patients had moderate asthma, suggesting that the patients could speak only in sentences, were mentally agitated and used accessory muscles. The results of the present study indicate that gender, occupational status and smoking status are associated with moderate asthma. Gender affects the severity of asthma development, with men having a reduced likelihood of moderate asthma. This implies that the differences seem to be the product of biological differences between the sexes as well as socio-cultural and environmental differences. Biological sex differences include genetic, lung (developmental) and immunological factors20. Differences in asthma severity trends suggest that sex hormones are involved in the pathogenesis of asthma, with female sex hormones and their receptors promoting the development of asthma and male sex hormones and their receptors exerting a protective effect. Some authors have also reported greater hyper-responsiveness in females than in males and others have shown gender differences in lung capacity.21.
Furthermore, in low- and middle-income countries (LMICs), including Ethiopia, different patterns of indoor activity might also be associated with differences in exposure between men and women. For example, gas cooking has been shown to be associated with respiratory symptoms and a mild reduction in lung function, and women generally do most of the cooking.20.
Occupational status was a predictor of moderate asthma, indicating that daily workers had increased risks compared to their counterparts. This means that patients who are daily workers come from low-income households, which limits the application of appropriate asthma prevention and control mechanisms due to poor patient access to health facilities. Moreover, these people live in poor quality housing occupied by such groups, use charcoal as a source of energy and live in rented houses which induce stress resulting in poor adherence to medication and exacerbation of symptoms, and finally poor asthma control and poor quality of life.8.Furthermore, day laborers are financially dependent on their manual daily work in which they are more likely to be exposed to causative chemical agents which in turn lead to exacerbation of asthma symptoms.22.
Conversely, government employees and shopkeepers were less likely to develop moderate asthma. This can be explained by the fact that government employees and merchants may have a good monthly income that they are able to afford for quality care to control asthma compared to their counterparts. These people are educated to live in urban areas, which increases the chances of obtaining information from different sources on disease control mechanisms, such as avoiding contact with etiological agents, appropriate use of drugs against asthma and physical activity to prevent and control comorbidities, thereby reducing asthma morbidity and mortality and improving quality of life23.
Smoking increased the risk of moderate asthma compared to those who did not smoke. Finding Implies Smoking Worsens Asthma Symptoms and Decreases Drug Effects16. Additionally, the effect of smoking on the airways, like tobacco smoke, flows to inflammatory cells, such as neutrophils, lymphocytes, eosinophils, mast cells, and macrophages. Various inflammatory mediators are released, including lipids, chemokines, cytokines, and growth factors, which cause inflammatory damage and bronchial hyperresponsiveness, a hallmark of asthma.24.
In this study, participants aged 40–59 and ≥60 years and with comorbidities had an increased odds ratio while participants residing in urban areas had a reduced risk of severe asthma compared to their counterparts. . Age seems to influence the severity of asthma. Asthma is a heterogeneous disease that affects patients from childhood to old age. Aging issues such as comorbidities in the elderly. There are also age-related issues that lead to decreased disease control, such as non-adherence, smoking, difficulty using inhalers, and corticosteroid-related side effects that impair disease control. asthma in different age groups.14.
Comorbidities affect the severity of asthma. In the current study, ninety-five percent of participants had comorbidities. The most common comorbidities observed in this study were pneumonia, allergic rhinitis, COPD and cardiovascular disease, resulting in patients with poorly controlled disease, high healthcare costs, reduced work productivity and poor quality of life. , putting additional strain on already economically burdened families and countries.25 including Ethiopia.
This means that the presence of comorbidities can complicate the diagnosis and management of asthma, which can lead to poor asthma control. Comorbid conditions can present various challenges, including diagnostic confusion due to exacerbation of asthma symptoms, therapy of comorbid conditions affecting asthma, or therapy of asthma affecting these conditions26.This suggests the importance of a detailed categorization of asthma patients in terms of comorbidities to adapt the best management27.
In the current study, urban residents were less likely to have severe asthma than their rural counterparts. This contrasts with a study showing that urbanization was associated with asthma attributed to several factors, such as Western diet, obesity, sedentary lifestyle, outdoor pollutants and indoor pollutants due to industrialization. and increasing migration. Alternatively, it has been postulated that this discrepancy is due to underdiagnosis of allergic conditions due to poor access to medical care among rural residents.13. Tegegnework, et al. found that urban residents were more likely to develop asthma than rural residents. This could be because outdoor air in urban areas is heavily polluted due to high levels of traffic and industry-related emissions, which could increase the risk of severe asthma.15.
Another study found that people residing in rural households that are not clean, use firewood for cooking, crop residues and cow dung cake, leading to indoor air pollution, are more likely to report severe asthma.12.
This study had several strengths and limitations. To our knowledge, this is the first study in this area to identify the severity of asthma. A strong analysis method was used to identify the associated factors. One of the limitations of this study was that not all the patients proposed to be included in the study were involved in the study due to the incompleteness of the data, in particular for the age-related data, comorbidities, patient address, registry season and degree of severity. The main limitation of this study was the inability to assess many risk factors that affect asthma severity which has greater significance for asthma prevalence in different studies. It may not be generalizable beyond the study population because it involves patients at a single center and a small sample size.
In conclusion, this study highlights that forty-six percent of patients had moderate asthma. Being male, shopkeeper, and government employee was negatively associated with moderate asthma compared to their counterparts, while being a day laborer and a smoker was positively associated with moderate asthma. The patients’ age and comorbidities had an increased risk of severe asthma compared to their participants in their reference category. Urban residents were less likely to have severe BA compared to their rural counterparts.
Thus, the JMC should have guidelines for the classification of asthma according to severity in order to accurately diagnose and manage asthma appropriately. Should provide up-to-date training to ER staff for the proper classification of asthma based on its severity. It also calls upon health care providers to pay due attention while providing routine care to their patients in accordance with identified factors, especially in patients with comorbidities, to rigorously stratify patients with asthma in terms of comorbidities, in order to adapt the best support. Further longitudinal studies should be conducted to determine its causes and effects.