![Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12)
36
Past Respiratory Problems:
Asthma, Chronic obstructive lung disease (COPD), Pneumonia,
Tuberculosis, Lower Respiratory Tract Infection (LRTI),
Pneumo Thorax, Malignant Lung, Sinusitis.
Non-respiratory co-morbidities: Hypertension (HTN), diabetes
mellitus type 2(DM2),Hypothyroidism.
5. Social history (smoking, alcohol & tobacco snoring)
6. Month of admission (July to October- Monsoon and
November to February- winter)
Ethical Issues: Institutional ethical committee (IEC) approval
was obtained prior to the initiation of the study
RESULTS
In these 8 months of study conducted at St. Joseph’s general
hospital, 71 in-patients have been diagnosed with respiratory
problems. Out of this 71 patients 39(55%) were male and
32(45%) were female. A general statistics is done on age
distribution of patients using SPSS version 16.0. The mean age of
the patients was found to be 54.800 (with a standard deviation of
±27.758).It was observed that males of 71-80 years of age and
females of 61-70 years of age have high prevalence of respiratory
problems, whereas, the least prevalence was observed in patients
of < 1 year and 11-20 years of age. The distribution of respiratory
problems at various locations was observed, and it was noted that
patients with respiratory problems were more from Guntur city
(59%), those from rural area of guntur district has intermediate
percentage of cases (27%) and least cases were from areas of non
guntur district (14%).When social history of the patients was
observed, it was found that majority of the patients (90%) do not
have any social history of tobacco or alcohol consumption. When
it comes to diagnosis, majority of the patients under study are
diagnosed with acute lower respiratory tract infection
(LRTI)[28.17%]. And it was also found that patients without any
previous history of respiratory problems were more (53.52%)
than those with previous history of respiratory problems
(46.48%).
Table 1: Age and gender distribution of respiratory problems
Age MALE FEMALE Total
<1 1 1 3%
1 TO 10 6 2 11%
11 TO 20 1 0 1%
21 TO 30 1 2 4%
31 TO 40 3 3 8%
41 TO 50 4 1 7%
51 TO 60 1 2 4%
61 TO 70 6 11 24%
71 TO 80 9 6 21%
81 TO 90 7 4 15%
Table 2: Area wise distribution of respiratory problems during different months
Location JUL-OCT (MONSOON & AUTUMN) NOV-FEB (WINTER) PERCENTAGE
NON GNT 6 4 14%
GNT URBAN 21 21 59%
GUNTUR RURAL 9 10 27%
TOTAL 36 35 100%
Table 3: Distribution of respiratory problems in association with social history
SOCIAL HISTORY NO. OF PATIENTS PERCENTAGE OF PATIENTS
SMOKING 4 6%
ALCOHOL 0 0%
BOTH 3 4%
TOBACCO SNORING 0 0%
NO SOCIAL RISK FACTORS 64 90%
TOTAL 71 100%
Table 4: Distribution of various respiratory problems among the patients under study
DIAGNOSIS WITH PREVIOUS HISTORY
OF RESPIRATORY
PROBLEMS
WITHOUT PREVIOUS
HISTORY OF
RESPIRATORY PROBLEMS
TOTAL PERCENT
TOTAL
ASTHMA 4 1 5 7%
ACUTE BRONCHITIS 0 5 5 7%
CHRONIC BRONCHITIS 1 0 1 1%
VIRAL BRONCHITIS 0 1 1 1%
COPD 8 6 14 20%
ILD 1 0 1 1%
LRTI 7 20 27 38%
LUNG CANCER 1 0 1 1%
PNEUMONIA 1 2 3 4%
RESPIRATORY FAILURE TYPE 2 4 3 7 10%
TB 2 0 2 3%
TONSILITIS 1 0 1 1%
SOB DUE TO PLEURAL
EFFUSION
2 0 2 3%](https://image.slidesharecdn.com/5-240928072123-bff7ddc8/85/EPIDEMIOLOGY-OF-RESPIRATORY-PROBLEMS-IN-ASSOCIATION-2-320.jpg)
![Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12)
39
Figure 4: Social habits among patients with respiratory problems
DISCUSSION
A total of 71 cases were collected from in-patient wards of
pulmonology department at St. Joseph’s general hospital. Highest
bar of the respiratory problems was observed in 61-70 years for
females (15.49%) and from there the height of the bar declined
gradually, as per the bar graph (Fig.1). Whereas for males the
peak was at 71-80 years (12.68%). This (Table 1 & Fig.1) shows
that though the distribution was not regular, majority of the
patients are elders (> 60 years) and the mean age of the patients
was found to be 54.8 (±27.758).Many experts state that there are
many age-associated changes in the respiratory and pulmonary
system. According to them, the size of the thoracic cavity
decreases with age, limiting lung volumes and altering the
muscles that aid in respiration. Muscle function on a cellular level
is less efficient and has decreased reserve. Due to some anatomic
changes and muscle atrophy, cough strength is reduced in the
elderly population and also the clearance of particles from the
lung through the mucociliary elevator is negatively impacted and
associated with ciliary dysfunction. Many complex changes in
immunity occur with aging that increases the susceptibility to
various infections. COPD has the highest prevalence in the
elderly and deserves special consideration in regard to treatment
in fragile (elderly) population6
.In our study more patients were
from areas within the Guntur city (59%). Also, the patients of
rural areas were not exempted from respiratory problems in our
study; more than ¼ patients under study (27%) were from non-
urban areas of Guntur. In a cross-sectional study conducted by
Pragti Chhabra and team7
, house-to-house survey was conducted
in an urban upper middle-class locality. In which they found that
all the symptoms [chronic cough, chronic phlegm and dyspnea]
increased with age (P < 0.05). No significant difference was
observed in these symptoms between males and females7
.
Though most of the patients in our study were without any social
habit (smoking & snoring tobacco or alcoholic consumption) they
were diagnosed with one or the other respiratory problems (90%).
Among the other (10%) patients, majority (6%) were only
smokers whereas others (4%) were having habit of both smoking
and alcohol consumption (Table.3 & Figure.4). In this study the
previous medical history of patients was categorized into
pulmonary (respiratory) and other co-morbidities. Table 7 shows
the medical history of patients who are without any social history
of smoking and/or alcohol consumption. It shows that, 45.3%
patients were with previous history of respiratory problems and
56.2% patients were with history of non-respiratory co-
morbidities. It also shows that 28.125% of patients were with
history of both respiratory and non-respiratory co-morbidities and
26.5% were without any previous medical history. According to
a review conducted in 2001, the reported smokers: nonsmokers
ratios varied from 61.6% to 91.1% in 10 different populations8
.
From Table 4 & Figure 3 it is clear that, the percentage of patients
without previous history of pulmonary diseases is more (53.52%)
than that of patients with previous history of pulmonary diseases
(46.48%).Among the non-pulmonary co-morbidities majority of
the patients were without any co-morbidity of
HTN/DM2/Hypothyroidism (36%) and 19% patients were with
both HTN and DM2, 6% were with HTN alone, 4% with DM2
alone, 3% with HTN + Hypothyroidism, 2% with
Hypothyroidism alone and 1% patients were with DM2 and
Hypothyroidism (Table 5). When the medical history data of the
patients was analyzed with SPSS version 6.0, it showed no
significant difference in both respiratory history and history of co-
morbidities was present between male and female (P > 0.05).
People with type 2 diabetes more frequently reported grade 2
dyspnoea and chronic cough/phlegm than the general population
of the same age, although presenting similar smoking habits9
.
Among the diagnosed respiratory problems, Acute Lower
Respiratory Tract Infection [LRTI] was seen in majority of
patients (38%), followed by COPD (20%) and type 2 respiratory
failure (10%). Further distribution of patients with other
respiratory problems can be known through Table 4 And Figure
3. In this study seasonal variation was also taken into
consideration and was observed for its influence on the rate of
admission of patients at pulmonology department. Climate
change represents a massive threat to respiratory health: 1) by
directly promoting or aggravating respiratory diseases; or 2) by
increasing exposure to risk factors for respiratory diseases.
According to a review by Gennaro D’Amato10
, climate change
increases the amount of pollen and allergen produced by each
plant, mould proliferation and the concentrations of outdoor
ozone and particulate matter at ground level. The main diseases
of concern during this climate change are asthma, rhinosinusitis,
chronic obstructive pulmonary disease (COPD) and respiratory
tract infections. Groups at higher risk of climate change effects
include individuals with pre-existing cardiopulmonary diseases
or elderly individuals10
. In our study, the range of months from
July to October was considered as one set (Monsoon &Autumn)
and duration from December to February was taken as another set
(winter). The viral infections are high in monsoons due to damp
and humid weather, which is a perfect environment for bacterial](https://image.slidesharecdn.com/5-240928072123-bff7ddc8/85/EPIDEMIOLOGY-OF-RESPIRATORY-PROBLEMS-IN-ASSOCIATION-5-320.jpg)
![Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12)
40
growth. In the current study it was observed that there is no much
difference in the number of in-patient admissions in between both
sets/seasons. In monsoon & autumn one extra case (51%) has
been observed than in winter (49%) which can be clearly
observed through Table 6.
CONCLUSION
This epidemiological study shows that respiratory problems are
becoming the major concern in the human health. Majority of
patients in our study were elderly. This shows that age has a major
effect on the occurrence of respiratory problems and there are
many studies to support this statement. Though most of the
patients in our study were from the urban area, the cases from the
rural area are not negligibly less. The results of our study show
that the effect of the locality of living, on prevalence of
respiratory problems, is more prominent than seasonal effect. No
significant difference (P>0.05) was observed in medical co-
morbidities between male and female. This shows that gender of
the patient doesn’t have significant effect on prevalence of the
respiratory problems in association with co-morbidities.
Although the previous history of pulmonary problems and non-
pulmonary co-morbidities may not be solely responsible for
developing a respiratory disease, they may exacerbate the
condition/disease. The results also show that, among the patients
without any smoking history, majority of patients were with the
history of both respiratory and non-respiratory co-morbidities.
From the overall study, it can be concluded that, presence of non-
respiratory co-morbidities (HTN, DM2, and Hypothyroidism)
acts as major risk factor and has more influence on prevalence of
respiratory problems. Though the results of this study are not
conclusive, many studies have been conducted on the effect of co-
morbidities on respiratory problems and most of them show that
the presence of co-morbidities influences the occurrence of
respiratory problems.
ACKNOWLEDGEMENT
Authors are very thankful to the management and working staff
at St. Joseph’s general hospital for providing the facilities to carry
out our study. We are also thankful to our professors who guided
us to conduct this study.
REFERENCES
1. Last JM, editor. Dictionary of epidemiology. 4th ed. New
York: Oxford University Press; 2001. p. 61.
2. Greenwood M.Epidemics and crowd-diseases: an
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3. Centers for Disease Control and Prevention (CDC), editors.
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in Public Health Practice; 3rd
edition;2006. p.1-2
4. GBD 2015 Mortality and Causes of Death Collaborators.
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death, 1980–2015: a systematic analysis for the Global
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5. Forum of International Respiratory Societies. The Global
Impact of Respiratory Disease – Second Edition. Sheffi eld,
European Respiratory Society, 2017.
6. Lowery, E. M., Brubaker, A. L., Kuhlmann, E., & Kovacs, E.
J. (2013). The aging lung. Clin Interv Aging. 2013; 8: 1489–
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7. Chhabra P, Sharma G, Kannan AT. Prevalence of respiratory
disease and associated factors in an urban area of Delhi.
Indian J Community Med. 2008; 33:229–32.
8. Jindal SK, Aggarwal AN, Gupta D. A review of population
studies from India to estimate national burden of chronic
obstructive pulmonary disease and its association with
smoking. Indian J Chest Dis Allied Sci. 2001 Jul-
Sep;43(3):139-47.
9. De Santi F, Zoppini G, Locatelli F, Finocchio E, Cappa V,
Dauriz M, Verlato G. Type 2 diabetes is associated with an
increased prevalence of respiratory symptoms as compared to
the general population. BMC Pulm Med. 2017 Jul
17;17(1):101.
10. Gennaro D’Amato, Lorenzo Cecchi, Mariella D’Amato and
Isabella Annesi-Maesano. Climate change and respiratory
diseases. European Respiratory Review 2014 [cited 2020 Dec
16]; 23: 161-169. Available from: https://err.ersjournals.com/
content/23/132/161
Cite this article as:
Vedantham Satya Chakravarthy et al. Epidemiology of
respiratory problems in association with various risk factors: A
clinical study at St. Joseph’s general hospital. Int. Res. J. Pharm.
2020;11(12): 35-40.
http://dx.doi.org/10.7897/2230-8407.1112105
Source of support: Nil, Conflict of interest: None Declared
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EPIDEMIOLOGY OF RESPIRATORY PROBLEMS IN ASSOCIATION
- 1. Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12) 35 INTERNATIONAL RESEARCH JOURNAL OF PHARMACY www.irjponline.com ISSN 2230 – 8407 Research Article EPIDEMIOLOGY OF RESPIRATORY PROBLEMS IN ASSOCIATION WITH VARIOUS RISK FACTORS: A CLINICAL STUDY AT ST. JOSEPH’S GENERAL HOSPITAL Vedantham Satya Chakravarthy 1 *, Dasari Rama Krishna Prasad 1 , Reddy Pavan Teja 1 , Darabadi Rispa 2 1 Department of Pharmacy Practice, Hindu college of pharmacy, Amaravathi road, Guntur, Andhra Pradesh, India 2 Assistant professor, Department of pharmacy practice, Hindu college of pharmacy, Amaravathi road, Guntur, Andhra Pradesh, India *Corresponding Author Email: [email protected] Article Received on: 6/12/20 Approved for publication: 31/12/20 DOI: 10.7897/2230-8407.1112105 ABSTRACT The aim of the study was to identify the epidemiology of respiratory problems and to assess their association with various risk factors in patients of St. Joseph’s general hospital, Guntur, Andhra Pradesh. The study was conducted over a period of 8 months (July-2019 to February-2020) in 71 patients (both males and females) and the data was analyzed using EXCEL 2007 and SPSS version 6.0. The study was conducted throughout 3 seasons (Monsoon, autumn, winter) during which people are more prone to respiratory problems. Demographic information like the name, age, gender, address, and previous medical history was included. The risk factors like time of admission (month), location, age, gender, past medical history & other co- morbidities and social history were considered. The diagnosed pulmonary problems include Asthma, Bronchitis (acute, chronic & viral), COPD, Interstitial Lung Disease, LRTI, Lung Cancer, Pneumonia, Respiratory Failure, Tuberculosis, Tonsillitis and Shortness of Breath due to either Plural Effusion or Pulmonary Oedema. This study depicts the epidemiology of respiratory problems as Non-Guntur district (14.084%), Guntur urban (59.154%), Guntur rural (26.760%). This study shows the results as; patient with social history of tobacco and/or alcohol (10%), patients without any social history (90%), without any past medical history or other co-morbidities (51%), with some past medical history (49%), males (54.93%), females (45.07), July to October (50.7%), November to February (49.3%). And 61-to-70-year patients are at the top (23.94%) and 11 to 20 year patients are at the bottom (1.40%) of the distribution. KEY WORDS: Clinical Study, Epidemiological Study, Respiratory Disorders, Respiratory Diseases. INTRODUCTION The aim of the study was to identify and assess the epidemiology of respiratory problems in St. Joseph’s Hospital and the association of various risk factors with the medical condition. Epidemiology is the study of distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems1 .Epidemiology was originally focused exclusively on epidemics of communicable diseases but was subsequently expanded to address endemic communicable diseases and non- communicable infectious diseases2 . By the middle of the 20th Century, additional epidemiologic methods had been developed and applied to chronic diseases, injuries, birth defects, maternal- child health, occupational health, and environmental health. Epidemiology is also used to search for determinants, which are the causes and other factors that influence the occurrence of disease and other health-related events. Determinant is any factor, whether event, or other definable entity, that brings about a change in a health condition or other defined characteristics3 . Respiratory problems are leading causes of death and disability in the world. Respiratory diseases impose an immense worldwide health burden. Five of these diseases (COPD, Asthma, acute lower respiratory tract infections, tuberculosis and lung cancer) are among most common causes of severe illness and death worldwide4,5 . MATERIALS AND METHODS Place of Study: The study was conducted at St. Joseph’s general hospital, Guntur, Andhra Pradesh, India. Inclusive Criteria • Male and female patients of all ages. • Patients with any respiratory problem • Patients who had admitted as In-Patients in pulmonology department, at St.Joseph’s general hospital, Guntur. Exclusion Criteria Respiratory illness due to Trauma of the chest and ribs Study Duration: 8 months (July to February) Source of Data: The source of data is from patient case sheets from wards, direct patient interview and archived patient data from record room. Data collected include name, age, gender and address of the patient, current disease diagnosed, past medical history and social history of the patient. Risk Factors Considered Are 1. Age (>1 year) 2. Gender (male and female) 3. Location where the patient is living (in the city and in the village) 4. Past medical history (respiratory problems and other co- morbidities)
- 2. Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12) 36 Past Respiratory Problems: Asthma, Chronic obstructive lung disease (COPD), Pneumonia, Tuberculosis, Lower Respiratory Tract Infection (LRTI), Pneumo Thorax, Malignant Lung, Sinusitis. Non-respiratory co-morbidities: Hypertension (HTN), diabetes mellitus type 2(DM2),Hypothyroidism. 5. Social history (smoking, alcohol & tobacco snoring) 6. Month of admission (July to October- Monsoon and November to February- winter) Ethical Issues: Institutional ethical committee (IEC) approval was obtained prior to the initiation of the study RESULTS In these 8 months of study conducted at St. Joseph’s general hospital, 71 in-patients have been diagnosed with respiratory problems. Out of this 71 patients 39(55%) were male and 32(45%) were female. A general statistics is done on age distribution of patients using SPSS version 16.0. The mean age of the patients was found to be 54.800 (with a standard deviation of ±27.758).It was observed that males of 71-80 years of age and females of 61-70 years of age have high prevalence of respiratory problems, whereas, the least prevalence was observed in patients of < 1 year and 11-20 years of age. The distribution of respiratory problems at various locations was observed, and it was noted that patients with respiratory problems were more from Guntur city (59%), those from rural area of guntur district has intermediate percentage of cases (27%) and least cases were from areas of non guntur district (14%).When social history of the patients was observed, it was found that majority of the patients (90%) do not have any social history of tobacco or alcohol consumption. When it comes to diagnosis, majority of the patients under study are diagnosed with acute lower respiratory tract infection (LRTI)[28.17%]. And it was also found that patients without any previous history of respiratory problems were more (53.52%) than those with previous history of respiratory problems (46.48%). Table 1: Age and gender distribution of respiratory problems Age MALE FEMALE Total <1 1 1 3% 1 TO 10 6 2 11% 11 TO 20 1 0 1% 21 TO 30 1 2 4% 31 TO 40 3 3 8% 41 TO 50 4 1 7% 51 TO 60 1 2 4% 61 TO 70 6 11 24% 71 TO 80 9 6 21% 81 TO 90 7 4 15% Table 2: Area wise distribution of respiratory problems during different months Location JUL-OCT (MONSOON & AUTUMN) NOV-FEB (WINTER) PERCENTAGE NON GNT 6 4 14% GNT URBAN 21 21 59% GUNTUR RURAL 9 10 27% TOTAL 36 35 100% Table 3: Distribution of respiratory problems in association with social history SOCIAL HISTORY NO. OF PATIENTS PERCENTAGE OF PATIENTS SMOKING 4 6% ALCOHOL 0 0% BOTH 3 4% TOBACCO SNORING 0 0% NO SOCIAL RISK FACTORS 64 90% TOTAL 71 100% Table 4: Distribution of various respiratory problems among the patients under study DIAGNOSIS WITH PREVIOUS HISTORY OF RESPIRATORY PROBLEMS WITHOUT PREVIOUS HISTORY OF RESPIRATORY PROBLEMS TOTAL PERCENT TOTAL ASTHMA 4 1 5 7% ACUTE BRONCHITIS 0 5 5 7% CHRONIC BRONCHITIS 1 0 1 1% VIRAL BRONCHITIS 0 1 1 1% COPD 8 6 14 20% ILD 1 0 1 1% LRTI 7 20 27 38% LUNG CANCER 1 0 1 1% PNEUMONIA 1 2 3 4% RESPIRATORY FAILURE TYPE 2 4 3 7 10% TB 2 0 2 3% TONSILITIS 1 0 1 1% SOB DUE TO PLEURAL EFFUSION 2 0 2 3%
- 3. Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12) 37 SOB DUE TO PULMONARY EDEMA 1 0 1 1% TOTAL 33 38 71 PERCENTAGE 46% 54% 100% Table 5: Respiratory problems in association with medical co-morbidities MEDICAL HISTORY PATIENTS PERCENTAGE WITHOUT ANY RISK FACTORS OF HTN/DM2/HYPOTHYROIDISM 36 51% HTN ALONE 6 8% DM2 ALONE 4 6% HYPOTHYROIDISM ALONE 2 3% HTN + DM2 19 27% HTN + HYPOTHYROIDISM 3 4% DM2 AND HYPOTHYROIDISM 1 1% TOTAL 71 100% Table 6: Effect of season on no. of in-patient admissions DURATION SEASON NO. OF IN-PATIENTS WITH RESPIRATORY PROBLEMS PERCENTAGE JULY-OCT MONSOON & AUTUMN 36 51% NOV-FEB Winter 35 49% Table 7: comparison and analysis of medical history among patients without any social history MEDICAL HISTORY WITH ANY H/O RESPIRATORY PROBLEMS WITHOUT ANY H/O RESPIRATORY PROBLEMS TOTAL WITH NON-RESPIRATORY CO-MORBIDITIES 18 18 36(56.2%) WITHOUT ANY NON- RESPIRATORY CO- MORBIDITIES 11 17 28(43.7%) TOTAL 29(45.3%) 35(54.6%) 64 (patients without any social history but with some medical history) Figure 1: Age and gender distribution among patients with respiratory problems
- 4. Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12) 38 Figure 2: Area wise distribution of patients with respiratory problems Figure 3: distribution of patients with various respiratory problems in association with past medical history
- 5. Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12) 39 Figure 4: Social habits among patients with respiratory problems DISCUSSION A total of 71 cases were collected from in-patient wards of pulmonology department at St. Joseph’s general hospital. Highest bar of the respiratory problems was observed in 61-70 years for females (15.49%) and from there the height of the bar declined gradually, as per the bar graph (Fig.1). Whereas for males the peak was at 71-80 years (12.68%). This (Table 1 & Fig.1) shows that though the distribution was not regular, majority of the patients are elders (> 60 years) and the mean age of the patients was found to be 54.8 (±27.758).Many experts state that there are many age-associated changes in the respiratory and pulmonary system. According to them, the size of the thoracic cavity decreases with age, limiting lung volumes and altering the muscles that aid in respiration. Muscle function on a cellular level is less efficient and has decreased reserve. Due to some anatomic changes and muscle atrophy, cough strength is reduced in the elderly population and also the clearance of particles from the lung through the mucociliary elevator is negatively impacted and associated with ciliary dysfunction. Many complex changes in immunity occur with aging that increases the susceptibility to various infections. COPD has the highest prevalence in the elderly and deserves special consideration in regard to treatment in fragile (elderly) population6 .In our study more patients were from areas within the Guntur city (59%). Also, the patients of rural areas were not exempted from respiratory problems in our study; more than ¼ patients under study (27%) were from non- urban areas of Guntur. In a cross-sectional study conducted by Pragti Chhabra and team7 , house-to-house survey was conducted in an urban upper middle-class locality. In which they found that all the symptoms [chronic cough, chronic phlegm and dyspnea] increased with age (P < 0.05). No significant difference was observed in these symptoms between males and females7 . Though most of the patients in our study were without any social habit (smoking & snoring tobacco or alcoholic consumption) they were diagnosed with one or the other respiratory problems (90%). Among the other (10%) patients, majority (6%) were only smokers whereas others (4%) were having habit of both smoking and alcohol consumption (Table.3 & Figure.4). In this study the previous medical history of patients was categorized into pulmonary (respiratory) and other co-morbidities. Table 7 shows the medical history of patients who are without any social history of smoking and/or alcohol consumption. It shows that, 45.3% patients were with previous history of respiratory problems and 56.2% patients were with history of non-respiratory co- morbidities. It also shows that 28.125% of patients were with history of both respiratory and non-respiratory co-morbidities and 26.5% were without any previous medical history. According to a review conducted in 2001, the reported smokers: nonsmokers ratios varied from 61.6% to 91.1% in 10 different populations8 . From Table 4 & Figure 3 it is clear that, the percentage of patients without previous history of pulmonary diseases is more (53.52%) than that of patients with previous history of pulmonary diseases (46.48%).Among the non-pulmonary co-morbidities majority of the patients were without any co-morbidity of HTN/DM2/Hypothyroidism (36%) and 19% patients were with both HTN and DM2, 6% were with HTN alone, 4% with DM2 alone, 3% with HTN + Hypothyroidism, 2% with Hypothyroidism alone and 1% patients were with DM2 and Hypothyroidism (Table 5). When the medical history data of the patients was analyzed with SPSS version 6.0, it showed no significant difference in both respiratory history and history of co- morbidities was present between male and female (P > 0.05). People with type 2 diabetes more frequently reported grade 2 dyspnoea and chronic cough/phlegm than the general population of the same age, although presenting similar smoking habits9 . Among the diagnosed respiratory problems, Acute Lower Respiratory Tract Infection [LRTI] was seen in majority of patients (38%), followed by COPD (20%) and type 2 respiratory failure (10%). Further distribution of patients with other respiratory problems can be known through Table 4 And Figure 3. In this study seasonal variation was also taken into consideration and was observed for its influence on the rate of admission of patients at pulmonology department. Climate change represents a massive threat to respiratory health: 1) by directly promoting or aggravating respiratory diseases; or 2) by increasing exposure to risk factors for respiratory diseases. According to a review by Gennaro D’Amato10 , climate change increases the amount of pollen and allergen produced by each plant, mould proliferation and the concentrations of outdoor ozone and particulate matter at ground level. The main diseases of concern during this climate change are asthma, rhinosinusitis, chronic obstructive pulmonary disease (COPD) and respiratory tract infections. Groups at higher risk of climate change effects include individuals with pre-existing cardiopulmonary diseases or elderly individuals10 . In our study, the range of months from July to October was considered as one set (Monsoon &Autumn) and duration from December to February was taken as another set (winter). The viral infections are high in monsoons due to damp and humid weather, which is a perfect environment for bacterial
- 6. Vedantham Satya Chakravarthy et al. Int. Res. J. Pharm. 2020, 11 (12) 40 growth. In the current study it was observed that there is no much difference in the number of in-patient admissions in between both sets/seasons. In monsoon & autumn one extra case (51%) has been observed than in winter (49%) which can be clearly observed through Table 6. CONCLUSION This epidemiological study shows that respiratory problems are becoming the major concern in the human health. Majority of patients in our study were elderly. This shows that age has a major effect on the occurrence of respiratory problems and there are many studies to support this statement. Though most of the patients in our study were from the urban area, the cases from the rural area are not negligibly less. The results of our study show that the effect of the locality of living, on prevalence of respiratory problems, is more prominent than seasonal effect. No significant difference (P>0.05) was observed in medical co- morbidities between male and female. This shows that gender of the patient doesn’t have significant effect on prevalence of the respiratory problems in association with co-morbidities. Although the previous history of pulmonary problems and non- pulmonary co-morbidities may not be solely responsible for developing a respiratory disease, they may exacerbate the condition/disease. The results also show that, among the patients without any smoking history, majority of patients were with the history of both respiratory and non-respiratory co-morbidities. From the overall study, it can be concluded that, presence of non- respiratory co-morbidities (HTN, DM2, and Hypothyroidism) acts as major risk factor and has more influence on prevalence of respiratory problems. Though the results of this study are not conclusive, many studies have been conducted on the effect of co- morbidities on respiratory problems and most of them show that the presence of co-morbidities influences the occurrence of respiratory problems. ACKNOWLEDGEMENT Authors are very thankful to the management and working staff at St. Joseph’s general hospital for providing the facilities to carry out our study. We are also thankful to our professors who guided us to conduct this study. REFERENCES 1. Last JM, editor. Dictionary of epidemiology. 4th ed. New York: Oxford University Press; 2001. p. 61. 2. Greenwood M.Epidemics and crowd-diseases: an introduction to the study of epidemiology, Oxford University Press; 1935. 3. Centers for Disease Control and Prevention (CDC), editors. Introduction to Epidemiology. In: Principles of Epidemiology in Public Health Practice; 3rd edition;2006. p.1-2 4. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459– 1544. 5. Forum of International Respiratory Societies. The Global Impact of Respiratory Disease – Second Edition. Sheffi eld, European Respiratory Society, 2017. 6. Lowery, E. M., Brubaker, A. L., Kuhlmann, E., & Kovacs, E. J. (2013). The aging lung. Clin Interv Aging. 2013; 8: 1489– 1496. 7. Chhabra P, Sharma G, Kannan AT. Prevalence of respiratory disease and associated factors in an urban area of Delhi. Indian J Community Med. 2008; 33:229–32. 8. Jindal SK, Aggarwal AN, Gupta D. A review of population studies from India to estimate national burden of chronic obstructive pulmonary disease and its association with smoking. Indian J Chest Dis Allied Sci. 2001 Jul- Sep;43(3):139-47. 9. De Santi F, Zoppini G, Locatelli F, Finocchio E, Cappa V, Dauriz M, Verlato G. Type 2 diabetes is associated with an increased prevalence of respiratory symptoms as compared to the general population. BMC Pulm Med. 2017 Jul 17;17(1):101. 10. Gennaro D’Amato, Lorenzo Cecchi, Mariella D’Amato and Isabella Annesi-Maesano. Climate change and respiratory diseases. European Respiratory Review 2014 [cited 2020 Dec 16]; 23: 161-169. Available from: https://err.ersjournals.com/ content/23/132/161 Cite this article as: Vedantham Satya Chakravarthy et al. Epidemiology of respiratory problems in association with various risk factors: A clinical study at St. Joseph’s general hospital. Int. Res. J. Pharm. 2020;11(12): 35-40. http://dx.doi.org/10.7897/2230-8407.1112105 Source of support: Nil, Conflict of interest: None Declared Disclaimer: IRJP is solely owned by Moksha Publishing House - A non-profit publishing house, dedicated to publishing quality research, while every effort has been taken to verify the accuracy of the content published in our Journal. IRJP cannot accept any responsibility or liability for the site content and articles published. The views expressed in articles by our contributing authors are not necessarily those of IRJP editor or editorial board members.