Risk factors for asthma exacerbation among Hajj pilgrims: a case study from DKI Jakarta, Indonesia

  • Anshari Saifuddin Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0003-4331-2381
  • Ujainah Zaini Nasir Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Iris Rengganis Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Hamzah Shatri Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0003-1393-9669
Keywords: asthma, exacerbation, risk factors
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Abstract

BACKGROUND Hajj pilgrims are prone to asthma exacerbation because of the high transmission rate of respiratory infections, severe environmental factors, and high-intensity activities during the Hajj. Well-controlled asthma status and preventive efforts prior to the Hajj could reduce such exacerbations. This research aimed to determine the risk factors of asthma exacerbation during the Hajj to help establish preventive measures.

METHODS Participants were evaluated at community health centers (puskesmas) through history taking, physical examination, and spirometry. The risk factors examined included a history of exacerbation one year before the Hajj, obesity, comorbidities (e.g., diabetes mellitus, hypertension, coronary heart disease), lung function, smoking, fitness level, and influenza vaccination. Asthma exacerbation while in Saudi Arabia was determined through direct observations by authors and physicians assigned to Hajj pilgrim groups and analysis of data obtained from questionnaires distributed to the pilgrims before their departure. Odds ratios (OR) were calculated using logistic regression.

RESULTS Among 68 pilgrims with asthma, exacerbation occurred in 27 (40%) pilgrims. Risk of asthma exacerbation was significantly increased in the pilgrims with a history of exacerbation one year before the Hajj (OR = 4.27; 95% confidence interval [CI] = 1.156–15.829; p = 0.029) and obesity grade II (OR = 4.02; 95% CI = 1.151–14.097; p = 0.029). Other factors, including smoking, comorbidities, lung function, fitness level, obesity grade I, and influenza vaccination, were not significantly related to exacerbation.

CONCLUSIONS Obesity grade II and history of asthma exacerbation one year before the Hajj are strong factors for asthma exacerbation during Hajj pilgrims.

References

  1. General Authority for Statistics, Kingdom of Saudi Arabia. Hajj statistics for the year 1438 H [Internet]. 2017 [cited 2018 Jan 26]. from: https://www.stats.gov.sa/en/5633.

  2. Direktorat Jenderal Penyelenggaraan Haji dan Umrah Kementerian Agama Republik Indonesia. Dasar hukum haji dan umroh. [cited 2018 Oct 22]. Available from: http://haji.kemenag.go.id. Indonesian.

  3. Gastrad AR, Sheikh A. Hajj: journey of a lifetime. BMJ. 2005;330(7483):133-7. https://doi.org/10.1136/bmj.330.7483.133

  4. Indonesian Hajj Health Center, Ministry of Health of the Republic of Indonesia. 2016 Hajj health center performance report. Jakarta: Ministry of Health of the Republic of Indonesia;2016. Indonesian.

  5. Indonesian Hajj Health Center, Ministry of Health of the Republic of Indonesia. 2017 Hajj health center performance report. Jakarta: Ministry of Health of the Republic of Indonesia;2017. Indonesian.

  6. Al-Ghamdi SM, Akbar HO, Qari YA, Fathaldin OA, Al-Rashed RS. Pattern of admission to hospitals during Muslim pilgrimage (Hajj). Saudi Med J. 2003;24(10):1073-6.

  7. Baharoon S, Al-Jahdali H, Al Hashmi A, Memish ZA, Ahmed QA. Severe sepsis and septic shock at the Hajj: etiologies and outcomes. Travel Med Infect Dis. 2008;7(4):247-52. https://doi.org/10.1016/j.tmaid.2008.09.002

  8. Global Initiave for Asthma. Pocket guide asthma management and prevention (for adults and children older than 5 years): a pocket guide for health professional updated 2017. Fontana: Global Initiave for Asthma; 2017.

  9. Schatz M, Mosen DM, Kosinski M, Vollmer VM, Magid DJ, O'Connor E, et al. Validity of the Asthma Control Test completed at home. Am J Manag Care. 2007;13(12):661-7.

  10. American Thoracic Society (ATS). Asthma Control Test (ACT) [Internet]. 2017 [cited 2018 Jan 26]. New York: American Thoracic Society (ATS). Available from: https://www.thoracic.org/members/assemblies/assemblies/srn/questionaires/act.php.

  11. Schanen JG, Iribarren C, Shahar E, Punjabi NM, Rich SS, Sorlie PD, et al. Asthma and incident cardiovascular disease: the atherosclerosis risk in communities study. Thorax. 2005;60(8):633-8. https://doi.org/10.1136/thx.2004.026484

  12. Herdy AH, Caixeta A. Brazilian cardiorespiratory fitness classification based on maximum oxygen consumption. Arq Bras Cardiol. 2016;106(5):389-95. https://doi.org/10.5935/abc.20160070

  13. Pollack ML, Schmidt DH, Jackson AS. Measurement of cardio-respiratory fitness and body composition in the clinical setting. Compr Ther. 1980;6(9):12-27.

  14. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update. An Official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med. 2019;200(8):e70-88. https://doi.org/10.1164/rccm.201908-1590ST

  15. National Heart, Lung, and Blood Institute. Guidelines for the diagnosis and management of asthma (EPR-3). USA: U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute; 2012.

  16. ten Brinke A, Sterk PJ, Masclee AA, Spinhoven P, Schmidt JT, Zwinderman AH, et al. Risk factors of frequent exacerbations in difficult-to-treat asthma. Eur Respir J. 2005;26(5):812-8. https://doi.org/10.1183/09031936.05.00037905

  17. Puranik S, Fomo E, Bush A, Celedón JC. Predicting severe asthma exacerbations in children. Am J Respir Crit Care Med. 2017;195(7):854-9. https://doi.org/10.1164/rccm.201606-1213PP

  18. Dalcin PT, Menegotto DM, Zanonato A, Franciscatto L, Soliman F, Figueiredo M, et al. Factors associated with uncontrolled asthma in Porto Alegre, Brazil. Braz J Med Biol Res. 2009;42(11):1097-103. https://doi.org/10.1590/S0100-879X2009005000035

  19. Hasegawa K, Tsugawa Y, Lopez BL, Smithline HA, Sullivan AF, Camargo CA Jr. Body mass index and risk of hospitalization among adults presenting with asthma exacerbation to the emergency department. Ann Am Thorac Soc. 2014;11(9):1439-44. https://doi.org/10.1513/AnnalsATS.201406-270BC

  20. Stanford RH, Gilsenan AW, Ziemiecki R, Zhou X, Lincourt WR, Ortega H. Predictors of uncontrolled asthma in adult and pediatric patients: analysis of the Asthma Control Characteristics and Prevalence Survey Studies (ACCESS). J Asthma. 2010;47(3):257-62. https://doi.org/10.3109/02770900903584019

  21. Umetsu DT. Mechanisms by which obesity impacts upon asthma. Thorax. 2017;72(2):174-7. https://doi.org/10.1136/thoraxjnl-2016-209130

  22. Gibson PG. Obesity and asthma. Ann Am Thorac Soc. 2013;10Suppl:S138-42. https://doi.org/10.1513/AnnalsATS.201302-038AW

  23. Meysamie A, Ardakani H, Razavi SM, Doroodi T. Comparison of mortality and morbidity rates among Iranian pilgrims in Hajj 2004 and 2005. Saudi Med J. 2006;27(7):1049-53.

  24. Plans-Rubió P. The vaccination coverage required to establish herd immunity against influenza viruses. Prev Med. 2012;55(1):72-7. https://doi.org/10.1016/j.ypmed.2012.02.015

  25. Vasileiou R, Sheikh A, Butler C, El Ferkh K, von Wissmann B, McMenamin J, et al. Effectiveness of influenza vaccines in asthma: a systematic review and meta-analysis. Clin Infect Dis. 2017;65(8):1388-95. https://doi.org/10.1093/cid/cix524

  26. Cates CJ, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev. 2013;2013(2):CD000364. https://doi.org/10.1002/14651858.CD000364.pub4

  27. Wang L, Gao S, Yu M, Sheng Z, Tan W. Association of asthma with coronary heart disease: a meta analysis of 11 trials. PLoS One. 2017;12(6):e0179335. https://doi.org/10.1371/journal.pone.0179335

  28. Thuesen BH, Husemoen LL, Hersoug LG, Pisinger C, Linneberg A. Insulin resistance as a predictor of incident asthma-like symptoms in adults. Clin Exp Allergy. 2009;39(5):700-7. https://doi.org/10.1111/j.1365-2222.2008.03197.x

  29. Rana JS, Mittleman AM, Sheikh J, Hu FB, Manson JE, Colditz GA, et al. Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women. Diabetes Care. 2004;27(10):2478-84. https://doi.org/10.2337/diacare.27.10.2478

  30. Christiansen SC, Schatz M, Yang SJ, Ngor E, Chen W, Zuraw BL. Hypertension and asthma: a comorbid relationship. J Allergy Clin Immunol Pract. 2016;4(1):76-81. https://doi.org/10.1016/j.jaip.2015.07.009

  31. Dart RA, Gollub S, Lazar J, Nair C, Schroeder D, Woolf SH. Treatment of systemic hypertension in patients with pulmonary disease: COPD and asthma. Chest. 2003;123(1):222-43. https://doi.org/10.1378/chest.123.1.222

  32. Schatz M, Zeiger RS, Drane A, Harden K, Cibildak A, Oosterman JE, et al. Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition technology. J Allergy Clin Immunol. 2007;119(2):336-43. https://doi.org/10.1016/j.jaci.2006.08.042

  33. Al-Jahdali HH, Al-Zahrani AI, Al-Otaibi ST, Hassan IS, Al-Moamary MS, Al-Duhaim AS, et al. Perception of the role of inhaled corticosteroids and factors affecting compliance among asthmatic adult patients. Saudi Med J. 2007;28(4):569-73.

  34. Al-Jahdali H, Anwar A, Al-Harbi A, Baharoon S, Halwani R, Al Shimemeri A, et al. Factors associated with patient visits to the emergency department for asthma therapy. BMC Pulm Med. 2012;12:80. https://doi.org/10.1186/1471-2466-12-80

  35. Ortega H, Yancey SW, Keene ON, Gunsoy NB, Albers FC, Howarth PH. Asthma exacerbation associated with lung function decline in patients with severe eosinophilic asthma. J Allergy Clin Immunol Pract. 2018;6(3):980-6.e1. https://doi.org/10.1016/j.jaip.2017.12.019

  36. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19-24. https://doi.org/10.1164/rccm.200807-1126OC

  37. Toennesen LL, Soerensen ED, Hostrup M, Porsbjerg C, BangsboJ, Backer V. Feasibility of high-intensity training in asthma. Eur Clin Respir J. 2018;5(1):1468714. https://doi.org/10.1080/20018525.2018.1468714

  38. Bumbacea D, Campbell D, Nguyen L, Carr D, Barnes PJ, Robinson D, et al. Parameters associated with persistent airflow obstruction in chronic severe asthma. Eur Respir J. 2004;24(1):122-8. https://doi.org/10.1183/09031936.04.00077803

  39. Bittner JC, Hasegawa K, Silverman RA, Camargo CA Jr. Smoking cessation intervention among adults hospitalized with asthma exacerbation [abstract]. Ann Emerg Med. 2015;66(4 Suppl 136). Abstract no. 374. https://doi.org/10.1016/j.annemergmed.2015.07.410

  40. Scott HA, Gibson PG, Garg ML, Pretto JJ, Morgan PJ, Callister R, et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clin Exp Allergy. 2013;43(1):36-49. https://doi.org/10.1111/cea.12004

Published
2020-07-01
How to Cite
1.
Saifuddin A, Nasir UZ, Rengganis I, Shatri H. Risk factors for asthma exacerbation among Hajj pilgrims: a case study from DKI Jakarta, Indonesia. Med J Indones [Internet]. 2020Jul.1 [cited 2020Aug.7];29(2):190–7. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/4170
Section
Community Research