Pattern of Respiratory Diseases and Comorbidities in Patients Attending Casualty Department
Background: The common causes of respiratory emergencies include pneumonias, acute severe asthma, acute exacerbation of Chronic Obstructive Pulmonary diseases (COPD), TB, lung cancers, pneumothorax, pleural effusion, pulmonary embolism and Acute Respiratory Distress Syndrome (ARDS) from other causes. Aims and Objectives: To study patterns and co-morbidities of respiratory disease in patients attending casualty department. Materials and Methods: This Cross Sectional Study was conducted on 193 patients of Respiratory disease attending emergency department in Medical College and tertiary health care institute. Study was conducted for a period of 2 years (August 2018 to December 2020). Patients were enrolled after matching inclusion and exclusion criteria. Institutional ethics committee permission was taken prior study. Observations and Results: The most common age group amongst study population was 51 to 60 years (39.4%) followed by 61 to 70 years (37.8%) and more than 70 years (19.2%). There was male predominance (76.7%) amongst study population as Most of the study population had normal BMI (55.4%) followed by Underweight (27.5%) and Overweight (13.5%). Most of the study population were Farmer (37.3%) followed by Housewife (23.5%), Labourer (11.8%) and Shopkeeper (9.8%). The most common clinical features amongst study population was Breathlessness (100%) followed by Cough with expectoration (58%) and dry cough (22%). Most of the study population had mMRC Dyspnoea Grade 3 (48.2%) followed by grade 2 (30.1%), grade 4 (11.9%), grade 1 (9.8%). COPD (38%) was the most common respiratory disease amongst study population followed by Pleural effusion (19%), Asthma (15%), Pulmonary TB (11%), Pneumonia (6%), Pneumothorax (4%), ARDS (3%), ILD (2%), Pulmonary embolism (1%) and Swine flu (1%). Diabetes (46%) was the most common comorbidity amongst study population followed by Hypertension (36%), Ischemic Heart Disease (15%), Chronic Liver Disease (11%), Chronic kidney Disease (8%), Pneumonia (6%), Pneumothorax (4%) and Malignancy (2%). Conclusion: In the present study, Diabetes (46%) was the most common comorbidity amongst study population followed by Hypertension (36%), Ischemic Heart Disease (15%), Chronic Liver Disease (11%), Chronic kidney Disease (8%), Pneumonia (6%), Pneumothorax (4%) and Malignancy (2%). This findings was comparable with the study conducted by Sonisha Gupta et al. (2016)41, among these patients 10 (35.7%) were diabetic, 16 (57.1%) hypertensive, 6 (21.4%) had cardiac problem and 17 (60.7%) joint pain.
- Hubbard R. The burden of lung disease. Thorax. 2006; 61:557-558. https://doi.org/10.1136/thx.2006.066050. PM id:16807390 PMCid:PMC2104658. DOI: https://doi.org/10.1136/thx.2006.066050
- European Respiratory Society. ERS. Global Burden of Diseases. Available from: http://www.ersnet.org/news/item/4606-lancet-publishes-global-burden-of-diseasestudy.html.
- 3. World Health Organization (WHO). Chronic Respiratory Diseases: Burden of COPD. Available from: http://www.who.int/resp/copd/burden/en/
- Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: Executive summary of the GINA Dissemination Committeereport. Allergy. 2004; 59:469-478. https://doi.org/10.1111/j.1398-9995.2004.00526.x. PMid:15080825. DOI: https://doi.org/10.1111/j.1398-9995.2004.00526.x
- World Health Organization (WHO). Strategy for prevention and control of Chronic Respiratory Diseases; Jan 2002.
- Ogun SA, Adelowo OO, Familoni OB, Jaiyesimi AE, Fakoya EA. Pattern and outcome of medical admissions at the Ogun State University Teaching Hospital, Sagamu:a three year review. West Afr J Med. 2000 Oct-Dec; 19(4):304-308. [PubMed].
- Afuwape OO, Alonge TO, Okoje VM. Pattern of the cases seen in the accident and emergency department in a Nigerian Tertiary Hospital over a period of twelve months. Niger Postgrad Med J. 2007 Dec; 14(4):302-305. [PubMed].
- Nkombua L. The practice of medicine at a district hospital emergency room: Middleburg Hospital, Mpumalanga Province. SA Fam Pract. 2008; 50(1):65. https://doi.org/10.1080/20786204.2008.10873671. DOI: https://doi.org/10.1080/20786204.2008.10873671
- World Health Organization . [homepage in the Internet] Geneva: World Health Organization; The top 10 causes of death - Fact sheet No 310; [cited 2012 Oct 10]. Jun 2011.
- Ramanakumar A, Aparajita C. Respiratory disease burden in rural India: A review from multiple data sources, The Internet Journal of Epidemiology. 2005; 2(2). https://doi.org/10.5580/3ed. DOI: https://doi.org/10.5580/3ed
- Jones PW, Harding G, Berry P et al. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009; 34:648-654. https://doi.org/10.1183/09031936.00102509. PMid:19720809. DOI: https://doi.org/10.1183/09031936.00102509
- Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988; 93:580-586. https://doi.org/10.1378/chest.93.3.580. PMid:3342669. DOI: https://doi.org/10.1378/chest.93.3.580
- van Manen JG, Bindels PJ, IJzermans CJ, van der Zee JS, Bottema BJ, Schade E. Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. J Clin Epidemiol. 2001; 54:287-293. https://doi.org/10.1016/S0895-4356(01)00346-8. DOI: https://doi.org/10.1016/S0895-4356(01)00346-8
- Mannino DM, Thorn D, Swensen A et al. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008; 32:962-969. https://doi.org/10.1183/09031936.00012408. PMid:18579551. DOI: https://doi.org/10.1183/09031936.00012408
- Kreuter M, Ehlers-Tenenbaum S, Palmowski K et al. Impact of comorbidities on mortality in patients with idiopathic pulmonary fibrosis. PLoS One. 2016; 11:e0151425. https://doi.org/10.1371/journal.pone.0151425. PMid:27023440 PMCid:PMC4811578. DOI: https://doi.org/10.1371/journal.pone.0151425
- Marrie TJ, File Jr TM. Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults. UpToDate. 2016.
- Prina E, Ceccato A, Torres A. New aspects in the management of pneumonia. Crit Care. 2016; 20:267. https://doi.org/10.1186/s13054-016-1442-y. PMid:27716262 PMCid:PMC5045574. DOI: https://doi.org/10.1186/s13054-016-1442-y
- Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315:801-810. https://doi.org/10.1001/jama.2016.0287. PMid:26903338 PMCid:PMC4968574. DOI: https://doi.org/10.1001/jama.2016.0287
- Patil SP, Krishnan JA, Lechtzin N, Diette GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med. 2003; 163:1180-1186. https://doi.org/10.1001/archinte.163.10.1180. PMid:12767954. DOI: https://doi.org/10.1001/archinte.163.10.1180
- Almagro P, Calbo E, Ochoa de Echaguen A, Barreiro B, Quintana S, Heredia JL, Garau J. Mortality after hospitalization for COPD. Chest. 2002; 121:1441-1448. https://doi.org/10.1378/chest.121.5.1441. PMid:12006426. DOI: https://doi.org/10.1378/chest.121.5.1441
- Jindal SK. Respiratory disease epidemiology in India. Lung India. 2006; 23(2):93-94. https://doi.org/10.4103/0970-2113.44419. DOI: https://doi.org/10.4103/0970-2113.44419
- Jindal SK. Bronchial asthma: the Indian Scene. Curr Opin Pulm Med. Jan 2007; 13(1):8-12. https://doi.org/10.1097/MCP.0b013e32800ffd09. PMid:17133118. DOI: https://doi.org/10.1097/MCP.0b013e32800ffd09
- Chakraborty AK. Epidemiology of tuberculosis: Current status in India. Indian J Med Res. 2004 Oct; 120(4):248-276.
- Jindal SK. Emergence of chronic obstructive airway disease as on epidemic in India. Indian J Med Res. 2006 Dec; 124(6):619-630.
- Chhabra SK, Chhabra P, Rajpal S, Gupta RK. Ambiant air pollution and chronic respiratory morbidity in Delhi. Arch Environ Health. Jan-Feb 2001; 56(1):58-64. https://doi.org/10.1080/00039890109604055. PMid:11256858. DOI: https://doi.org/10.1080/00039890109604055
- Behera D, Kashyap S. Pattern of malignancy in a north Indian hospital. J Indian Med Assoc. Feb 1988; 86(2):28-29.
- Karai GS, Nath HK, Paul G, Saha D, Roy HK. Carcinoma of the lung: A record and analysis of 100 cases. Indian J Cancer. Jun 1967; 4(2):105-113.
- Lozano R, Naghavi M, Foreman K, Lim S, Shibuya, K. Aboyans, V. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2010; 380(9859):2095-2128. DOI: https://doi.org/10.1016/S0140-6736(12)61728-0
- WHO. Global Burden of Disease: 2004 update. World Health Organization, Geneva, Switzerland, Vol. 1211, 2008. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html.
- Smit KR. National Burden of disease in India from indoor air pollution 2000. Proc Natl Acad Sci USA. 2000 Nov 21; 97(24):13286-13293. https://doi.org/10.1073/pnas.97.24.13286. PMid:11087870 PMCid:PMC27217. DOI: https://doi.org/10.1073/pnas.97.24.13286
- Olufemi Olumuyiwa Desalu, Joshua Afolayan Oluwafemi, Ololade Ojo, Respiratory diseases morbidity and mortality among adults attending a tertiary hospital in Nigeria. J Bras Pneumol. 2009; 35(8):745-752. https://doi.org/10.1590/S1806-37132009000800005. PMid:19750326. DOI: https://doi.org/10.1590/S1806-37132009000800005
- World Health Organization. WHO strategy for prevention and control of chronic respiratory diseases. Geneva: WHO; 2002.
- Madhuragauri Shevade, Komalkirti Apte, Sushma Jadhav, Sapna Madas, Sundeep Salvi, Renu Sorte, What are the most common respiratory diseases encountered in clinical practice? Results of a pilot study in 737 Indian patients. European Respiratory Journal. 2015; 46:PA3864. DOI: https://doi.org/10.1183/13993003.congress-2015.PA3864
- Chhabra P, Sharma G, Kannan AT. Prevalence of respiratory disease and associated factors in an urban area of Delhi. Indian J Community Med. 2008; 33:229-232. https://doi.org/10.4103/0970-0218.43227. PMid:19876495 PMCid:PMC2763694. DOI: https://doi.org/10.4103/0970-0218.43227
- Dubey A, Sharma P. Profile of respiratory problems in patients attending a tertiary care center OPD - A study from central India. Int J Med Res Rev. 2015; 3(7):743-747. https://doi.org/10.17511/ijmrr.2015.i7.142. DOI: https://doi.org/10.17511/ijmrr.2015.i7.142
- Ghoshal AG, Ravindran GD, Gangwal P, Rajadhyaksha G, Cho SH, Muttalif AR, Lin HC, Thanaviratananich S, Bagga S, Faruqi R, Sajjan S, Shetty P, Syed R, Hamrosi KK, Wang DY. The burden of segregated respiratory diseases in India and the quality of care in these patients: Results from the Asia-Pacific Burden of Respiratory Diseases study. Lung India. 2016; 33:611-619. https://doi.org/10.4103/09702113.192878. PMid:27890989 PMCid:PMC5112817. DOI: https://doi.org/10.4103/0970-2113.192878
- Katherine Paulson et al. India State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: The Global Burden of Disease Study 19902016. The Lancet Global Health; 12 September 2018.
- Dominici F, Peng D, Bell M, Pham L, McDermott A, Zeger SL, Samet JM. Fine Particulate Air Pollution and Hospital Admissions for Cardiovascular and Respiratory Diseases. JAMA. 2006 Mar 8; 295(10):1127-1134. https://doi.org/10.1001/jama.295.10.1127. PMid:16522832 PMCid: PMC3543154. DOI: https://doi.org/10.1001/jama.295.10.1127
- Mahesh PA, Jayaraj BS, Prahlad ST, Chaya SK, Prabhakar AK, Agarwal AN, Jindal SK. Validation of a structured questionnaire for COPD and prevalence of COPD in rural area of Mysore: A pilot study. Lung India. 2009; 26:63-69. https://doi.org/10.4103/0970-2113.53226. PMid:20442838 PMCid:PMC2862508. DOI: https://doi.org/10.4103/0970-2113.53226
- Dasgupta A, Bagchi A, Nag S, Bardhan S, Bhattacharyya P. Profile of respiratory problems in patients presenting to a referral pulmonary clinic. Lung India. 2008 Jan-Mar; 25(1):4-7. https://doi.org/10.4103/0970-2113.44129. PMid:20390068 PMCid: PMC2851148. DOI: https://doi.org/10.4103/0970-2113.44129
- Sonisha Gupta et al. Prevalence and pattern of respiratory diseases including Tuberculosis in elderly in Ghaziabad - Delhi – NCR. Indian Journal of Tuberculosis. 2016; 63:236-241. https://doi.org/10.1016/j.ijtb.2015.07.007, https://doi.org/10.1016/j.ijtb.2016.09.012, https://doi.org/10.1016/j.ijtb.2015.07.006. PMid:27451815. DOI: https://doi.org/10.1016/j.ijtb.2016.09.012
- Brachier B, Londhe J, Madas S, Vincent V, Salvi S. Prevalence of self reported respiratory symptoms asthma and chronic bronchitis in a slum area of a rapidly developing Indian city. Open J Respir Dis. 2012; 2:73-81. https://doi.org/10.4236/ojrd.2012.23011. DOI: https://doi.org/10.4236/ojrd.2012.23011
- Pandey MR. Prevalence of chronic bronchitis in a rural community of the hill region of Nepal. Thorax. 1984; 39:331-336. https://doi.org/10.1136/thx.39.5.337, https://doi.org/10.1136/thx.39.5.331. PMid:6740535, PMCid: PMC459797. DOI: https://doi.org/10.1136/thx.39.5.331