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Mirrahimova Maktuba Habibullayevna, associate professor of the Department of Children's Diseases № 1
Tashkent Medical Academy Khalmatova Barno Turdihadjayevna, professor, head of the Department of Children's Diseases № 1
Tashkent Medical Academy Tashmatova Gulnoza Aloyevna, assistant of the Department of Children's Diseases № 1 Tashkent Medical Academy, Uzbekistan E-mail: [email protected]
PREVALENCE OF BRONCHIAL ASTHMA IN CHILDREN OF AN INDUSTRIAL REGION IN THE USBEKISTAN
Abstract: The article presents the results of the ISAAC questionnaire to assess the prevalence ofbronchial asthma among children aged 7-8 and 13-14 living in industrial regions of Uzbekistan. 2500 pupils from 4 regions took part in the survey. Before the study, BA was diagnosed in 2.3% of children of school age (23 per 1000 children). After the survey, the prevalence of clinically diagnosed BA in children of school age increased almost 3 times and averaged 6.6%. Keywords: children, questioning, ISAAC, prevalence, bronchial asthma.
Actuality. All over the world, including Uzbekistan, there epidemiological studies of the ISAAC program have not been
is a tendency to an increase in the incidence of asthma and its more severe course. Epidemiological studies indicate that from 4 to 8.2% of the population suffers from bronchial asthma in different regions ofthe world [1; 2]. At the same time, the frequency of bronchial asthma in the adult population varies within 5%, and in the pediatric population it rises to 5-12% [3]. Epi-demiological studies conducted using various methodological techniques indicate that the true prevalence ofbronchial asthma among children significantly exceeds the official statistics. Thus, for example, epidemiological studies conducted on the basis of studying the appealability of patients to medical treatment and preventive institutions do not reflect the true picture of asthma prevalence, since not all cases of asthma are recorded. The most reliable and comparable data on the prevalence of atopic pathology in assessing the structure of the disease by severity in many countries of the world were obtained in connection with the implementation of the ISAAC program [6].
It is known that the health of the population, including children, is influenced by climatic, geographical, social, endemic and, to a large extent, environmental factors, there is information about the influence of man-made environmental pollutants on the pathology of the bronchopulmonary system in children [1; 4; 6]. Meanwhile, in each region there are different technologies and volumes of production, almost unique by types, as well as by levels of anthropogenic impact on the environment and the human body, which must be considered when conducting epidemiological studies and studying the characteristics of the course of diseases [5; 6]. So far, in the industrial regions of the Tashkent region (Uzbekistan), the
conducted, the risk factors and features of the course of bronchial asthma among children have not been studied.
Purpose. To study the prevalence of bronchial asthma in children of school age living in industrial regions of the Tashkent region.
Materials and methods. We conducted a survey of2500 children, aged 7-8 years and 13-14 years. The study was conducted in two stages: Stage I included conducting a survey on the ISAAC questionnaire adapted to our conditions and translated into Uzbek. The survey was conducted in three regions of the Tashkent region - Angren, Almalyk, Chirchik. The reason for conducting research in three regions of the Tashkent region was the fact that several industrial facilities are located in these regions. For example, in Almalyk there is a large industrial holding AGMK (Almalyk Mining and Metallurgical Combine), where zinc is periodically released into the water. In Chirchik, there is a large industrial holding company, Uzneftegazmash, which manufactures technological equipment for the chemical industry, and chlorine vapor is periodically released into the atmosphere. In Angren, the metallurgical industry is located, where large quantities of aluminum are emitted into the soil. For comparison, a survey was conducted among children living in an ecologically more favorable region (Tashkent).
High school students filled out the questionnaires themselves, for the first graders of the questionnaire filled out parents.
Phase II of the survey (clinical, functional and allergologi-cal studies) was conducted for children who gave positive answers to questionnaire questions.
PREVALENCE OF BRONCHIAL ASTHMA IN CHILDREN OF AN INDUSTRIAL REGION IN THE USBEKISTAN
The results of studies on the ISAAC program in children
in the age group of 13-14 years. To the question "Have you had wheezing breath or whistling in your chest in the last 12 months" there was a wide range of positive responses between regions - 15.3%; 9.7%; 8.9% and 2.4% in Tashkent. Positive answers to the questionnaire's 3 questions regarding the severity of asthma-like symptoms (difficulty wheezing with a frequency of 4 or more times a year, a severe attack of breath-lessness and night symptoms more than 1 time per week) indicated a severe persistent course of the disease. Episodes of wheezing wheezing with a frequency of 4 or more times a year fluctuated according to the respondents' answers from 18.7% in the Tashkent region, and 7.2% in the city of Tashkent (a difference of 2.6 times). The frequency of sleep disorders due to attacks of difficulty wheezing, wheezing more than 1 time per week ranged from 4.7 to 1.3% (the difference is 3.6 times). Severe episodes of wheezing during the last 12 months were observed with a frequency of 9.2 to 0.4% (a difference of 23 times), the largest percentage was observed in the regions of Angren (10.2%) and the Almalyk region (6.4%). Symptoms of bronchospasm during exercise were observed with a frequency of 16.7 to 2.8% (4.7 times difference).
Bronchospasm for physical exertion and dry nighttime cough during the last 12 months was determined more often than shortness of wheezing in the last 12 months in most of the regions examined. The proportion of children who responded positively to the question about the presence of a dry night cough ranged from 20.9% to 2.7% (a difference of 7.7 times). More than 19% of teenagers from Angren, Almalyk and Chirchik answered this question positively.
97 schoolchildren of the Tashkent region answered positively to the question of the questionnaire "Have you ever had bronchial asthma?" More than 3.1% of this figure was in the city of Tashkent.
The results of the survey revealed that in children aged 13-14 years more often (92.7%) than in children aged 7-8 years (79.2%), asthma-like symptoms such as fits of wheezing and sleep disturbance occurred. for wheezing, difficulty wheezing and wheezing with speech restriction, the presence of shortness of breath during exercise and dry, not associated with the common cold, cough at night, as well as diagnosed with asthma.
The results of studies on the ISAAC program in children
in the age group of 7-8 years. In this age group, parents of 976 first-graders from 4 regions took part in the survey. There was a wide range of responses between different regions to the question of the prevalence of shortness of wheezing over the past 12 months - from 12.1 to 3.2% (a difference of 3.7 times). The prevalence ofthis symptom is more than 10% was determined in Angren.
The frequency ofwheezing wheezing episodes with a frequency of 4 or more times per year ranged from 8.2 to 3.6% (a difference of 2.3 times); a level of more than 5.2% is registered only in Angren.
The frequency of sleep disorders in connection with the attacks of difficulty wheezing wheezing more than 1 time per week ranged from 3.1 to 0.9% (a difference of 3.4 times). The level of this indicator is more than 2.9% defined in the Almalyk region. Severe episodes of difficulty wheezing with speech dyspnea over the past 12 months have been observed with a frequency of 6.3 to 0.4% (15.7 times the difference); the highest rate was recorded in Almalyk - 4.4%.
Symptoms of bronchospasm during exercise were observed with a frequency of 7.1 to 0.3% (a difference of 24.7 times). The frequency of this symptom is more than 5% defined in Chirchik and Almalyk.
The proportion of parents of children who responded positively to the question about the presence of dry night cough, ranged from 10.9 to 2.3% (the difference is 4.7 times). At the same time, the frequency level of this indicator is more than 9.3% recorded in the responses from parents of first-graders from Angren, Almalyk and Chirchik.
951 parents of first-graders responded positively to the question of the questionnaire "Did your child ever have bronchial asthma, the percentage varied by region from 5.2 to 0.6% (the difference is 8.6 times); the highest value of this indicator is noted in Angren (5.7%).
Discussion: Before an epidemiological study on the ISAAC program in practical health care facilities in the Tashkent region, BA was diagnosed in 2.3% ofchildren of school age (23 per 1000 children). After the ISAAC survey, the prevalence of clinically diagnosed BA in school-age children increased almost 3 times and averaged 6.6% (66 per 1000 children). When comparing these indicators, the hypnosis of asthma becomes apparent. When comparing the prevalence of the disease depending on gender, no significant differences were found in children aged 7-8 years. However, girls aged 13-14 years, compared with boys ofthis age group, more often had shortness ofbreath on exertion and a dry, not associated with a cold, cough at night.
Conclusions
1. Clinically diagnosed on the basis of the ISAAC program, asthma among schoolchildren in industrial regions at the age of 7-8 years was 3.6 ± 0.7%, at the age of 13-14 years - 9.7 ± 0.8%. The true prevalence of BA among children in the Chirchik, Al-malyk, Angren regions averaged 6.6%, which is almost 3 times higher than the official statistics (an average of 2.3%).
2. Despite the relatively high specificity and sensitivity of each question, for the final diagnosis, an in-depth clinical, functional and allergological examination is required based on generally accepted clinical guidelines.
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