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Wheeze, asthma diagnosis and medication use: a national adult survey in a developing country
  1. R I Ehrlich1,
  2. N White2,
  3. R Norman3,
  4. R Laubscher4,
  5. K Steyn5,
  6. C Lombard4,
  7. D Bradshaw3
  1. 1School of Public Health and Family Medicine, University of Cape Town, South Africa
  2. 2UCT Lung Institute, Cape Town, South Africa
  3. 3Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  4. 4Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  5. 5Chronic Diseases of Lifestyle Research Unit, South African Medical Research Council, Cape Town, South Africa
  1. 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; ehrlichcormack.uct.ac.za

Abstract

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.

  • asthma
  • wheeze
  • developing countries
  • South Africa

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Footnotes

  • * Apartheid sought to categorise all South Africans into one of four racial groups: Asian (or Indian) (2.6% of the population, 1996 census), African (or black) (76.7%), coloured (8.9%), and white (10.9%). The social stratification by racial group reflects large and enduring historical disparities in socioeconomic status, quality of housing and services and access to medical care, and consequently in disease risk. Racial group stratification has been retained in national health surveillance in South Africa to reflect a social complexity not fully captured by education, income, etc and to monitor progress toward reduction of health disparities.

  • Competing interests: none declared

  • Dedicated to the memory of Neil Walton White, 1954–2004.

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