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BACKGROUND: Asthma is chronic lung disease. Reducing exposure to tobacco smoke is vital for both primary prevention of asthma and disease management. Adherence to medical advice is crucial for the effectiveness of treatments. This research explores the connected dynamics of smoking habits, asthma prevalence, and medication adherence among urban slum dwellers. METHODS: A door-to-door survey was conducted in two urban slums of Delhi, employing a random sampling method to study 318 households comprehensively. Two proficient research volunteers administered a questionnaire designed to assess smoking habits, asthma prevalence, adherence to prescribed medications, and devices used by individuals with asthma. RESULTS: The overall prevalence of asthma was found at 1.6%, with gender-specific rates of 0.9% and 0.7% for males and females, respectively, with a mean age of 35.62 years (standard deviation = 15.93) in the population of 1376 individuals. Within the cohort of asthmatic patients, 13.6% exhibited severe asthma. Despite their asthma diagnosis, 9.1% were current active smokers, and 18.2% transitioned to the use of smokeless tobacco. The odds ratio for being asthmatic in smokers as compared to nonsmokers was 2.11 (95% confidence interval: 0.81–5.46, P = 0.1224). A significant proportion of patients displayed lapses in adhering to prescribed medication regimens. CONCLUSION: The current study sheds light on a concerning trend of negligence observed in both medical adherence and smoking habits among asthmatic patients. The findings underscore the imperative for targeted interventions and educational initiatives aimed at enhancing adherence to medical regimens and mitigating smoking behaviors within this vulnerable patient population. Addressing these factors is pivotal for enhancing comprehensive asthma management, alleviating associated risks, and promoting more favorable long-term health outcomes. [ABSTRACT FROM AUTHOR]

In the same review, the RR of early-onset asthma associated with a maternal history of asthma was more (3.9 versus 3.3) compared to that of paternal asthma.[[153]] Children with a family history of asthma are suggested to have a more severe course.[[155]],[[156]] Although the association of adult-onset asthma with family history is weak than that of childhood-onset asthma, however, it is still a significant risk factor for adult-onset asthma. A family history of asthma is seen less frequently than those with early-onset asthma.[[111]] This phenotype of asthma is relatively steroid-resistant but highly responsive to biologic therapies targeting T2 pathways.[[112]],[[113]],[[114]],[[115]] Obesity-related asthma Obesity-related asthma is not a well-understood phenotype, and it is unclear whether it is comorbidity common in asthma that confers greater likelihood of breathing pattern disorder or it promotes a pro-inflammatory state that results in asthma.[[116]],[[117]],[[118]],[[119]] Higher body mass index (BMI) is associated with increased levels of inflammatory markers, such as, tumour necrosis factor-alpha (TNF-a), interleukin-6 (IL-6), and leptins and fewer eosinophils, fractional exhaled nitric oxide (FeNO) and corticosteroid responsiveness.[[118]],[[119]] Clinically, this phenotype comprises of a group of older non-allergic, obese females who have significant symptoms but minimal health-care utilization.[[103]],[[104]] Neutrophilic asthma Neutrophilic asthma does not have a widely accepted definition, and the consensus about the characterization of this entity is also lacking. [Extracted from the article]

BACKGROUND: Meteorological factors and environmental air pollutants may affect pollen counts in the North Delhi region that produce a variety of pollen and it may affect patients with respiratory illness. OBJECTIVE: This study was planned to see the effect of meteorological factors and environmental air pollutants on pollen counts and its association with emergency hospital visits. MATERIALS AND METHODS: From 2015 to 2020, atmospheric pollen was collected (24-h sampling) using a Volumetric Burkard Air Sampler. RESULTS: The total pollen count was (n = 461,474) in the last 6 years and the maximum pollen count was (n = 85,363) observed in the year 2016. Pollen count was high (>500) in the months of March and April during the study tenure, however, October month of the year 2015 and 2017 also crossed this range of pollen count (>500). During the years 2015–2020, nitrogen dioxide and carbon dioxide had a negative association with pollen count that was statistically significant (P < 0.05), but sulfur dioxide had a positive correlation that was statistically significant (P < 0.05). Maximum emergency hospital visits were in 2019. Pollen count positively correlated with emergency hospital visits only for the year 2015. CONCLUSION: This study concludes that meteorological factors and environmental air pollutants have a significant influence on the pollen counts that may affect the patient's hospital visits. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asthma is a multifaceted condition defined by chronic airway inflammation. Skin prick test (SPT), serum total immunoglobulin E (tIgE), and absolute eosinophil counts (AEC) estimation are commonly available tools for evaluating allergen sensitization. OBJECTIVE: The present study evaluates the sensitivity to common aeroallergens and also compares serum tIgE and AEC levels with spirometry in Indian individuals with a history of allergy symptoms. MATERIALS AND METHODS: An observational prospective study was conducted in the Outpatient Department of Viswanathan Chest Hospital, VPCI, Delhi, between 2017 and 2019. Two hundred asthma patients diagnosed as per the Global Initiative for Asthma guidelines undergo SPT against a battery of common aeroallergens and measured serum tIgE and AEC. RESULTS: Out of 200 cases, the overall prevalence of common aeroallergens sensitization was found to be 57% (114) in asthmatic patients (atopic). SPT positivity to common aeroallergens was highest in people between the ages of 21 and 30 and lowest in people over 50. The most prevalent annoying aeroallergens were found to be weed pollens (14%), house dust mites (11%), fungi (10.5%), tree pollen (9.5%), dust (6%), kapok cotton (5.5%), grass pollen (3.5%), silk (1.5%), and wool (1%). The mean tIgE was higher in atopic asthmatic patients than in nonatopic asthmatic patients (553.25 ± 218.12 IU/ml and 489.1 ± 251.16 IU/ml; P = 0.056). CONCLUSION: In the present study, we found that insects are the most common offending aeroallergens with higher SPT sensitivity and serum tIgE in atopic patients. Spirometry severity is not affected by allergens sensitivity in asthma patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asthma is a chronic disease that affects large number of people worldwide. In urban areas, asthmatic people are getting exposed to pigeon antigen (droppings and feathers) around the workplace and domestic areas. The present study was conducted to the determination of MUC1 protein in the blood of pigeon-exposed asthmatic patients by the high-performance liquid chromatography (HPLC) method. MATERIALS AND METHODS: This was a prospective study of 108 pigeon-exposed asthma patients. We enrolled 17 asthmatic patients for detection of MUC1 expression in their serum sample who were atopic and skin prick testing positive for pigeon antigens (droppings and feathers). The MUC1 analysis was done with HPLC method. RESULTS: A total of 17 asthmatic patients were enrolled on the basis of the history of pigeon exposure and positive skin prick test for pigeon's feather and dropping allergens including 9 males and 8 females, the average age of the study candidates was 28.8 ± 10.1 years. MUC1 concentration was raised in all of the asthmatic patients exposed to pigeons. The MUC1 was upregulated in 15 and downregulated in 2 patients. A higher concentration of MUC1 was seen in younger patients. CONCLUSION: Pigeon droppings and feathers allergen exposed and sensitivity showed the higher MUC1 expression in serum in asthma patients. The concentration of MUC1 was higher in the younger age group. The HPLC method was easier and economical for the detection of MUC1. [ABSTRACT FROM AUTHOR]

Indian J Allergy Asthma Immunol 2023;37:S1-98. 12 Singh AB, Kumar P. Climate change and allergic diseases: An overview. Indian J Allergy Asthma Immunol 2015;29:32-9. 17 Kumar R, Kumar D, Singh K, Mavi AK, Kumar M. Identification of airborne pollens in Delhi. Asthma is found in up to 38% of patients with AR and nasal symptoms are present in 6%-85% patients with asthma.[[5]] A wide inter-regional variation in prevalence of asthma has also been observed. [Extracted from the article]

BACKGROUND: Bronchial asthma (BA) is characterized by chronic airway inflammation. Many studies have shown a significant overlap between BA and allergic rhinitis (AR). Specific allergen immunotherapy (AIT) is effective for the treatment of BA and AR. Only limited studies have evaluated the role of immunological parameters to assess the response in patients on AIT. Hence, this study was done to assess the role of interleukin-4 (IL-4), IL-5, and IL-6 in the follow-up of patients of BA and AR on AIT. MATERIALS AND METHODS: This study was conducted on diagnosed cases of BA, AR, and BA with AR attending the outpatient department who were started on subcutaneous immunotherapy as per the standard Indian guidelines. Blood samples were collected at the beginning of the treatment and every 3 months thereafter for a period of 51 months, and serum IL-4, IL-5, and IL-6 levels were measured. RESULTS: In this study, 170 patients were enrolled over a period of 51 months. Out of 170, 80 (47.1%) patients had completed 1 year of treatment with AIT at the end of 51 months of follow-up. Significant reduction was observed in IL-4, IL-5, and IL-6 levels during the treatment with AIT over a period of 12 months. CONCLUSION: Our study suggests a possible role of IL-4, IL-5, and IL-6 in the follow-up of BA and AR patients; however, further studies are needed in this area. [ABSTRACT FROM AUTHOR]

BACKGROUND: Skin prick test (SPT) is the "gold standard" in the assessment of sensitivity to inhalant allergens. SPT is performed with antigen extracts from India and evaluated according to the Standard Indian Guidelines. OBJECTIVE: The aim of this study was to determine sensitivity by skin prick test in asthma patients in metropolitical city of Delhi-National Capital Region (NCR). MATERIALS AND METHODS: This is a prospective study of skin prick test with aeroallergens in asthma patients and their combination with clinical diagnosis. Two hundred asthma patients consisting of 81 (40.5%) males and 119 (59.5%) females with a mean age of 30.51 ± 9.85 years aged between 12 and 60 years were selected for study from Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, Delhi, between 2017 and 2018. Fifty-eight different common aeroallergen tests were tested through skin prick test (SPT) in patients of bronchial asthma. The sensitivity of all common aeroallergens was analyzed by MS Excel 2010. RESULTS: A significant (2+ and above) skin-positive reaction against aeroallergens was found in 114 (57%) asthma patients. The younger adults aged 21-30 years were the foremost commonly affected group with 84 (43.5%). Among individual allergens, the most common aeroallergens showed a significant positive skin reaction, which were cockroaches 68 (34%) and moth 63 (32.5%), followed by mosquito 61 (30.5%), housefly 55 (27.5%), rice weevil 41 (20.5%), and house dust mite (HDM) 22 (11.0%). CONCLUSION: In the present study, we found that insects (cockroaches, housefly, mosquito, and rice weevil) and HDM are the most common skin sensitive aeroallergens in Delhi-NCR. The sensitization was the most common in the younger age group patients. [ABSTRACT FROM AUTHOR]

Asthma is a chronic airway illness that affects millions of people worldwide. In India, the prevalence of asthma in adults and children ranges from 0.96% to 11.9%. Sensitization to specific allergens, such as house dust mites and animal dander, is a major risk factor for asthma. Pigeons and their droppings and feathers are a significant source of allergens that can trigger allergic reactions in people with airway diseases. Pigeon-breeder's lung, rhinitis, and asthma are common allergies associated with pigeon exposure. It is recommended that asthmatic patients avoid unnecessary exposure to pigeon antigens to effectively control their condition. [Extracted from the article]

AIMS: To quantify and identify the pollen grains in the atmosphere of Delhi. SETTINGS AND DESIGN: The study was conducted at the National Centre of Respiratory Allergy, Asthma and Immunology, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi, India. SUBJECTS AND METHODS: The study was conducted for 2 months at VPCI, University of Delhi (North Campus), Delhi. Pollen grains were collected on a daily basis using 24-h Burkard (UK) volumetric air sampler. Trapped pollen film was stained with a fuchsin stain that is protected with a cover slip and examined under a light microscope. Identification was done with the help of manuals for pollen identification. STATISTICAL ANALYSIS USED: Data analysis was done by Microsoft Excel 2007. RESULTS: In this study period (April and May 2017), a total of 10,858/m3 pollens were counted; of these, 7758/m3 pollens of 34 species of trees, weeds, and grasses were identified. Overall, Juniper sp. (1385/m3) pollen of tree was found to be the most dominant pollen, followed by Cannabis sativa (726/m3), Pooideae grasses (e.g. Poa sp., Lolium perenne, Dactylis glomerata) (654/m3), Cynodon dactylon (509/m3), Amaranthus sp. (506/m3), Artemisia sp. (460/m3), Cassia sp. (447/m3), Chenopodium album (412/m3), Helenium autumnale (381/m3), and Parthenium (301/m3). Juniper sp. (1310/m3) pollens in April 2017 and C. sativa (421/m3) pollens in May 2017 have shown their dominance. CONCLUSIONS: In our study, various pollens of different plant species were counted and identified in this short study period. The common pollens found were Juniper sp., C. sativa, Pooideae grasses (e.g. Poa sp., Lolium perenne, Dactylis glomerata), C. dactylon, Amaranthus sp., C. album, H. autumnale, Parthenium, and Artemisia sp. in 2 months. This short study may be helpful for the respiratory allergic patients to protect themselves by pollens. [ABSTRACT FROM AUTHOR]

This article discusses the prevalence of cockroach allergy in respiratory allergic patients. Allergic reactions, particularly in the respiratory system, are a major global health issue, with asthma and allergic rhinitis being common respiratory diseases. Cockroaches have been identified as significant contributors to indoor allergies, and their sensitivity has been linked to the development of asthma and bronchial allergies. The prevalence of cockroach sensitivity varies worldwide, with rates ranging from 6.3% to 58%. To manage cockroach allergen sensitivity, the best approach is avoidance, such as maintaining a clean home and eliminating cockroach infestations. Immunotherapy with cockroach extracts can also be considered as a treatment option. [Extracted from the article]

BACKGROUND: Exposures to various aeroallergens play a crucial role in the pathogenesis of bronchial asthma (BA) and allergic rhinitis (AR). On the basis of climate change, the prevalence of aeroallergens may vary in different regions. AIMS: The aim of the study was to determine the prevalence of the sensitivity to aeroallergens among patients with BA and/or AR based on skin prick test (SPT) reactivity in India. SETTINGS AND DESIGN: This study was conducted at National Centre of Respiratory Allergy, Asthma and Immunology and Department of Respiratory Allergy and Applied Immunology, (Department of Respiratory Medicine), Vallabhbhai Patel Chest Institute, University of Delhi, Delhi-110007 (India). SUBJECTS AND METHODS: A total of 4835 patients were screened from the Outpatient Department of institute during the period of August 2008 to July 2016. Out of 4835 patients, 4263 patients were performed SPT consisting of 2361 (55.38%) males and 1902 (44.62%) females, with a mean age of 30.06 years were included in the study. Diagnosis of BA and AR was made according to the GINA and ARIA guidelines, respectively. SPT was done with 58 different types of aeroallergens, which included grass pollens, weed pollens, tree pollens, dust, fungi, insects, kapok cotton, wool, and silk antigens. STATISTICAL ANALYSIS USED: Data analysis was done using Excel 2007. RESULTS: Significant skin positive reaction (2 + and above) against aeroallergens were found in 1993 (46.77%) participants including 422 (9.9%) BA patients, 570 (13.37%) AR patients, and 1001 (23.48%) of both BA/AR. The younger adults aged 20-29 years were the foremost commonly affected group with 626 (14.68%) significant skin-positive patients. Among individual allergens, most common aeroallergen was mosquito (30.89%) and least common was Ehretia (0.37%). CONCLUSIONS: In different states of India, the mosquito was found the most common sensitizing allergen in BA and/or AR patients. Sensitization was the most common in the younger age group (20-29 years) patients. [ABSTRACT FROM AUTHOR]

The practice of Allergy and Immunotherapy is not streamlined in our country and there were no guidelines till we published in 2009 in IJAAI. The guidelines are updated now incorporating the additional information after 2009. The purpose of bringing out these guidelines was to maintain the uniformity in the methods of diagnosis and management i.e. Immunotherapy in the country. Because of different soil conditions, temperature, different allergens, different seasonal variations etc, it was the felt the need to have separate guidelines for India, although such guidelines are available from other organisations. These guidelines are based on available guidelines with modifications/alterations at appropriate places keeping in mind the situation in our country. [ABSTRACT FROM AUTHOR]

Background: Asthma is one of the most common chronic diseases worldwide. For asthma and allergic disorders, diet has been recently established as a potential risk factor. Thus, a change in dietary habit may be postulated, as one of the unknown factors responsible for the rise in prevalence of asthma among children in rural India. Objectives: To assess the association of diet with asthma in Indian rural population. Materials and Methods: This study was a cross-sectional study of children aged <18 years residing in Khanpur Jupti village, Ghaziabad, Uttar Pradesh, during 2011-2015. A questionnaire-based survey was carried out for respiratory illness-related symptoms. It was developed on the basis of American Thoracic Society (ATS), British Medical Research Council, and the International Study of Asthma and Allergies in childhood questionnaires to detect the presence of symptoms suggestive of asthma. The age and sex, birth order, duration of breastfeeding, educational status, food habits (vegetarian and nonvegetarian), and major chronic chest symptoms (cough, sputum, shortness of breath, and wheezing) were included in the questionnaire-based survey. The diagnosis of asthma was made by the physician examining the children, based on the guidelines of ATS. Results: Of 187 houses which were surveyed, there were a total of 607 children (males n = 339 [55.84%] and females n = 268 [44.16%]). 17.1% (n = 104; males n = 59 [56.73%]) children were diagnosed as asthma. In the evaluation of dietary habits, children diagnosed with asthma had significantly higher consumption of nonvegetarian food (43.27% vs. 28.23; P < 0.05). However, age and gender distribution, educational status, birth order, and duration of breastfeeding did not show a significant difference between children diagnosed with asthma and without asthma. Conclusion: The study concluded that increased risk of asthma was associated with higher consumption of nonvegetarian food. Furthermore, breastfeeding did not have any protective effect on asthma. [ABSTRACT FROM AUTHOR]

Background: The prevalence of asthma in adults varied from 0.96% to 11.03% while in children ranged from 2.3% to 11.9% in India. A number of factors including genetic predisposition, environment, and lifestyle factors including dietary habits influence the development and expression of asthma. The goal of asthma treatment is to achieve and maintain clinical control, which can be achieved in a majority of patients with pharmacologic intervention strategy. Objective: To assess the role of diet and lifestyle factors in asthma control in Indian population. Materials and Methods: Diagnosed asthma patients (aged 12-40 years) were enrolled from the outpatient clinics. All patients were followed up and reassessed after 4 weeks with asthma control test (ACT) and dietary and lifestyle questionnaire. The assessment of dietary pattern was performed by food frequency questionnaire (Nordic Nutrition Recommendations-Danish Physical Activity Questionnaire). The lifestyle factor included body mass index, smoking status, tobacco chewing, alcohol consumption, duration of travel (h/week), mental stress (visual analog scale: 0-10), sports activity - h/day, television (TV) watching/video games - h/day, duration of sleep - h/day. Results: Seventy-five asthma patients (43 males and 32 females) were divided into three groups according to ACT, 18 (24%) patients in poorly-controlled asthma, 35 (46.7%) in well-controlled asthma, and 22 (29.3%) patients with totally-controlled asthma. Increased consumption of vegetables and cereals in patients with total-controlled asthma while increased consumption of sugar, nonvegetarian, fast food, salted and fried snacks in patients with poorly-controlled asthma. Poorly-controlled asthma had the highest duration of watching TV and sleep and least duration of travel and sports, though the results failed to reach statistical significance. Conclusion: The dietary and lifestyle factors too contribute to degree of control of asthma in India. [ABSTRACT FROM AUTHOR]

Introduction: Airborne pollen data varies from place to place due to floristic diversities in a geographical region. In Delhi, a variety of trees, weeds, and grasses produce a variety of pollens, and climatic conditions are also known to affects the pollen concentration. Aim: This study was designed to describe the prevalence of pollen in North Delhi region during the year 2013-2014. Materials and Methods: Atmospheric pollen was collected on daily bases by using Volumetric Burkard (UK) 24 h air sampler with the speed of 10 L/min airflow. Pollen was counted with light microscopy (Olympus, Japan) and the average monthly pollen count was studied from May, 2013 to April 2014. Results: A total of 42,232 pollens were collected for 1-year (2013-2014). The maximum and minimum pollen was counted for year 2013 in the month of September (4805 pollens) and December, (1973 pollens), respectively. The average pollen concentration started increasing in the year 2013 from the months of May to June (239.33, 279.38 pollen/m3/month) and started falling in 2013 in months of July to August (227.47, 148.60 pollens/m3/month). The pollen concentration again started increasing in year 2013 in the months of September, October and November (282.65, 275.73, and 245.44 pollens/m3/months) and started declining in December 2013 till the months of next year 2014 January, February, (131.53, 133.82, 139.56 pollens/m3/months). An increase in pollen concentration was noted in 2014 in the months of March and April (274.31, 263.75 pollens/m3/month). The humidity correlated significantly with the average pollen count in the year 2013 in June (P = 0.025, r = -0.556), July (P = 0.00, r = -0.848), August (P = 0.033, r = -0.552), September (P = 0.007, r = -0.627) and October (P = 0.001, r = -0.755). The average temperature correlated significantly with the average pollen count in 2013 October (P = 0.042, r = -0.530). Conclusion: The current study provides a preliminary data of pollen count in North Delhi region. The results will provide information to the allergy practitioners in order to advice avoidance of exposure to allergens. [ABSTRACT FROM AUTHOR]

Background: Bronchial asthma (BA) and allergic rhinitis (AR) are chronic inflammatory disorders of the airways. The allergic response is driven by the production of different immunological effector cells cytokines like interleukin-5 (IL-5) and IL-6 among others. Subcutaneous allergen-specific immunotherapy (SCIT) modifies basic immunological mechanisms, reducing IL-5 production. The effect of SCIT on levels of IL-6 is undetermined. Objective: The aim is to study the changes in immunological parameters that follow SCIT in patients suffering from BA and/or AR. Materials and Methods: Twenty-nine patients (18-48 years, mean 25.5 years) diagnosed with BA and/or AR were evaluated for allergic sensitivity using skin prick test (SPT). The patients were started on standardized treatment for BA and AR as per global initiative for asthma and AR and its impact on asthma guidelines, respectively. SCIT was initiated as per the standard Indian guidelines. IL-5 and IL-6 levels were obtained at 0, 3 and 6 months during the course of SCIT and the response was evaluated using Friedman test. Results: Twenty-nine patients; 16 males and 13 females were evaluated and initiated on SCIT. The decreasing order of antigen sensitivity on SPT was mosquito (65.5%), housefly (58.6%), female cockroach (58.6%), male cockroach (48.2%), moth (34.4%) and house dust mite (17.2%). The IL-5 and IL-6 levels, for 0, 3 and 6 months were compared, and it was noted that with an increase in duration of treatment, the levels of inflammatory markers significantly decreases (P = 0.003). On comparison, the inflammatory response between male and female, duration of symptoms and number of positive antigens was not statistically significant. Conclusion: Immunologic changes associated with immunotherapy are complex and allergic patients suffering from asthma, and/or rhinitis showed a significant reduction in levels of inflammatory markers. [ABSTRACT FROM AUTHOR]

The unprecedented situation due to coronavirus disease-2019 (COVID-19) pandemic has unleashed havoc on health-care systems worldwide. Patient-related Measures Prior to giving an appointment for allergy testing, patients should be screened with a structured questionnaire related to COVID-19 symptoms and signs. [Extracted from the article]