Correlation of respiratory symptoms and spirometric lung patterns in a rural community setting, Sindh, Pakistan: a cross sectional survey

Abstract

BackgroundSymptom-based questionnaires can be a cost effective tool enabling identification and diagnosis of patients with respiratory illnesses in resource limited setting. This study aimed to determine the correlation of respiratory symptoms and spirometric lung patterns and validity of ATS respiratory questionnaire in a rural community setting.MethodsThis cross sectional survey was conducted between January – March 2009 on a sample of 200 adults selected from two villages of district Khairpur, Sindh, Pakistan. A modified version of the American thoracic society division of lung disease questionnaire was used to record the presence of respiratory symptoms. Predicted lung volumes i.e. forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and their ratio (FEV1/FVC) were recorded using portable spirometer.ResultsIn the study sample there were 91 (45.5%) males and 109 (54.5%) females with overall mean age of 34 years (±11.69). Predominant respiratory symptom was phlegm (19%) followed by cough (17.5%), wheeze (14%) and dyspnea (10.5%). Prevalence of physician diagnosed and self-reported asthma was 5.5% and 9.5% respectively. Frequency of obstructive pattern on spirometry was 28.72% and that of restrictive pattern was 19.68%. After adjustment for age, gender, socioeconomic status, spoken dialect, education, smoking status, height, weight and arsenic in drinking water, FVC was significantly reduced for phlegm (OR 3.01; 95% CI: 1.14 – 7.94), wheeze (OR 7.22; 95% CI: 2.52 – 20.67) and shortness of breath (OR 4.91; 95% CI: 1.57 – 15.36); and FEV1 was significantly reduced for cough (OR 2.69; 95% CI: 1.12 – 6.43), phlegm (OR 3.01; 95% CI: 1.26 – 7.16) and wheeze (OR 10.77; 95% CI: 3.45 – 33.6). Presence of respiratory symptoms was significantly associated with restrictive and/or obstructive patterns after controlling for confounders. Similar findings were observed through linear regression where respiratory symptoms were found to be significantly associated with decrements in lung volumes. Specificity and positive predictive values were found to be higher for all the symptoms compared to sensitivity and negative predictive values.ConclusionSymptoms based respiratory questionnaires are a valuable tool for screening of respiratory symptoms in resource poor, rural community setting.

Evaluation of Respiratory Symptoms, Spirometric Lung Patterns and Metal Fume Concentrations among Welders in Indoor Air-Conditioned Building at Malaysia

“…From the results findings, there is low (zero per cent) of sensitivity recorded and positive predictive value compared to high readings of specificity and negative predictive values for all symptoms as in the ATS questionnaire. This indicates the consistency of research findings with the previous study that reported the low sensitivity and high specificity [26], [35]. The results of a physical environmental parameter of velocity, humidity, temperature and dust (PM10) from area monitoring of four workstations are tabulated in Table 5.…”

“…Surprisingly, from an overall research study, the respiratory symptoms of a cough, phlegm, wheeze and short breath are not statistically significant (P>0.05) with the decrement of lung function volumes (FEV 1 , FVC and FEV 1 /FVC). The findings are not aligned as the study is focused on a small sample size than the previous study with sample N=200 [26]. Despite there are less significant shows in the model, still, in the logistic regression, shows that a cough and phlegm as the strongest predictors of FEV 1 and FEV 1 /FVC.…”

Respiratory symptoms and lung function 8–10 months after community exposure to chlorine gas: a public health intervention and cross-sectional analysis

“…An isolated reduction in FEV1 cannot diagnose any distinctive abnormal air-flow pattern. Nevertheless, in previous population based studies, reduction in only FEV1 was a reliable predictor of mortality from chronic respiratory or cardiovascular disease [46-48]. In addition, a recent Asian study found that isolated FEV1 reduction was associated with a history of smoking, abnormal chest radiography, and history of asthma or chronic bronchitis [49].…”

Respiratory Health Status of Rural Women Exposed to Liquefied Petroleum Gas and Solid Biomass Fuel Emissions

“…Spirometric measurements, along with the respiratory questionnaire, are recommended to be the basic tool for diagnosis of respiratory illnesses. [35][36][37] Based on these recommended tools, Abbasi et al 35 carried out a cross-sectional survey in a rural community setting by using the American Thoracic Society (ATS) questionnaire (ATS-DLD-78A) and by conducting spirometric measurements. Previous studies have compared the exposure to mixed fuels (households using both SBF and LPG in combination) and LPG in outcomes on asthma, bronchitis, and respiratory symptoms.…”