Prevalence of Self-Reported Respiratory Symptoms, Asthma and Chronic Bronchitis in Slum Area of a Rapidly Developing Indian City


Background: Poverty is an important surrogate marker for obstructive airway diseases (OAD). Slum constitutes a habitat wherein various poverty related parameters are perpetually prevalent in the ambience. 1/6th of world population lives in slums yet there is no information regarding their health status in context to asthma and COPD. Aims: We investigated the prevalence of asthma and chronic-bronchitis symptoms and associated risk-factors in slum habitats of Pune city. Methodology: 7062 adult slum-dwellers living in 12 slums of Pune city were cross-sectionally interviewed by local healthcare workers with respiratory health questionnaire which was designed using respiratory symptoms of validated European Community Respiratory Health Survey (ECRHS II) questionnaire and International Union against Tuberculosis and Lung Disease (IUATLD) bronchial symptoms questionnaire. Results: The overall prevalence of selfreported asthma symptoms was 10% (18 - 40 years: 6.5%; >40 years: 13.5%). The overall prevalence of chronic bronchitis was 8.5% [18 - 40 years: 7% (males: 7%, females: 7%); >40 years: 10% (males: 10%, females: 10%)]. Increasing age (p = 0.00), female gender (p = 0.001), unemployment (0.00) current smoking (p = 0.00) and ex-smoking (p = 0.004) emerged as significant risk factor for asthma. While, ex-smoking (p = 0.004) and low-education status (p = 0.00) emerged as significant risk factors for chronic bronchitis. Conclusion: In slums reporting of asthma and chronic-bronchitis symptoms was much higher than what has been reported earlier from India. Asthma was commonly seen in females, old age, unemployed and ever-smokers. While chronic bronchitis was commonly seen in ex-smokers and illiterate subjects. Chronic bronchitis was equally distributed amongst male and females, despite 0% prevalence of smoking in females.

Share and Cite:

B. Brashier, J. Londhe, S. Madas, V. Vincent and S. Salvi, "Prevalence of Self-Reported Respiratory Symptoms, Asthma and Chronic Bronchitis in Slum Area of a Rapidly Developing Indian City," Open Journal of Respiratory Diseases, Vol. 2 No. 3, 2012, pp. 73-81. doi: 10.4236/ojrd.2012.23011.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] R. J. Wright and S. V. Subramanian. “Advancing Multi Level Framework for Epidemiologic Research on Asthma Disparities,” Chest, Vol. 132, No. , 2007, pp. 757S-769S. doi:10.1378/chest.07-1904
[2] J. M. Anto, P. Vermeire, J. Vestbo, et al., “Epidemiology of Chronic Obstructive Pulmonary Disease,” European Respiratory Journal, Vol. 17, No. 5, 2001, pp. 982-994. doi:10.1183/09031936.01.17509820
[3] S. Shohaimi, A. Welch, S. Bingham, et al., “Area Deprivation Predicts Lung Function Independently of Education and Social Class,” European Respiratory Journal, Vol. 24, No. 1, 2004, pp. 157-161. doi:10.1183/09031936.04.00088303
[4] D. A. Lawlor, S. Ebrahim and S. G. Davey, “Association between Self-Reported Childhood Socioeconomic Position and Adult Lung Function: Findings from the British Women’s Heart and Health Study,” Thorax, Vol. 59, No. 3, 2004, pp. 199-203. doi:10.1136/thorax.2003.008482
[5] D. M. Mannino and A. S. Buist, “Global Burden of COPD: Risk Factor Prevalence, and Future Trends,” Lancet, Vol. 370, No. 9589, 2007, pp. 765-773. doi:10.1016/S0140-6736(07)61380-4
[6] G. L. Ooi and K. H. Phua, “Urbanization and Slum Formation,” Journal of Urban Health, Vol. 84, No. 1, 2007, pp. 27-34. doi:10.1007/s11524-007-9167-5
[7] E. D. Sclar, P. Garau and G. Carolini, “The 21st Century Health Challenge of Slums and Cities,” Lancet, Vol. 365, No. 9462, 2005, pp. 901-903. doi:10.1016/S0140-6736(05)71049-7
[8] United Nations Settlement Programe (UN-HABITAT), “State of World Cities,” 2006/2007.
[9] A. Unger and L. W. Riley, “Slum Health: From Understanding to Action (Essay),” PLoS Medicine, Vol. 4, No. 10, 2007, pp. 1561-1566.
[10] L. W. Riley, A. I. Ko, A. Unger, et al., “Slum Health: Diseases of Neglected Populations,” BMC International Health and Human Rights, Vol. 7, 2007, p. 2. doi:10.1186/1472-698X-7-2
[11] B. Nongkynrih, B. K. Patro and C. S. Pandav, “Current Status of Communicable and Non-Communicable Diseases in India,” Journal of Association of Physicians in India, Vol. 52, 2004, pp. 118-123.
[12] J. E. Gern, L. A. Rosenthal, R. L. Sorkness and R. F. Lemanske Jr., “Effects of Viral Respiratory Infections on Lung Development and Childhood Asthma,” Journal of Allergy and Clinical Immunology, Vol. 115, No. 4, 2005, pp. 668-674. doi:10.1016/j.jaci.2005.01.057
[13] N. Bruce, R. Perez-Padilla and R. Albalak, “Indoor Air Pollution in Developing Countries: A Major Environmental and Public Health challenge,” Bulletin of the World Health Organization, Vol. 78, No. 9, 2000, pp. 1078-1092.
[14] P. Kulshreshtha, M. Khare and P. Seetharaman, “Indoor Air Quality Assessment in and around Urban Slums of Delhi City, India,” Indoor Air, Vol. 18, No. 6, 2008, pp. 488-498. doi:10.1111/j.1600-0668.2008.00550.x
[15] B. Brunekreef, R. Beelen, G. Hoek, et al., “Effects of Long-Term Exposure to Traffic-Related Air Pollution on Respiratory and Cardiovascular Mortality in the Netherlands: The NLCS-AIR Study,” Research Report (Health Effects Institute), Vol. 139, 2009, pp. 5-71, 73-89.
[16] A. L. Kozyrskyj, G. E. Kendall, P. Jacoby, et al., “Association between Socioeconomic Status and the Development of Asthma: Analyses of Income Trajectories,” American Journal of Public Health, Vol. 100, No. 3, 2010, pp. 540-546. doi:10.2105/AJPH.2008.150771
[17] R. J. Wright, “Stress and Atopic Disorders,” Journal of Allergy and Clinical Immunology, Vol. 116, 2005, pp. 1301-1306. doi:10.1016/j.jaci.2005.09.050
[18] S. Sen, J. Hobson and P. Joshi, “The Pune Slum Census: Creating a Socio-Economic and Spatial Information Base on a GIS for Integrated and Inclusive City Development,” Habitat International, Vol. 27, No. 4, 2003, pp. 595-611. doi:10.1016/S0197-3975(03)00007-9
[19] Department of Women and Child Development, Ministry of Human Resources Development, “Report: Government of India Integrated Child Development Services,” New Dehli, 1995, pp. 1-24.
[20] P. G. Burney and D. Jarvis, “The European Community Respiratory Health Survey II (ECRHS II),” 2002.
[21] P. G. Burney, L. A. Laitinen, S. Perdrizet, et al., “Validity and Repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: An International Comparison,” European Respiratory Journal, Vol. 2, No. 10, 1989, pp. 940-945.
[22] R. V. Chowgule, V. M. Shetye, J. R. Parmar, et al., “Prevalence of Respiratory Symptoms, Bronchial Hyperreactivity, and Asthma in a Mega city. Results of the European Community Respiratory Health Survey in Mumbai (Bombay),” American Journal of Respiratory and Critical Care Medicine, Vol. 158, 1998, pp. 547-554.
[23] A. N. Aggarwal, K. Chaudhry, S. K. Chhabra, et al., “Prevalence and Risk Factors for Bronchial Asthma in Indian Adults: A Multi-Centre Study,” Indian Journal of Chest Disease and Allied Sciences, Vol. 48, 2006, pp. 13-22.
[24] S. K. Jindal, A. N. Aggarwal, K. Chaudhry, et al., “Asthma Epidemiology Study Group. A Multicentric Study on Epidemiology of Chronic Obstructive Pulmonary Disease and Its Relationship with Tobacco Smoking and Environmental Tobacco Smoke Exposure,” Indian Journal of Chest Disease and Allied Sciences, Vol. 48, 2006, pp. 23-27.
[25] P. A. Mahesh, B. S. Jayraj, S. T. Prahlad, et al., “Validation of Structured Questionnaire for COPD and Prevalence of COPD in Rural Area of Mysore: A Pilot Study,” Lung India, Vol. 26, No. 3, 2009, pp. 63-69. doi:10.4103/0970-2113.53226
[26] A. Kotwani, S. K. Chhabra, V. Tayal, et al., “Qualityvof Asthma Management in Urban Community in Delhi, India,” Indian Journal of Medical Research, Vol. 135, No. 20, 2012, pp. 184-192.
[27] A. Banerjee, J. S. Bhawalkar, S. L. Jadhav, et al., “Access to Health Services among Slum Dwellers in an Industrial Township and Surrounding Rural Areas: A Rapid Epidemiological Assessment,” Journal of Family Medicine and Primary Care, Vol. 1, No. 1, 2012, pp. 20-26.
[28] G. J. Huchon, A. Vergnenegre, F. Neukirch, et al., “Chronic Bronchitis among French Adults: High Prevalence and under Diagnosis,” European Respiratory Journal, Vol. 20, 2002, pp. 806-812. doi:10.1183/09031936.02.00042002
[29] R. E. Kanner, N. R. Anthonisen and J. E. Connett, “Lower Respiratory Illnesses Promote FEV1 Decline in Current Smokers But Not Ex-Smokers with Mild Chronic Obstructive Pulmonary Disease: Results from the Lung Health Study,” American Journal of Respiratory and Critical Care Medicine, Vol. 164, 2001, pp. 358-364.
[30] M. Masoli, D. Fabian, S. Holt, et al., “Global Initiative for Asthma (GINA) program: The Global Burden of Asthma: Executive Summary of the GINA Dissemination Committee Report,” Allergy, Vol. 59, 2004, pp. 469-478. doi:10.1111/j.1398-9995.2004.00526.x
[31] R. A. Pauwels, A. S. Buist, P. M. Calverley, et al., “The GOLD Scientific Committee. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/ WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop Summary,” American Journal of Respiratory and Critical Care Medicine, Vol. 163, 2001, pp. 12561276.
[32] L. E. Loschmann, J. Sunyer, E. Plana, et al., “Socioeconomic Status, Asthma and Chronic Bronchitis in a Large Community-Based Study,” European Respiratory Journal, Vol. 29, 2007, pp. 897-905. doi:10.1183/09031936.00101606
[33] S. Liu, Y. Zhou, X. Wang, et al., “Biomass Fuels Are the Probable Risk Factor for Chronic Obstructive Pulmonary Disease in Rural South China,” Thorax, Vol. 62, No. 10, 2007, pp. 889-897. doi:10.1136/thx.2006.061457
[34] S. O. Shaheen, D. J. P. Barker and S. T. Holgate, “Do Lower Respiratory Tract Infections in Early Childhood Cause Chronic Obstructive Pulmonary Disease?” American Journal of Critical Care Medicine, Vol. 151, No. 5, 1995, pp. 1649-1652.
[35] N. Kawakami, E. A. Abdulghani, J. Alonso, et al., “Early-Life Mental Disorders and Adult Household Income in the World Mental Health Surveys,” Biological Psychiatry, Vol. 72, No. 3, 2012, pp. 228-237. doi:10.1016/j.biopsych.2012.03.009

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.