Background & Objectives: Asthma is a common chronic respiratory condition mostly starting at childhood. There are studies showing an increase in prevalence of asthma in high socioeconomic group and an increase in asthma severity among low socioeconomic group. As there are very little data on the observed association between asthma and socioeconomic status this study was aimed to find out prevalence of asthma in school children belong to high and low socioeconomic families in Thrissur district.

Materials & Methods: This cross sectional observational study was conducted among school children of age 12-15 years in a private and a Government high school in Thrissur district, Kerala, using a semi structured validated ISAAC questionnaire1. With the help of school teachers, the questionnaires were distributed to children and filled up forms were collected and analyzed for respiratory symptoms like wheezing, its severity, and socio economic status. Those with a positive history for asthma were examined and data rechecked. Pulmonary function test was done in those with clinical diagnosis of asthma.

Results: Of the 1050 distributed questionnaires 95 were excluded, rest 955 were analyzed. Boys to Girls ratio was 1.01:1. Children belong to each socioeconomic group (according to Modified Kuppuswami Scale) were as follows. Upper class I- 13(1.4%), Middle upper II- 157(16.4%), Middle lower III- 296(31%), Lower  upper IV-486(50.8%), Lower class V- 3(0.3%). Prevalence of asthma was 10.4 %. There was 2.1 times of increased risk for asthma among children belong to upper classes I,II compared to lower classes III,IV,V as per this present study (95% CI=1.31-3.35,χ²=9.96,p=0.001). Asthma severity (assessed by  nocturnal symptoms, difficulty in speech, sleep disturbing episodes, affecting daily life and school absence) between groups showed a higher trend in lower classes even though it was not found to be statistically significant. Majority (73.9%) had normal pulmonary function. Children from low economic classes, children with more frequent wheezing episodes in last year showed low FEV1. School absenteeism was high (39.3%) in this study and low FEV1 was found to be a risk factor for absenteeism.

Conclusion: The overall prevalence of asthma in school children of age group 12-15 years was 10.4%. Prevalence of asthma was higher in the upper socioeconomic class. There was no significant difference in the severity of asthma between upper and lower socioeconomic group. The use of school-based asthma education and disease management to decrease school absenteeism due to asthma should be explored.

Keywords: Asthma; School children; Socio economic status; Prevalence; Pulmonary function test

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Thomas George Puthusseril

Professor and HOD, Department of Pulmonary Medicine, Government Medical College, Thrissur

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