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Year : 2018  |  Volume : 35  |  Issue : 6  |  Page : 459-460  

Respiratory disease burden in India: Indian chest society SWORD survey

1 Director, Asthma Bhawan, Jaipur, Rajasthan, India
2 Department of Medicine, SMS Medical College Hospital, Jaipur, Rajasthan, India

Date of Web Publication30-Oct-2018

Correspondence Address:
Dr. Bharat Bhushan Sharma
Department of Medicine, SMS Medical College Hospital, Jaipur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/lungindia.lungindia_399_18

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How to cite this article:
Singh V, Sharma BB. Respiratory disease burden in India: Indian chest society SWORD survey. Lung India 2018;35:459-60

How to cite this URL:
Singh V, Sharma BB. Respiratory disease burden in India: Indian chest society SWORD survey. Lung India [serial online] 2018 [cited 2019 Jun 26];35:459-60. Available from: http://www.lungindia.com/text.asp?2018/35/6/459/244506

Developing countries have to bear burden of both communicable and noncommunicable diseases simultaneously. The recent Global Burden of Disease (GBD) survey data have shown that both acute and chronic respiratory diseases are prevalent in substantial number in India.[1] Chronic respiratory diseases, especially asthma and chronic obstructive pulmonary disease (COPD), are of particular importance for having wide variations in morbidity and mortality in various Indian states.[2]

Certain questions still remain to be answered such as what are the factors that lead to region-specific variations in common respiratory diseases in India. The actual practice patterns and socioeconomic impact of these common respiratory ailments need to be known. The impact of seasonal trends in occurrence or exacerbation of these diseases is also not known. To answer some of these questions, the Indian Chest Society in association with Asthma Bhawan, as a national coordinating center, initiated the Seasonal Waves of Respiratory Disorders (SWORD) survey in India. There were four seasonal phases of this survey and dates were selected based on the midpoint of trimester coinciding with a stable climate of that season. With participation of over 350 principal investigators, it is expected to provide good data on various aspects of respiratory diseases. Four main levels of health care included in the survey were medical college, district hospital, private hospitals, and private clinic. Similarly, qualifications of health-care providers having DTCD, MD Chest, MD Medicine, and DM DNB/Other were also prespecified subgroups. In this manner, the survey intended to include all the respiratory practitioners working at all levels of health care across the states of India.

The pro forma used in SWORD survey was developed at a national coordinating center. Rigorous efforts were made in making it lucid and comprehensive so that it could be completed easily in a time-effective manner. The prevalence of symptoms on a single indian healthcare day on a Nationwide scale (POSIEDON) study group had used similar pro forma.[3] The pro forma included the risk factors including pollution, details of the residence, comorbid conditions, disease symptoms, standard International Classification of Diseases-10-based respiratory diagnosis, and its investigations. Air pollution is important as it might have significant impact on respiratory health of an individual. It is noteworthy that Delhi became one of the most polluted cities in the world in November 2017 and the situation is almost the same in other metropolitan cities of India.[4],[5]

After identification of participating respiratory health-care providers, ethical clearance was sought and data were recorded at three levels of an individual seasonal survey. The data of patients coming to outdoor of a respiratory health-care provider were recorded first followed by data of all patients hospitalized for a respiratory illness within the next 24 h of start of survey. The mortality data were also recorded as per the WHO international standards at the third level of this point prevalence survey.[6]

The field of respiratory epidemiology is relatively new as compared to its some more popular counterparts, for example, cardiovascular and cancer epidemiologies. The SWORD survey is expected to provide valuable Indian data. INSEARCH was an epidemiological survey from India on asthma, respiratory symptoms, and chronic bronchitis by Jindal et al. It included more than 1.5 lakh people both from urban and rural sites. Estimated asthma prevalence was 2% and that of chronic bronchitis was 3.5% while one or more respiratory symptoms were present in about 9% of individuals in this survey.[7] In the Indian subgroup analysis of the International Study of Asthma and Allergies in Childhood study, the prevalence of asthma was found to be 6% among schoolchildren.[8]

The POSIEDON was a point prevalence survey including all medical conditions that were seen by a population sample of practitioners in India. Clinic-based data constituted a large proportion of this survey.[3] Respiratory symptoms and diagnoses emerged as the most common conditions seen by practitioners in the survey. Respiratory symptoms were recorded for all patients while diagnoses were also available in the majority of patients included in this survey. In a survey conducted during NAPCON 2015 by a separate group, it was pretty encouraging to find that majority of practicing doctors follow standard guidelines in making respiratory diagnosis in India.[9]

In the Indian subgroup of Asia-Pacific Burden of Respiratory Diseases study, it was found that asthma was the most frequent primary diagnosis among four common respiratory diseases including COPD. Loss of productivity and expenditure on medications were the most significant contributors to the burden of disease.[10] Similarly, secondary data analysis from the second round of Indian Human Development Survey showed that there is rising prevalence of asthma in India. The prevalence rate of asthma was higher in poorer states and in those individuals living in households using solid fuels (firewood and kerosene).[11]

The respiratory subgroup analysis of GBD survey mentioned above showed that there is an increase in contribution to the disability-adjusted life year (DALY) due to respiratory diseases in India from 1990 to 2016. COPD and asthma contributed to three-fourth and one-fifth of DALYs in 2016, respectively. The highest rates were in the states of Rajasthan and Uttar Pradesh. Furthermore, the DALY per case of asthma and COPD was approximately 2 times higher than the global average. The air pollution, tobacco use, and occupational risks were the leading risk factors for COPD.[2]

Until now, in our country, only selected respiratory disorders have scarcely been studied with respect to seasonal variations. In a study by Chandra and Guleria from Delhi, it was found that there was an increase in the frequency of admissions due to acute exacerbation of COPD starting in November and peaking in February of the subsequent year without any clear-cut tendency toward seasonality.[12] In another study by Behera and Sharma at the similar location, sputum-positive tuberculosis was seen maximally in April–June with a gradient of about 35% in comparison to October–December and an amplitude of about 14% to annual mean quarterly smear-positive cases.[13] Similarly, the influenza viruses have shown seasonality at subregional level in India and that could have important implication in timing of vaccination.[14]

Obstructive lung diseases are major contributors to adverse respiratory health status of a country, and control of these diseases is of paramount importance for any health-care system. In the last seasonal survey of SWORD, specific additional questions were included for obstructive lung diseases. For asthma, important questions related to control of disease were included, and for COPD, questions related to the severity of disease were included.

Finally, looking at the rising burden of respiratory diseases, especially obstructive lung diseases in India, extraordinary efforts need to be undertaken in order to control these problems. India represents replica of global atmosphere having all sorts of climatic conditions prevailing in disparate geographic locations. We think that recording of seasonal point prevalence data along with risk factors mainly tobacco, biomass fuel exposure, and air pollution will help in understating of interactive nature of major classifiable respiratory disorders better. It will also be useful to know why obstructive respiratory disorders still are number one adversary of public health in many parts of India. The SWORD, therefore, is likely to bridge the gap between disease burden data identified through national reporting system and actual practice patterns of our country.

   References Top

India State-Level Disease Burden Initiative Collaborators. Nations within a nation: Variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study. Lancet 2017; 390:2437–60.  Back to cited text no. 1
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 1990-2016. Lancet Glob Health 2018. pii: S2214-109X(18)30409-1.  Back to cited text no. 2
Salvi S, Apte K, Madas S, Barne M, Chhowala S, Sethi T, et al. Symptoms and medical conditions in 204 912 patients visiting primary health-care practitioners in India: A 1-day point prevalence study (the POSEIDON study). Lancet Glob Health 2015;3:e776-84.  Back to cited text no. 3
New Delhi smog, death-sentence appeal and a porpoise setback. Nature 2017;551:276-7.  Back to cited text no. 4
Guo H, Kota SH, Sahu SK, Hu J, Ying Q, Gao A, et al. Source apportionment of PM2.5 in North India using source-oriented air quality models. Environ Pollut 2017;231:426-36.  Back to cited text no. 5
World Health Organization. International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death [Based on Recommendations of the Ninth Revision Conference, 1975]. Geneva: World Health Organization; 1977.  Back to cited text no. 6
Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, et al. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis 2012;16:1270-7  Back to cited text no. 7
Singh S, Sharma BB, Sharma SK, Sabir M, Singh V; ISAAC collaborating investigators. Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: Associations with parental smoking and traffic pollution. J Asthma 2016;53:238-44.  Back to cited text no. 8
Singh S, Singh N. Current trends of management of respiratory diseases by pulmonologists: Results of national conference of pulmonary disease-2015 survey. Lung India 2017;34:13-8.  Back to cited text no. 9
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Ghoshal AG, Ravindran GD, Gangwal P, Rajadhyaksha G, Cho SH, Muttalif AR, et al. 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;33:611-9.  Back to cited text no. 10
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Kumar P, Ram U. Patterns, factors associated and morbidity burden of asthma in India. PLoS One 2017;12:e0185938.  Back to cited text no. 11
Chandra D, Guleria R. Effects of seasonal variation on hospitalisations for acute exacerbations of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2009;51:139-43.  Back to cited text no. 12
Behera D, Sharma PP. A retrospective study of seasonal variation in the number of cases diagnosed at a tertiary care tuberculosis hospital. Indian J Chest Dis Allied Sci 2011;53:145-52.  Back to cited text no. 13
Chadha MS, Potdar VA, Saha S, Koul PA, Broor S, Dar L,et al. Dynamics of influenza seasonality at sub-regional levels in India and implications for vaccination timing. PLoS One 2015;10:e0124122.  Back to cited text no. 14


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