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.
Highlights
Symptom-based questionnaires can be a cost effective tool enabling identification and diagnosis of patients with respiratory illnesses in resource limited setting
On the basis of quality assessment of spirometry reports 12 entries were excluded from the analysis of lung volumes
After adjustment for confounders in multivariate analysis, forced vital capacity (FVC) was significantly reduced for phlegm, wheeze and shortness of breath; FEV1 was significantly reduced for cough, phlegm and wheeze
Summary
Symptom-based questionnaires can be a cost effective tool enabling identification and diagnosis of patients with respiratory illnesses in resource limited setting. Spirometry is recommended as basis for diagnosing impaired lung function [1,2] but lack of spirometry equipment and expertise to use it in primary care settings of developing countries make it an unfeasible option [3]. In these settings, respiratory symptom-based questionnaires can be a simple and cost effective tool enabling identification and diagnosis of patients with respiratory illnesses. American Thoracic Society Division of Lung Disease questionnaire (ATS – DLD-78A) [9] is a commonly used questionnaire for identifying the respiratory symptoms It contains questions regarding frequent and chronic respiratory symptoms including cough, phlegm, wheeze and shortness of breath. When used in conjunction with spirometry, symptoms based questionnaires can be a useful adjunct in the screening of population for respiratory illnesses [14]
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