Air Pollution a Major Factor in Asthma Predictability Index Among Children

Asthma is the most common pediatric chronic disease. Hindrance in asthma diagnosis is widespread resulting in unsatisfactory management in asthma. About 80 % of pediatric asthma patients have symptom onset before age six , most of them before age three . However, only about 1/3 of children with at least one episode of asthmatic symptoms by age three will have asthma at age six and over, Asthma is under-diagnosed in 18 75 % of asthmatic children . This city is categorized unhealthy for human beings. Deterioration in urban air quality in most megacities is quite profound and Kolkata Metropolitan City is no exception to this. An assessment of Kolkata air quality is done where the listed pollutants’ (RPM, SPM, NO2,and SO2) annual average concentration are classified into four different categories; namely critical, high, moderate, and low pollution. There are 17 monitoring stations in Kolkata and out of which five fall under the critical category, and the remaining 12 locations fall under the high category of NO2 concentration, regarding RPM, four stations are critical, and 13 stations record data which are under the high pollution category. Model questionnaires were run through 10% of the households to assess socio-economic conditions, critical environmental conditions, nature and types of health burdens as well as gauge the attitude in the direction of health care facilities were done. A comprehensive and up-to-date knowledge about the seasonal and spatial variation of asthma and studying air quality of the area. Mapping through GIS.

It is desirable to construct an accurate model ( Asthma Prediction Index) to predict whether a child will develop asthma in the future due to the deteriorating air pollution in the city.

Introduction

Kolkata is one of the most prominent metropolis in Asia. The Kolkata Metropolitan Area (KMA) is a large urban-industrial corridor covering area of 1,350 sq. km (38 municipalities and 3 municipal corporations) . Kolkata had been placed among the most polluted cities of the world with respect to SPM levels according to Global Pollution and Health, a report published by WHO and UNEP. A health impact study with respect to air pollution was conducted during November 1996 to July 2001 to assess the degree of lung function impairment in persons chronically exposed to Kolkata’s air. Asthma is the most common paediatric chronic disease. Delay in asthma diagnosis is prevalent, resulting in suboptimal asthma management. To help avoid delay in asthma diagnosis and advance asthma prevention research, researchers have proposed various models to predict asthma development in children. The prediction of clinically severe allergic reactions would be of great importance, but current attempts have been limited by the lack of a well-founded applicable methodology and the wide spatiotemporal distribution of allergic reactions. The valid prediction of severe allergies (and especially those needing hospital treatment) in a region, could alert health authorities and implicated individuals to take appropriate preventive measures. About 80% of paediatric asthma patients have symptom onset before age six, most of them before age three . However, only about 1/3 of children with at least one episode of asthmatic symptoms by age three will have asthma at age six and over, Asthma is under-diagnosed in 18 75 % of asthmatic children.

Background and statement of the problem:

Six pollutants are considered in the reporting of air quality in the Air Quality Index (AQI): ground-level ozone (O3), fine particulate matter (PM ‰ 2.5 Оm in aerodynamic diameter; PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO). Fine Particulate matter (PM 2.5) is much above the permissible level (Kolkata US Consulate Air Pollution 2017).

It is desirable to construct an accurate model( Asthma Prediction Index) to predict whether a child will develop asthma in the future. By identifying children at high risk for asthma and scheduling more frequent follow-up with a clinician familiar with asthma, the clinician can diagnose asthma in a timely manner and start asthma treatment earlier.

Second, asthma is a subjective, clinical diagnosis in children under five. Most children under five cannot cooperate reliably with objective lung function measurements. Also, there is no genetic marker or diagnostic test that can reliably diagnose asthma .Using a predictive model can help physicians better diagnose asthma, particularly in children under five.

Third, the information provided by a predictive model can contribute directly to children’s quality of life. A low predicted risk for asthma can alleviate concerns of the child and his/her caregivers .A high predicted risk may help the child and caregivers understand symptoms, improve treatment adherence, and adjust lifestyle and living conditions to avoid exposing the child to environmental contaminants and allergens .

Objectives

The main objectives are:

a) To draw an Asthma Prediction Index(API) to assess and predict asthma in children.

b) Identify the areas with higher incidence

c) To assess the air pollution of the study area regarding air pollution parameters and pollens. Four air pollutants viz., Sulphur Dioxide (SO2), Oxides of Nitrogen as NO2 and Suspended Particulate Matter (SPM) and Respirable Suspended Particulate Matter (RSPM/PM10), are to be identified for regular monitoring .

Other sources of pollutants can be screened. Different types of pollens escalating the shortness of breath are to be highlighted .

Review of Research and Development in the Subject

The Asthma Predictive Index (API) was developed by Castro-Rodriguez et al in 2000 to identify children who may develop asthma. The API has since been well validated and internationally supported, although many clinicians remain skeptical about its utility.

Not all children who wheeze will develop asthma, and yet identifying asthmatic children early may be important in reducing respiratory complications later in life (Asthma and wheezing in the first six years of life. The Group Health Medical Associates.Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJN Engl J Med. 1995 Jan 19). Evidence suggests that children who develop asthma early in life, before the age of 3 years, may develop persistent lung function abnormalities (Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence.Morgan WJ, Stern DA, Sherrill DL, Guerra S, Holberg CJ, Guilbert TW, Taussig LM, Wright AL, Martinez FDAm J Respir Crit Care Med. 2005 Nov 15). Having a tool, such as the API, to determine which children may develop asthma may help clinicians target and treat atopic and asthmatic children before they develop chronic and persistent lung function abnormalities.

Appropriate asthma treatment can prevent serious asthma complications. A delay (median=3.3 years) in diagnosis is experienced by 2/3 of asthmatic children (Is childhood asthma still underdiagnosed and undertreated in Istanbul?Karadag B, Karakoc F, Ersu R, Dagli EPediatr Int. 2007 Aug;) By identifying children at high risk for asthma and scheduling more frequent follow-up with a clinician familiar with asthma, the clinician can diagnose asthma in a timely manner and start asthma treatment earlier(The challenge of managing wheezing in infants.Frey U, von Mutius E, 2009). Asthma is a subjective, clinical diagnosis in children under five [Early diagnosis of asthma in young children by using non-invasive biomarkers of airway inflammation and early lung function measurements: study protocol of a case-control study(Van de Kant KD, Klaassen EM, Jbsis Q, Nijhuis AJ, van Schayck OC, Dompeling E,2009).

Methodology:

Asthma Data

Asthma data in this study was collected from outdoor department of Allergy and Asthma Research Centre, Kolkata, Missionaries of Charity, Kolkata.

Standard questionnaires to assess demography, literacy, standard of living with socio-economic variables, basic environmental conditions, confounding factors, load, nature and types of health burdens as well as assess the attitude towards health care facilities.

Evaluation of Respiratory Symptoms by questionnaire and clinical examination of children belonging to different economic structure.

Assessing the air pollution condition of different areas of Kolkata and correlating that with the incidence of respiratory disorder.

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