Prevalence of Asthma in School Children of Rural Areas of
Kanpur, Uttar Pradesh
Chandra Madhur Sharma1, Santokh Singh Bhatia2, Deepti Sharma3, Ravi Prakash
Agrawal4, Manoj Kumar Meghwani5, Bijay Kumar6
1.
2.
3.
4.
5.
6.
Assistant Professor, Department of Pediatrics, Rama Medical College, Hospital & Research Centre, Kanpur
Associate Professor, Department of Pediatrics, Rama Medical College, Hospital & Research Centre,
Kanpur
Junior Resident, Department of Obstetrics and Gynecology, G.S.V.M. Medical College, Kanpur
Assistant Professor, Department of Pediatrics, Rama Medical College, Hospital & Research Centre, Kanpur
Associate Professor, Department of TB & Chest, Rama Medical College, Hospital & Research Centre,
Kanpur
Associate Professor, Department of Pharmacology, Rama Medical College, Hospital & Research Centre,
Kanpur
Corresponding Author
Dr. Chandra Madhur Sharma
Department of Pediatrics,
Rama Medical College, Hospital & Research Centre, Mandhana, Kanpur – 209217
Email: dr.cmsharma@gmail.com
Abstract
Background: Asthma is the most common chronic disease of the childhood and major public
health problem worldwide. However, there is paucity of data on asthma prevalence among
school children in rural areas of Kanpur. The present study was conducted to determine the
prevalence of childhood asthma in rural areas of Kanpur
Methods: This was a questionnaire-based, cross sectional study (International Study of Asthma
and Allergies in Childhood [ISAAC] questionnaire with slight modification) carried out in six
randomly selected schools in the rural areas of Kanpur. The age group included in the study was
5-15 years. The questionnaire was distributed to all the children (n=2275). A response rate of
77.58% was achieved.
Results: Overall prevalence of asthma in our study was found to be 8.20 percent. Boys had a
higher prevalence than girls. Numbers of asthmatic children in different age groups were as
follows: 5-8 years 37/525 (7.04%), 9-11 years 43/560 (7.67%) and 12-15 years 59/610 (9.67%).
Conclusion: In the present study, the prevalence of bronchial asthma in school children in the
age group of 5-15 years was 8.20 percent. Only 4.48% children were diagnosed case of asthma,
reflecting under diagnoses of asthma.
Key words: Asthma, Children, Atopy, Prevalence.
Introduction
Asthma is derived from the Greek word for panting or breathlessness. Unfortunately asthma is
the most common chronic disease of the childhood and it is being increasingly diagnosed [1, 2].
Fortunately asthma in this young age group can be effectively treated and control can be
achieved in most patients.
Though, there are several epidemiological studies available, direct comparisons among studies
are often limited by differences in methodologies used. In an attempt to overcome this limitation,
a standardized protocol has been developed by the International Study of Asthma and Allergies
in Childhood (ISAAC) Committee that comprises a standardized written questionnaire for selfcompletion by teenage children. This method is well validated in the epidemiological studies of
bronchial asthma. This method is cheap, widely acceptable and convenient requiring no special
equipment. Reported prevalence of asthma is ranging from 2.3 % up to 29.5% in various studies
from India [1-9]. However, there is relative lack of data from rural areas. We observed an
increase in the prevalence of childhood asthma with duration of time in our clinical experience.
Therefore, the present study has been carried out to assess the prevalence of bronchial asthma in
school children of rural areas of Kanpur.
Methods
We conducted a cross-sectional questionnaire based study of school going children (5-15 years)
in rural areas of Kanpur city during 2011-2012. We adopted International Study of Asthma and
Allergy in childhood (ISAAC) questionnaire with slight modification, printed in Hindi as well as
English languages [8]. Questions related to severity of asthma were excluded. With the help of
school teachers, the questionnaire was distributed to all children in the age group of 5- 15 years.
The students were then explained in detail the contents of the questionnaire and the usefulness of
the study. For children in the age group of < 10 years years, the questionnaire was filled up by
the parents and in the age group of 10-15 years the questionnaire was filled up by the students
themselves or by parents. This was followed by complete general and systemic examination of
the children. Age was verified from the school register. Those children who answered yes to any
questions related to asthma were labeled as probable asthmatic and were evaluated further for
confirmation of diagnosis including detailed history, physical examination, PEFR before and
after bronchodilation in all probable case and spirometry wherever diagnosis was in doubt.
Children who had many of the qualifier symptoms like recurrent cough or wheezing, exercise
induced symptoms, night symptoms, seasonal variations, personal history of atopy or allergic
rhinitis and family history of asthma or atopy were labeled to have asthma.
Results
Out of the 2275 students who received the questionnaire, 1765 students returned the
questionnaire. Thus, the response rate was 77.58 percent. A total of 96.03 percent questionnaires
(1695/ 1765) were completely filled. Male: female ratio in children with asthma was 1.46:1 and
1.34:1 in overall study population. Children in 12-15 years age comprised the largest group
(35.98%). After analyzing the questionnaires 355 children were labeled probable asthmatics.
After detailed history and physical examination, 139 out of 1695 (8.20%) children were found to
have asthma (in last 12 months). Prevalence of various asthma related symptoms are displayed in
Table 1. Numbers of asthmatic children in different age groups were as follows: 5-8 years 37/525
(7.04%), 9-11 years 43/560 (7.67%) and 12-15 years 59/610 (9.67%). A total of 46.04% (64/139)
subjects had Personal history of atopy or allergic rhinitis and family history of asthma was
present in 56 of 139 (40.29%). History of allergic disorders (rhinitis, conjunctivitis or skin
allergy) was present in 41(29.49%) asthmatic children.
Discussion
In the present study, the prevalence of asthma in school children from rural areas of Kanpur city
was found to be 8.2 percent. However, in a study in school children from rural areas of Ajmer
3.4% children had asthma which is quite low as compared to our study [7]. Similar lower
prevalence rate (2.3%) was reported by Behl RK et al [9]. On the other hand Chhabra et al [6]
reported a higher prevalence rate of 11.9% amongst Delhi school children. Similar higher
prevalence rate was reported by Parmesh [3] who showed a prevalence of 29.5% in Bangalore
city. Thus there are wide variations in the prevalence of childhood asthma. There are many
studies on prevalence of childhood asthma in different parts of India and majority of them
showing increasing trends [2-6]. According to the steering committee of ISAAC, in 1998,
prevalence of Current Wheeze and ever asthma was 6.0% and 4.5% in India. However, there
were wide variations in the prevalence from different regions and concerns that prevalence may
have been underestimated due to various reasons [8]. Prevalence of current wheeze in our study
was 9.5 % which is quite similar to the trends has seen in recent studies [3, 5, 6]. The rate of
diagnosed cases of asthma was 4.48 % in our study which is lower than current asthma
prevalence, reflecting under diagnosis of childhood asthma. Actual prevalence of asthma could
be even higher as we also had the limitations of questionnaire based surveys including
underreporting, due social stigma attached with asthma , poor perception of symptoms and also
the exercise induced asthma and mild episodic cases where symptoms may not be present and
physical examinations as well as pulmonary functions test may be normal.
Conclusions
In the present study, the prevalence of bronchial asthma in school children in the age group of 515 years was 8.20 percent. This indicates that the burden of bronchial asthma in Indian children
is higher than was previously understood. Only 4.48% children were diagnosed case of asthma,
reflecting under diagnoses of asthma.
Table – 1 Prevalence of Asthma related symptoms
Asthma related factors
Prevalence (N=1695)
Recurrent cough
355 (20.94%)
Wheezing / Whistling sound during breathing any time in the past
161 ((09.50%)
Wheezing / Whistling sound during breathing in last 12 months
149 (08.79%)
Previously diagnosed cases of asthma
76
(04.48%)
Sleep disturbances due to wheezing in last 12 months
67
(03.95%)
Dry cough in night in last 12 months not associated with cold/ chest 223 (13.16%)
infection
Family H/O asthma
132 (07.79%)
Family H/O allergy or eczema
96
(05.67%)
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