I.A. Azeez1, M.M.A. Ladipo2, and O.M. Ige3
- Medical Outpatient Department, State Hospital, Oyo, Nigeria.
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria.
- Department of Medicine, University College Hospital, Ibadan, Nigeria.
Background: Asthma is a chronic disease which places considerable economic, social and public health burdens on the society. Education, occupation and income are the most widely used indicators of socioeconomic status (SES). Studies have shown increased asthma hospital admissions for those who are materially deprived and increased asthma severity in low social class groups. The aim of this study is to determine the impact of socioeconomic status on control of asthma in adults.
Methods: The study was a cross-sectional analytical one, conducted over a year at the Medical Outpatient Clinic of the University College Hospital Ibadan. The study population was composed of 355 randomly selected adults aged between 18years and 55years with an established diagnosis of asthma already on treatment.
Results: Respondents with monthly income of N40000 and above had a higher proportion with good asthma control (74.1%) compared to those that earned N10000 to N39999 (69.0%) and less than N10000 (47.8%). This was statistically significant. Respondents in occupational class I/II had a slightly higher proportion with good asthma control (70.9%) compared to those in occupation class III/IV (70.1%) and occupation class V/VI (50.6%). This was statistically significant at p = 0.003.
Conclusion: Respondents in the higher occupational class had better asthma control than respondents in the lower occupational class. Respondents who were earning N40000 and above as monthly income had better control of asthma than other respondents. After adjusting for other variables, the predictor of good asthma control was monthly income of the respondents.
Keywords: Education, Occupation, Monthly income, Asthma control
Dr. I.A. Azeez
Medical Outpatient Department,
State Hospital, Oyo,
Tel: 08023635934, 08034428328;
Asthma is a chronic condition that requires long term management, although asthma cannot be cured, but it can be controlled.1 Asthma is a very common chronic disease which places substantial economic, social and public health burdens on the society. 2, 3
Appropriate use of asthma medications reduces morbidity and mortality from asthma and improves quality of life. The World Bank defines poverty as a condition in which a person, family, or community lacks the essentials necessary for material well-being. 4 Poverty is usually measured and quantified as an income below the minimum level of income considered necessary to meet the basic necessities of life.5 The new poverty line of $1.25 a day was recently announced by the World Bank (in 2008).4 Poverty may contribute to the aetiology, exacerbation, and inadequate treatment of asthma.
Education, occupational status and income are the most widely used indicators of socioeconomic status (SES). Though moderately correlated, each of these measures can capture distinctive aspects of social position and they are not substitutable.6-8 The trends from the use of beta agonist inhalers to the use of steroid inhalers have introduced another dimension to management of asthma in terms of cost-effectiveness.4 Studies have shown increased asthma hospital admissions for those who are materially deprived and increased asthma severity in low social class groups.9 Matthew et al in their study found that poverty was associated with illness, disability, and premature death.10
Corvalan and colleagues reported a consistent inverse association between number of belongings and asthma symptoms.11 According to a study conducted in Canada, the cost of drugs, past experience with medications, beliefs about drugs and relationship with health care providers influence patients hopes of their medications.12 The results of another study in Canada showed that there was no association between age, gender, or genotype and Short Acting Beta Agonist(SABA) use. However, patients with lower SES and greater severity of asthma used greater amount of SABA than those with higher SES13
Vallabh in a South African study reported that peak flow meters were underutilized by Family Practitioners. The cost was an important cause of under-utilization.14 Poverty and ignorance were identified as possible causes of underutilization of peak flow meters and patients have to be educated on the importance of peak-flow meters in the diagnosis and monitoring of asthma.
The metered dose inhalers (MDI) are aerosols driven by propellants. There is low lung deposition but high oropharyngeal deposition.15 Dry powder inhalers (DPI) are inhalation driven, easy to use but expensive. Asthma control is defined as a condition in which the patient has minimal to no daytime asthma symptoms, no limitations on activities, no nocturnal symptoms, minimal to no need for reliever therapy, normal lung function (Forced Expiratory Volume per second or Peak Expiratory Flow rate) and no exacerbations.
The aim of this study is to determine the impact of socioeconomic status on control of asthma in adult asthmatics presenting to University College Ibadan Hospital.