ASTHMA

Wheeze, asthma diagnosis and medication use: a national adult survey in a developing country

R I Ehrlich¹, N White², R Norman³, R Laubscher⁴, K Steyn⁵, C Lombard⁴, D Bradshaw³

¹ School of Public Health and Family Medicine, University of Cape Town, South Africa
² UCT Lung Institute, Cape Town, South Africa
³ Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
⁴ Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
⁵ Chronic Diseases of Lifestyle Research Unit, South African Medical Research Council, Cape Town, South Africa

Correspondence to:
Correspondence to:
Professor R I Ehrlich
School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, South Africa; ehrlich{at}cormack.uct.ac.za

Background: As relatively little is known about adult wheeze and asthma in developing countries, this study aimed to determine the predictors of wheeze, asthma diagnosis, and current treatment in a national survey of South African adults.

Methods: A stratified national probability sample of households was drawn and all adults (>14 years) in the selected households were interviewed. Outcomes of interest were recent wheeze, asthma diagnosis, and current use of asthma medication. Predictors of interest were sex, age, household asset index, education, racial group, urban residence, medical insurance, domestic exposure to smoky fuels, occupational exposure, smoking, body mass index, and past tuberculosis.

Results: A total of 5671 men and 8155 women were studied. Although recent wheeze was reported by 14.4% of men and 17.6% of women and asthma diagnosis by 3.7% of men and 3.8% of women, women were less likely than men to be on current treatment (OR 0.6; 95% confidence interval (CI) 0.5 to 0.8). A history of tuberculosis was an independent predictor of both recent wheeze (OR 3.4; 95% CI 2.5 to 4.7) and asthma diagnosis (OR 2.2; 95% CI 1.5 to 3.2), as was occupational exposure (wheeze: OR 1.8; 95% CI 1.5 to 2.0; asthma diagnosis: OR 1.9; 95% CI 1.4 to 2.4). Smoking was associated with wheeze but not asthma diagnosis. Obesity showed an association with wheeze only in younger women. Both wheeze and asthma diagnosis were more prevalent in those with less education but had no association with the asset index. Independently, having medical insurance was associated with a higher prevalence of diagnosis.

Conclusions: Some of the findings may be to due to reporting bias and heterogeneity of the categories wheeze and asthma diagnosis, which may overlap with post tuberculous airways obstruction and chronic obstructive pulmonary disease due to smoking and occupational exposures. The results underline the importance of controlling tuberculosis and occupational exposures as well as smoking in reducing chronic respiratory morbidity. Validation of the asthma questionnaire in this setting and research into the pathophysiology of post tuberculous airways obstruction are also needed.

Keywords: asthma; wheeze; developing countries; South Africa

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