Thesis - Dr. Francis Ankitha 08.02.23-1

ASSESSMENT OF KNOWLEDGE AND ATTITUDE OF
ASTHMATIC PATIENTS AND THEIR CARE GIVERS

REGARDING THE DISEASE USING AN ASTHMA
KNOWLEDGE QUESTIONNAIRE IN A TERTIARY CARE
HOSPITAL IN CHENNAI
By
Dr. Francis Ankita

Dissertation submitted to the
Bharath Institute of Higher Education and Research,
Chennai
In partial fulfillment of the requirement for the degree of

M.D. (RESPIRATORY MEDICINE)
DEPARTMENT OF RESPIRATORY MEDICINE
SREE BALAJI MEDICAL COLLEGE & HOSPITAL

CHENNAI – 44
2020 – 2023
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “Assessment of knowledge

and attitude of Asthmatic patients and their care givers regarding the
disease using an Asthma Knowledge Questionnaire in a tertiary care
hospital in Chennai” is a bonafide and genuine research work carried out
by me under the guidance of Dr. Ghanshyam Verma, Professor & Head,
Department of Respiratory Medicine, Sree Balaji Medical College and
Hospital, Chrompet, Chennai.
Date: Signature of the candidate
Place: Dr. Francis Ankita

CERTIFICATE BY THE GUIDE
This is to certify that this dissertation entitled “Assessment of knowledge
and attitude of Asthmatic patients and their care givers regarding the
disease using an Asthma Knowledge Questionnaire in a tertiary care
hospital in Chennai” is a bonafide research work carried out by Dr. Francis
Ankita in partial fulfillment of the requirement for the degree of
M.D in Respiratory Medicine.
Date: Signature of the Guide
Dr. Ghanshyam Verma

CERTIFICATE BY THE CO-GUIDE
This is to certify that this dissertation entitled “ASSESSMENT OF KNOWLEDGE
AND ATTITUDE OF ASTHMATIC PATIENTS AND THEIR CARE GIVERS
REGARDING THE DISEASE USING AN ASTHMA KNOWLEDGE
QUESTIONNAIRE IN A TERTIARY CARE HOSPITAL IN CHENNAI” is a
bonafide research work carried out by Dr. Francis Ankita in partial fulfillment of the
requirement for the degree of M.D in Respiratory Medicine.
Date: Signature of the Co-guide
Dr Jayamol Revendran
ENDORSEMENT BY THE HOD AND THE HEAD OF THE INSTITUTION
This is to certify that this dissertation entitled “ASSESSMENT OF

KNOWLEDGE AND ATTITUDE OF ASTHMATIC PATIENTS AND
THEIR CARE GIVERS REGARDING THE DISEASE USING AN
ASTHMA KNOWLEDGE QUESTIONNAIRE IN A TERTIARY
CARE HOSPITAL IN CHENNAI” ,
is a bonafide research work done by Dr.Francis Ankita, under the guidance
of Dr. Ghanshyam Verma, Professor & Head, Department of
Respiratory Medicine, Sree Balaji Medical College and Hospital,
Chennai.
SEAL AND SIGNATURE OF SEAL AND SIGNATURE HEAD

THE OF THE HOD OF THE INSTITUTION
Date:
Place:
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Bharath Institute of Higher Education and
Research, Chennai shall have the right to preserve, use and disseminate
this thesis in print or electronic format for academic / research purposes.
Date: Signature of the Candidate
Place:
INSTITUTIONAL ETHICAL COMMITTEE APPROVAL
ACKNOWLEDGEMENT
I express my deep sense of gratitude to my guide and teacher, Dr.
GHANSHYAM VERMA Professor and Head of the Department who helped
and guided me in this work with his valuable suggestions and advice. My sincere
thanks to him, for all the help that he rendered in the preparation of this work.
My special thanks to DR JAYAMOL REVENDRAN, Co-guide who has
constantly supported and guided me for the completion of my thesis.
I express my utmost gratitude to my Dean DR. JOHNSON for providing
me an opportunity to conduct this study. I also express my sincere thanks to the
Superintendent for permitting me to use the hospital facilities for my study to the
full extent.
I'm also thankful to my professor Dr. RAJA AMARNATH.G, Dr O.R
Krishnarajasekhar my associate professor Dr.Harish.M, my Assistant
Professors Dr.Sreenivasan, Dr.Rajasekharam.G, Dr.Sabarinath.R, Dr
Mohanakrishnan, Dr Jayamol, DR.Jince and my Senior Residents Dr. Rowhit
Y, Dr Ashwin Kailash, Dr Sahana MK for their valuable suggestions.
I thank my parents FRANCIS K.L and BEENA FRANCIS for their
constant support throughout my PG period.
I thank my Seniors Dr. Aravind, Dr. Saravanan MC for their constant
support, my co-post graduates Dr. Yasar Arafat. M, Dr. Mahitha, Dr. Jishna,
Dr. Srinidhi, Dr Koushik L and my juniors Dr. Prasana, Dr. Roopesh, Dr.
Dhayalnithi, Dr. Thanigaiarasu, Dr. Riaz, Dr. Harshith, Dr. Aldrin, Dr.
Pavithra, Dr. Akhhil, Dr. Raagavi, Dr. Keerthana, Dr. Mounika.
1 thank all my PATIENTS, who formed the backbone of this study without
whom this study would not have been possible.
Last but not the least, I am ever grateful to GOD for always showering His
blessings on me and my family.
DR. FRANCIS ANKITA

CONTENTS
S.No Chapters Page No.
1 INTRODUCTION 12
2 REVIEW OF LITERATURE 18
3 AIM & OBJECTIVES OF THE 46
STUDY
4 METHODOLOGY 48
5 RESULTS 53
6 DISCUSSION 71
7 CONCLUSION 78
8 BIBLIOGRAPHY 81
9 ANNEXURES 90
INTRODUCTION
INTRODUCTION
Asthma is a major non- communicable disease which affects both children
and adults. It is the most common chronic disease among children. Asthma is
estimated to be affecting 300 million individuals globally with increasing
prevalence in developing countries associated with increasing cost of treatment
and rising burden for patients and the community. Asthma causes loss in
productivity, seriously affects children, disrupts family which turn contributes to
an unacceptable burden on health care system and results in higher mortality
especially among children.
Asthma, defined by GINA (Global Initiative for Asthma) as a heterogenous
disease is usually characterized by chronic airway inflammation. It is defined by
the history of respiratory symptoms, such as wheeze, shortness of breath, chest
tightness and cough, that vary over time and in intensity, together with variable
expiratory airflow limitation. Airflow limitation may later become persistent.
The clinical phenotypes of asthma are recognizable clusters of
demographic, clinical and/or pathophysiological characteristics. Some of the
most common phenotypes are
1. Allergic asthma: This category is easily recognized phenotype and it
begins in childhood. It is associated with a past and/ or family history
of allergic disorder such as eczema, allergic rhinitis, food or drug
allergy. Sputum will reveal eosinophilic airway inflammation and such
patients respond well to Inhaled corticosteroids treatment.

2. Non-allergic asthma: This type is not associated with allergy however
the cellular profile of sputum may show neutrophilic, eosinophilic or
few inflammatory cells. Such patients show less short term response to
inhaled steroid therapy.
3. Adult onset (late onset) asthma: Some patients, particularly women
present with asthma for the first time in adult life. These patients tend
to be nonallergic and they require higher doses of Inhaled
corticosteroid treatment or relatively refractory to corticosteroid
treatment. Occupational asthma (due to work exposure) should be ruled
out in such patients.
4. Asthma with persistent airflow limitation: Patients with long standing
asthma develop airflow limitation which is persistent or incompletely
reversible due to airway remodelling.
5. Asthma with obesity: Some obese patients have prominent respiratory
symptoms and little eosinophilic airway inflammation.
Incidence of asthma in India is around 17.23 million with an overall
prevalence of 2.05%. Total burden of asthma in India- 34.3 million accounts for
13.09% of the global burden. Asthma accounts for 27.9% of DALY’s (Disability
adjusted life years) in Indian population.
India has 3 times higher mortality and more than 2 times higher DALY’s
compared to global proportion of asthma burden.

The etiology of asthma symptoms are airway inflammation, resulting in
mucus hyper secretion, alteration of bronchial wall and bronchial hyper
responsiveness (BHR) which is the propensity of smooth muscle cells to respond
to unspecific stimuli like cold air. The disorder’s acute symptoms also known as
“asthma attacks” are recurrent, cyclic episodes brought on by chronically
hyperactive and inflamed airways that impede airflow.
Global efforts focus on improving the patient education and self-management
behavior. The primary reasons for poor prognosis are inadequate education to
patients and poor adherence to medication. Poor adherence is defined as the
failure of treatment to be taken as agreed upon by the patient and the health care
provider.
The factors causing poor adherence in asthma are:
Medication/regimen factors:
• Having trouble using the inhaler (e.g. arthritis)
• Difficult regimen
• Availability of multitude of alternative inhalers
Unintentionally failing to comply
• Misunderstanding about instructions
• Forgetfulness
• Absence of a daily routine
• Expensive
Intentional poor adherence
• Perception that treatment is not necessary
• Denial or anger about asthma or its treatment
• Inappropriate expectations
• Concerns about side-effects (real or perceived)
• Dissatisfaction with health care providers
• Stigmatization
• Cultural or religious issues
• Cost
Many patients and their care givers perceive asthma as an episodic illness
not requiring regular treatment. Management of disease involves knowledge
about the disease, its treatment and effective use of different therapies. Health
care providers play a vital role in empowering patients with the necessary skills
and knowledge to manage asthma. Without adequate knowledge of the disease,
treatment regimen will fail as patient is unaware of appropriate management and
how to avoid triggers.
Education of patients and caregivers is becoming very essential in
managing the disease with increasing population of people with chronic disease.
Effectiveness of drug therapy highly depends on compliance which in turn affects
attitude towards treatment. Patient’s attitude, beliefs ad expectancies about their
plight, coping capacity and health care system influence the disability response
to treatment and prognosis.
Clinicians can find an annual update of an evidence-based management
and prevention strategy for asthma in the Global Initiative for Asthma (GINA)
Strategy Report, which can be modified for local conditions. In order to create a
plan for the diagnosis and treatment of asthma, the World Health Organization
(WHO) and the U.S. NHLBI collaborated in 1993 to create GINA.
Compliance with therapeutic regimens in asthma is low. Knowledge
attitudes and beliefs of patients towards bronchial asthma are recognized as major
determinants of health behavior. Hence education to the population can be
considered as an important strategy in therapy to improve knowledge and attitude
towards the disease in patients and caregivers can influence proper adherence to
inhaler therapy and therefore improve therapeutic outcome.
The current study aims to assess knowledge and attitude of asthmatic
patients and their caregivers towards the disease using a questionnaire and the
treatment options which are available. We had framed 2 questionnaires for this
study- one to assess the knowledge and the other to assess the attitude
respectively.
REVIEW OF
LITERATURE
REVIEW OF LITERATURE
The Greek word asthmaino, which means panting or gasping, was used by
the ancient Greek physician Hippocrates to describe asthma in the first instance.
Understanding the genetics, epidemiology, and pathophysiology of asthma, a
disorder whose incidence has increased globally over the past 20 years, has come
a long way since antiquity 8. A chronic inflammatory condition of the airways
known as Asthma causes chest tightness, coughing, wheezing, and shortness of
breath. The cause of asthma symptoms is airway inflammation, which results in
the creation of mucus, alteration of the airway wall and bronchial hyper
responsiveness (BHR), which is the propensity of smooth muscle cells to respond
to unspecific stimuli like cold air. The disorder's acute symptoms, also known as
"asthma attacks," are recurrent, cyclical episodes brought on by chronically
hyperactive and inflamed airways that impede airflow1,2,3. More than 300 million
people worldwide suffer from asthma, which is a severe health and
socioeconomic problem. The condition is regarded as an inflammatory disease of
the airways since it causes blockage, mucus overproduction, hyperresponsiveness
of the airways, and remodeling of the airway walls 7.
The history of respiratory symptoms, such as wheezing, shortness of
breath, chest tightness, and cough, as well as varied expiratory airflow limitation,
combined identify asthma as a diverse disease. Later, a restriction in airflow may
continue.
Airway inflammation and hyperresponsiveness are frequently linked to
asthma, however neither of these factors is required for a diagnosis. Clinical
phenotypes (such as allergic versus nonallergic, childhood onset versus late onset,
etc.) do not closely correspond with particular pathogenic processes or
therapeutic outcomes.
The diagnosis of asthma is made on the basis of a history of distinctive
symptom patterns and proof of variable expiratory airflow restriction from
bronchodilator reversibility testing or from other tests, such as a positive result
from a bronchial provocation test, excessive variability during PEF monitoring,
excessive variation in FEV1 between visits, or a significant increase in FEV1
following ICS treatment. For patients who are already receiving controller
medication, the elderly, smokers, and people living in low-resource
environments, additional techniques may be required to confirm the diagnosis of
asthma. Age affects the asthma differential diagnosis differently.
According to consensus, the degree of treatment needed to control
symptoms and exacerbations is used to retrospectively evaluate the severity of an
asthma attack after at least 2-3 months of treatment. Since there is no proof that
the treatment response differs between so-called "intermittent" and "mild
persistent" asthma, GINA does not make this distinction. Severe asthma is asthma
that requires high-dose ICS-LABA medication to keep it from getting worse or
that remains uncontrolled after optimal management.

Airway smooth muscle pathophysiology in Asthma: In prenatal ASM,
airway responsiveness increases after stimulation with contractile agonists,
which may be a result of the stress of compression on the airway epithelium.
Airway narrowing is resisted by normal breathing, deep inspiration, and
the injection of b2 agonists. When allergens or other environmental stresses
cause airway inflammation in susceptible individuals, the
proliferative/secretory ASM phenotype results, which in turn promotes the
inflammatory response, the production of ECM, and an excess of ASM, all
of which are characteristics of airway remodeling23
Asthma was defined as follows in the 1991, 1997, and 2007 National
Institute of Health Guidelines on Asthma (NIH Guidelines): Asthma is a chronic
inflammatory disorder of the airways in which many cells and cellular elements
play a role: in particular, mast cells, eosinophils, T lymphocytes, macrophages,
neutrophils, and epithelial cells. In susceptible individuals, this inflammation
causes recurrent episodes of wheezing, breathlessness, chest tightness, and
coughing, particularly at night or in the early morning. These episodes are usually
associated with widespread but variable airflow obstruction that is often
reversible either spontaneously or with treatment. The inflammation also causes
an associated increase in the existing bronchial hyperresponsiveness to a variety
of stimuli. Reversibility of airflow limitation may be incomplete in some patients
with asthma 9,14, 15.
Atopic asthma typically develops throughout infancy or adolescence and has
recognisable triggers that cause wheezing. According to Diamant et al. (2007)
and Townshend et al. (2007), atopic asthma is frequently accompanied by atopy
symptoms such eczema and rhinitis as well as a family history of allergic illnesses
9, 11, 13
. Atopic patients who are exposed to an allergen have their B lymphocytes
release an excessive amount of immunoglobulin E (IgE).

Anatomy of the Lung with normal alveoli and enlarged alveoli
Cross section of the alveoli exhibiting the inflammation in

relation to the alveoli
Inflammatory mediators are released when IgE attaches to cells implicated in
inflammation, which leads to airway inflammation and bronchoconstriction.
Since not all cases of asthma are caused by atopy, other factors that are unrelated
to the atopic condition are equally significant (Anderson 2005). Non-atopic
asthma, which occurs in certain people in adulthood and is frequently caused by
viral respiratory infections, is also known as adult-onset asthma. With few
evident causes other than illness, this kind of asthma can be more persistent
(Diamant et al. 2007, Rees 2010). Non-atopic asthma is not influenced by IgE.
(Ward et al 2010) 9, 14,15,16,17.
EPIDEMIOLOGY OF ASTHMA:
More than 300 million people worldwide are affected by the illness, which results
in about 250,000 fatalities each year (Bousquet et al., 2007). The mortality of
asthma has dropped over the past few of decades as inhaled corticosteroids have
replaced other forms of treatment (Wijesinghe et al., 2009). In the meantime,
urbanization has been linked to a significant rise in allergy illnesses like asthma
over the previous 50 years (Alfvén et al., 2006). Compared to other generation
groups, children are the ones that experience asthma the most frequently (Centers
for Disease Control and Prevention, 2011). Then, by 2025, it is anticipated that
there would be more than 100 million patients (Masoli et al., 2004)1,3,4,11,12,13.
PATHOPHYSIOLOGY OF ASTHMA:
INITIAL OBSTRUCTION:
The primary symptom of asthma is airway obstruction, which is brought on by a
narrowing of the airways. The chronic inflammation of the airway wall, which is
responsible for the constriction of the airways, is characterised by immune cell
infiltration and activation, including mast cells, innate lymphoid cells (ILCs),
eosinophils, neutrophils, lymphocytes, and dendritic cells (DCs).
The development of asthma symptoms like BHR, which is typically
reversible by using bronchodilators, is caused by a complicated interplay between
these immune cell types and with nearby structural cells like epithelial cells.
However, airway blockage does not always return to normal after treatment in
more severe cases of asthma.
The formation of persistent mucus plugs in smaller airways in such people
may provide an explanation1,5,6,7,9. Variable airway blockage, which can vary in
size over the course of minutes to days due to bronchoconstriction, mucosal
inflammation, and luminal secretions, is a key characteristic of asthma. This leads
to increased airflow resistance and labour of breathing. The airway blockage in
more severe or persistent disease may be totally fixed or only partially reversible
with bronchodilator therapy5,7,8.

Schematic representation of asthma pathophysiology. Several inflammatory cells and
mediators are recruited or activated, producing acute effects on the airway
(bronchoconstriction, plasma leakage, mucus secretion, sensory nerve activation,. .. ), together
with remodeling structural changes (subepithelial fibrosis, angiogenesis, increased thickness
of airway smooth muscle, hyperplasia of mucus-secreting cells. 22
EPITHELIAL-DERIVED CYTOKINES CONTRIBUTE TO TYPE 2-
HIGH ASTHMA:
Toll-like receptors (TLRs), nucleotide-binding oligomerization do-main (NLRs),
C-type lectin receptors (CLRs), retinoic acid-inducible gene (RIG)-I-like
receptors (RLRs), protease-activated receptors (PARs), and purinergic receptors
are just a few of the pattern recognition receptors expressed by lung ECs. These
receptors enable the production of chemokines and cytokines by ECs in response
to a range of external cues 1,12,14.
EPITHELIAL DAMAGE:
The layer of cells that lines the airways, the epithelium, can get harmed and start
to peel away in people with asthma. In addition to the loss of enzymes that
break down inflammatory mediators and the exposure of sensory nerves that
may result in reflex neurological effects on the airway, epithelial shedding can
also cause a loss of barrier function, which may allow allergens to penetrate the
airway (Barnes 1996). The subepithelial layer may also change, for example, by
forming collagen 1,8,12,14.
HYPER RESPONSIVENESS OF THE AIRWAY:
Asthma causes the mucus-secreting cells in the airways to multiply and the
mucous glands to
expand. Increased mucus secretion contributes to the formation of viscid mucous
plugs that
8,14,15,16
can occlude the airways . Airway hyperresponsiveness is an exaggerated
response consisting of reduction in airway caliber after a stimulus and has been
recognized as a hallmark of asthma from the time of Claudius Galen, a physician
in about AD 150. Airway hyperresponsiveness may be induced by allergens (eg,
pollen, animal danders), chlorine, pollutants (eg, sulfur dioxide), diesel exhaust
particulates and viral upper respiratory tract infections 5.
WELL DEVELOPED INFLAMMATION:
Airway inflammation is recognized as a pathogenic factor in asthma.
Inflammation involves many different cells (eosinophils, lymphocytes, mast
cells, neutrophils) and is commonly initiated by allergen-dependent release of
histamine and other mediators from mast cells and subsequent infiltration of
lymphocytes (particularly T-helper type 2 [TH2]) and granulocytes into the
airway5,8,11.
Anatomy of the Lung with normal alveoli and enlarged alveoli

ONSET OF ASTHMA:
Childhood-onset asthma is the most common type of asthma, however some
people might get the condition later in life (late-onset asthma). Early-onset
asthma and late-onset asthma are very different from one another. When
compared to asthma that starts in childhood, late-onset asthma is more severe and
less linked to allergies.
Atopy, decreased pulmonary function, and respiratory tract infections,
particularly those caused by rhinovirus, are significant risk factors for the
continuation of asthma in children. It is still unclear whether repeated viral
infections as a young kid predispose children to developing asthma or whether
the underlying inflammation seen in asthmatic children promotes the
pathogenicity of respiratory viruses1,3,4.
CARDINAL SIGNS OF ASTHMA:
The hallmark symptom of bronchial asthma is recurrent attacks of acute shortness
of breath, which typically happen at night or in the early morning. Coughing,
wheezing, and a tightness in the chest are other symptoms. Symptoms of asthma
can frequently develop following physical activity 3.

Mechanism and cardinal signs of inflammation: This diagram indicates the harmful stimuli
responsible for inflammation process, types, signs, mechanism of inflammation and
traditional anti-inflammatory drug therapy.
HISTOPATHOLOGY OF AN ASTHMATIC AIRWAY 8, 11, 15, 16, 17, 18, 19
SURFACE EPITHELIUM:
Histologically, airway surface epithelium loss and destruction are evident in
biopsy samples from patients with moderate atopic dermatitis as well as in fatal
asthma cases. The degree of airways' reactivity tends to increase with the loss of
surface epithelium in biopsy specimens, which is thought to reflect the lining's
acute fragility. Occasionally, squamous metaplasia may be seen.
RETICULAR BASEMENT MEMBRANE:
Long recognized as a constant change in asthma, thickening and hyalinization of
the reticular basement membrane is common. Despite the possibility of isolated
and variable thickening of the reticular basement membrane in COPD and other
inflammatory chronic lung disorders (such as bronchiectasis and tuberculosis),
the lesion is distinctive and evident early on even in moderate asthma.
MUCUS-SECRETING CELLS:
According to reports, the histological indicators and correlates of mucus-
hypersecretion in chronic bronchitis are bronchial goblet cell hyperplasia and
submucosal gland hypertrophy. Status asthmaticus is characterised by
considerable submucosal gland enlargement, although it is not as severe as in
chronic bronchitis. Contrary to bronchitis, where there is evidence of a relative
loss of serous acini, it is believed that asthma maintains the ratio of serous to
mucous acini.
The fundamental point of contact between the environment and the lung is the airway epithelium. Epithelial cells respond to
allergens, house dust mites, or microorganisms by secreting soluble substances that draw in and activate immune cells.
Macrophages, dendritic cells, neutrophils, mast cells, eosinophils, and lymphocytes all contribute to the immune response's
amplification. Paracrine signals, which are produced by both the epithelium and immune cells, cause the submucosal
mesenchyme, which contains resident airway smooth muscle cells and fibroblasts, to grow, expand, and become active 20.
BRONCHIAL SMOOTH MUSCLE:
The amount of bronchial smooth muscle (BSM) on the bronchial wall indicates a
significant and possibly constant rise in status asthmaticus. Contrarily, readings
for the proportion of the wall occupied by BSM in segmental bronchi in chronic
bronchitis and emphysema fall mostly within the normal range in the absence of
wheeze; nonetheless, intermediate levels are found in what is known as wheezy
bronchitis. Airways less than 2 mm in diameter do not appear to be affected by
the increase in muscle mass in asthma.
CELLULAR INFILTRATE:
Both the airway wall and the occluding plug exhibit a strong cellular infiltrate in
status asthmaticus; eosinophils are distinctive, neutrophils are conspicuously
absent, and lymphocytes are in high concentrations. There is a substantial
correlation between tissue eosinophilia and asthma. Few studies have
demonstrated that the increase in leucocytes, including lymphocytes and
eosinophils, occurs in relatively mild asthma (especially of the intrinsic form),
and that it is linked to the presence of lymphocytes with irregular shapes as well
as "activation" markers for both lymphocytes (i.e. CD25+ cells) and eosinophils
(i.e. Le. EG2+ cells). This lymphokine's release, if it results in protein secretion,
may have significant functional effects on eosinophils, favouring their selective
adherence and driving the differentiation of committed eosinophil precursors,
increasing eosinophil survival, and encouraging their activation.

CELLULAR INFILTRATE:
Both the airway wall and the occluding plug exhibit a strong cellular infiltrate in
status asthmaticus; eosinophils are distinctive, neutrophils are conspicuously
absent, and lymphocytes are in high concentrations. There is a substantial
correlation between tissue eosinophilia and asthma. Few studies have
demonstrated that the increase in leucocytes, including lymphocytes and
eosinophils, occurs in relatively mild asthma (especially of the intrinsic form),
and that it is linked to the presence of lymphocytes with irregular shapes as well
as "activation" markers for both lymphocytes (i.e. CD25+ cells) and eosinophils
(i.e. Le. EG2+ cells). This lymphokine's release, if it results in protein secretion,
may have significant functional effects on eosinophils, favouring their selective
adherence and driving the differentiation of committed eosinophil precursors,
increasing eosinophil survival, and encouraging their activation.
BRONCHIAL VASCULATURE:
Asthma that is lethal is characterised by bronchial mucosal blood vessel dilation,
congestion, and wall oedema with enlarged endothelial cells.It is dubious that the
thickening of the muscles and the enlargement of the submucosal glands alone
may explain the thickening of the bronchial wall in asthma; instead, mucosal
vascular dilatation, congestion, and subsequent wall oedema may be to blame.
According to research by James and colleagues, the aggregate impact of these

factors on airway wall thickening only needs to be marginal to have a significant
impact on the pattern of airflow limitation seen in asthma.
Risk Factors for Asthma and COPD and the Influence of

Environment and Aging.
DIAGNOSTIC CRITERIA FOR ASTHMA:41,43,46
Diagnostic criteria for asthma in adults, adolescents, and children 6-11 years:
HISTORY OF VARIABLE RESPIRATORY SYMPTOMS
Feature Symptoms or features that support the diagnosis of

asthma
Wheeze, shortness of More than one type of respiratory symptom (in adults,
breath, isolated cough is seldom
chest tightness and due to asthma)

cough
Symptoms occur variably over time and vary in intensity
(Descriptors may vary Symptoms are often worse at night or on waking
between
Symptoms are often triggered by exercise, laughter,
cultures and by age) allergens, cold air
Symptoms often appear or worsen with viral infections
CONFIRMED VARIABLE EXPIRATORY AIRFLOW LIMITATION
Feature Considerations, definitions, criteria
Documented expiratory At a time when FEV is reduced, confirm that FEV/FVC

is reduced compared with
airflow limitation
the lower limit of normal (it is usually >0.75-0.80 in
adults, >0.90 in children)
Documented excessive The greater the variations, or the more occasions excess
variability in lung variation is seen, the more confident the diagposis. If
function (one or more initially negative, tests can be repeated during symptoms
of the following) or in the early morning
The asthma management cycle for personalized asthma care 46
Adapted from GINA, Global Strategy for Asthma Management and

Prevention. Updated 2021
For many patients in primary care, symptom control is a good guide to a reduced
risk of exacerbations, Is When inhaled corticosteroids (ICS) were introduced into
asthma management, large improvements were observed in symptom control and
lung function, and exacerbations and asthma-related mortality decreased.

Adapted from: Helen K. Reddel, Leonard B. Bacharier, Eric D. Bateman, Christopher E. Brightling, Guy G.
Brusselle, Roland Buhl, Alvaro A. Cruz, Liesbeth Duijts, Jeffrey M. Drazen, J. Mark FitzGerald, Louise J.
Fleming, Hiromasa Inoue, Fanny W. Ko, Jerry A. Krishnan, Mark L. Levy, Jiangtao Lin, Kevin Mortimer,
Paulo M. Pitrez, Aziz Sheikh, Arzu A. Yorgancioglu, Louis-Philippe Boulet; European Respiratory Journal
2022 59: 2102730; DOI: 10.1183/13993003.02730-2021
SCRUTINIZATION OF THE DIAGNOSIS:
When feasible, it is required to confirm the asthma diagnosis in adults,
adolescents, and children under the age of 6 before beginning controller therapy,
as it is frequently more challenging subsequently. Recurrent wheezing is common
in children under the age of five, but asthma is more likely if the child experiences
wheezing or coughing during physical activity, when laughing or crying, or when
they don't have a respiratory infection. It's also more likely if the child has eczema
or allergic rhinitis in the past.
TREATMENT AND FOLLOW UP: 23,24,43,45,46
After an asthma diagnosis has been made, short-term peak expiratory flow (PEF)
monitoring may be used to gauge a patient's response to therapy, identify triggers
(such as situations at work) for symptoms that are getting worse, or create a
baseline for future action plans. Within two weeks on average after beginning
ICS, the patient reaches their personal best PEF (based on twice-daily readings).
Since around three months ago, average PEF has been rising while diurnal PEF
variability has been declining.
Excessive variance in PEF indicates poor asthma control and raises the possibility
of flare-ups.
Currently, only patients with severe asthma or those who have impaired
perception of airflow limitation are advised to undergo long-term PEF
monitoring.
ASSESSING FUTURE RISK OF ADVERSE OUTCOMES
Identifying if the patient is at risk of unfavourable asthma outcomes, such as
exacerbations, persistent airflow restriction, and medication side effects, is the
second step in evaluating asthma control. Although an important outcome for
patients and a powerful predictor of future risk of exacerbations, asthma
symptoms are insufficient on their own to assess asthma because- Asthma
symptoms can be controlled by placebo or sham treatments, Asthma symptoms
can be inappropriately treated with long-acting beta-agonists (LABA) alone, 30
leaving airway inflammation untreated, Respiratory symptoms may be caused by
other conditions such as inactivity or comorbidities.
The reporting of symptoms may be influenced by anxiety or depression. Since
poor symptom management and exacerbation risk may have diverse causes and
necessitate various therapeutic modalities, they should not simply be added
numerically.
Exacerbation risk factors
The likelihood of exacerbations is significantly increased by poor asthma
symptom control in isolation. There are, however, a number of additional
independent risk factors that, when present, raise the patient's chance of
exacerbations even if symptoms are minimal. These risk factors can all be
evaluated in primary care and include a history of 21 exacerbations in the

previous year, poor adherence, improper inhaler technique, chronic sinusitis, and
smoking. Independent of the stage of treatment, the risk of severe exacerbations
and mortality rises gradually with increased SABA use.
Risk factors for adverse drug reactions
Any drug decision is based on a balance between benefit and risk. The majority
of asthma patients who take medication do not have any negative effects.
Although few patients require them, the risk of side effects rises with increasing
doses of medication. Long-term, high dose ICS adverse effects that could affect
the entire body include cataracts, glaucoma, a rise in the risk of osteoporosis
above the typical age-related risk, and adrenal suppression. Oral thrush and
dysphonia are a couple of the local side effects of ICS. Higher doses or more
strong formulations, as well as improper inhaler technique for local side effects,
put patients at greater risk of experiencing ICS side effects, according to research
MANAGEMENT OF THE CONDITION: To reduce symptoms and avoid
exacerbations, asthma care should be customised and modified in a continuous
cycle of assessment, treatment, and review. Take into account symptom
management, exacerbation and side effect risk factors, lung function,
comorbidities, self-management abilities, and the objectives, preferences, and
satisfaction of the patient and/or carer.\

PREVIOUS STUDIES
The following are various similar studies that were carried out with regard to the
knowledge, attitude and practice of asthmatic patient care.
Kosisochi Chinwendu Amorha et al., 27 conducted in the University of Nigeria
Teaching Hospital's Paediatric Respiratory Unit in Ituku-Ozalla, Enugu State (July 2017-
September 2017). They used the 13-item Pediatric Asthma Caregiver's QoL Questionnaire and
a 46-item questionnaire with knowledge and attitude dimensions (PACQLQ). With the help of
IBM SPSS Version 25.0, data was examined. A total of 51 caregivers took part in the study.
The majority of the caregivers (n = 36, 70.6%) were over 40 years old, female (n = 37, 72.5%),
higher education degrees (n = 33, 64.7%), and self-employed (n = 27, 52.9%). A quarter (n =
13, 25.5%) of participants had a family history of asthma, and a comparable percentage (n =
14, 27.5%) were familiar with the three primary symptoms of asthma. Dust (n = 35, 68.6%)
and smoke (n = 31, 60.8%) were named by more than half of the carers as the most typical
asthma triggers in their kids. Most of the carers had some sort of formal schooling. Another
study found a substantial correlation between caregivers' awareness of childhood asthma and
their postsecondary educational attainment. It is essential to adapt the asthma education to the
carers' level of education.
Rakhee Sodhi et al., 28 performed a prospective study with asthmatic patients who
visited the pulmonary medicine department at KGMU Lucknow, India. Each patient was given
a questionnaire that enquired about their general knowledge on asthma, its triggers, and how it
should be managed. The findings were then documented. This study comprised a total of 140
participants with a confirmed diagnosis of asthma. Each patient had seen 3.2 doctors (on an
average) before coming to us. Out of 140 patients, 64% were unaware of the cause of their
illness, 47.1% believed it would be fatal and 30% refused to accept the diagnosis of asthma.
Regarding triggering factors, 25.71% of patients were unable to connect any cause with the
aggravation of their disease. In an effort to treat their illness, 62.14% of patients also used
alternative medical practises. 62.1% of patients preferred oral drugs, while 73.6% preferred
inhalers, and of them, 71.8% used them improperly. In an effort to cure their illness, 62.14%
of patients sought an alternative medical method. Homeopathic medication was the most
popular alternative form of treatment (47.77%), followed by ayurvedic medicine (39.77%) and
saintly therapy (12.5%).
Donques et al., 29 put forth the most likely causes that contribute to a rise in patients
with uncontrolled asthma as the lack of knowledge, poor attendance at educational sessions,
and not willing to participate in activities related to asthma day. In a cross sectional study
conducted by them, during World Asthma Day, more than 100 participant were involved in the
study with the majority being men (50.94%) and Saudi nationals (67.92%). The majority of the
participants now know that asthma is characterised by shortness of breath and coughing (87%)
which are thought to be the key signs and symptoms of asthma. Additionally, 25% of them do
not think that asthma is caused by belly pain. Participants were aware that exposure to smoke
(94%) and polluted air (91%) are the two main risk factors for developing asthma. When asked
what type of medication they knew and thought should be used for asthma, most participants
said ventolin spray (77%) and then oxygen (72%). The study "Statistical Relationship between
Parents Ideas and Beliefs Toward Asthma and Received Health Education about Asthma"
revealed a statistically significant relationship between the parents' ideas and beliefs about
"Asthma can be recovered under good control" and the health education they received about
asthma (P=0.009, chi-square=9.35).
Furthermore, there was no significant association between the parent's ideas and beliefs
about asthma and the information in the health education they received, such as improving and
expanding their knowledge of asthma, changing some behaviours and beliefs they have about
asthma, and developing their skills for treating it, with a P value of 0.05 and a df of 8. The
results of the study revealed a statistically significant relationship between the parents' beliefs
and ideas about asthma being curable (P value = 0.02), asthma being a genetic disease (P value
= 0.04), asthma being a psychological disease (P value = 0.01), and using ventolin causing
addiction (P value = 0.05) and the type of health education offered.
Gulnur Com et al., 30 aimed to assess caregiver knowledge about asthma causation,
treatment, and self-management, and to describe the sociodemographics and clinical
characteristics of kids with well-controlled and poorly-controlled asthma who are seen in a
pulmonology clinic or admitted to a children's hospital. In view of this they conducted a cross-
sectional study, with 132 kids between the ages of 2 and 18 who had been diagnosed with
asthma (n=112) or had been hospitalised for an asthma exacerbation (n=20) and their
caregivers were invited to take part. Healthcare professionals used survey responses from
caregivers to customise asthma instruction for the patient and carer. Children with well-
controlled vs. poorly-controlled asthma were compared based on their demographics and
clinical traits using two-tail t-tests and Chi-square testing. In this cohort of 132 kids, 111 kids
(84%) had poorly managed asthma. Medical aid insurance was linked to having asthma that
was not well-controlled compared to having it (63% vs. 35%, p=0.01).
Caretakers of children with both well-controlled and poorly-controlled asthma still expressed
misconceptions about asthma pathology and management, such as quitting daily prescriptions
when asthma is managed, despite having previously received asthma action plans (AAP) from
113 caregivers (86%). Of the 132 caregivers who participated in the survey, 93 (71%) said they
felt confident managing their kid's asthma at home, including 12 of 20 (63%) caregivers whose
child was receiving treatment for an asthma exacerbation in the hospital. Before the survey
encounter day, 113 (86%) caregivers had received asthma action plans (AAP). According to
survey findings, 42 (32%) parents admitted to feeling powerless in the face of their child's
asthma. Twenty (15%) of the carers acknowledged that they had trouble scheduling or keeping
doctor's appointments, and 22 (17%) of the caregivers admitted that they had ran out of their
kid's asthma medication and were without any when the child experienced an asthma
exacerbation.
Hala Mostafa et al., 31 aimed to evaluate the impact of implementing of an asthma
educational intervention and to examine the factors influencing the knowledge and self-care
management practice of asthmatics and their caretakers. Subsequently they conducted an
interventional study to compare the change in knowledge and self care practice among
participants before and after implementing a health educational program. After implementing
the educational programme, asthma educational intervention significantly improved asthma
symptoms control and paediatric asthma quality of life among the studied asthmatic children,
as well as asthma knowledge and paediatric asthma caregivers quality of life among the studied
asthmatic children's caregivers (P 0.001). A study on asthmatic children found that their mean
age was 8.38 2.03 years, that 51.7% of them were male, that 57.8% of them were from rural
areas, that the majority of their mothers and fathers (92.2% and 95.7%, respectively) were
literate, and that 63.8% of the families had a moderate socioeconomic status. Nearly half of the
asthmatic children in the study (50.9%) had an average BMI, 46.6% had a positive family
history of asthma, 65.5% had the condition for less than three years, 52.5% had been exposed
to passive smoking, and 63.8% did not have any other allergies, while 81% had previously
received asthma education. In the study, a relationship between asthma knowledge level and
family history of asthma was found to be statistically significant (P 0.001). Of the caregivers
with good asthma knowledge level, 78.9% had asthmatic children with a positive family history
of asthma, compared to 44%, 43.4%, and 48.6% of those with poor and moderate asthma
knowledge level, respectively.

Assiri et al., 32 conducted a study to explore knowledge, attitude and practices of
physicians working at primary health care regarding assessment and management of acute
bronchial asthma. The primary care setting and its staff of medical experts are the first point of
contact for treating acute BA; nevertheless, information on knowledge, attitude, practise, and
the availability of necessary medications and equipment was not sufficiently examined in this
context. The study thus aimed to explore the knowledge, attitude and practices of physicians
working at PHC and discussed regarding assessment and management of acute asthma. 200
out of the 240 doctors at the PHCC participated in the trial, with an overall response rate of
(83%) Males made up 57.5% of the PHC doctors, while Saudi Arabia accounted for 45.5% of
them. 60 percent of the physicians had less than five years of PHC experience. 53 percent of
the doctors had a diploma or master's degree, 44.5% had an MBBS, and 2.5% had a doctorate
or fellowship. Physicians made up 52.5% of specialists and consultants and 47.5% of general
practitioners. About 60% of the doctors have received training in managing asthma. The
primary sources of information for doctors on asthma were textbooks (26%), clinical guidelines
(61.5%), and workshops (11.5%).

AIM AND
OBJECTIVES OF
THE STUDY
The paradox of asthma is that, despite therapeutic advancements and greater
understanding of the pathophysiology, its prevalence and financial impact on the
healthcare system and the community have not significantly changed. In view of
the same, the aim and objectives of the current study is as follows:
AIM
Assessment of knowledge and attitude of asthmatic patients and their caregivers
regarding the disease using an asthma knowledge and attitude questionnaire in a
tertiary care hospital in Chennai.
OBJECTIVES
1. To assess knowledge of Asthma among patients and their caregivers using
an Asthma knowledge questionnaire.
2. To assess attitude towards Asthma among patients and their caregivers using
an Asthma knowledge questionnaire and treatment options available .

METHODOLOGY
METHODOLOGY
The current study is a cross sectional study that involved and included the
patients and their care givers attending OPD with Bronchial Asthma in the
Department of Respiratory medicine, at Sree Balaji Medical College & Hospital,
Chennai 600 044. The study period was between May 2021 to November 2022
and included a study population of 150 Asthmatic patients and their caregivers.
The study participants were selected by the basis of random sampling and the
sample size was calculated statistically. The data collection was carried out with
the aid of a proforma for demographic variables and 2 Questionnaires were used
to assess Knowledge and Attitude of participants towards Asthma.
Parameters used in this study included:-
1. Asthma Knowledge questionnaire
2. Asthma Attitude questionnaire
An easily comprehensible questionnaire was framed, the questioned were
all closed and thus present with “yes or”no” options only. The questions were
sketched to gain information about the participants perception of etiology,
triggers, symptoms and treatment regimen. The questions were designed to elicit
a short answer or response to a multiple-choice format. The questions dealt with
the nature of illness, natural history, etiology, treatment and prognosis. No
attempt was made to correct a wrong answer or response until the completion of
the interview. Two questionnaires were used in the study to assess namely asthma
knowledge questionnaire and asthma attitude questionnaire.
Each question with “no” answer and “yes” where “yes” carried 1 mark and
“no” carried 0 mark and thus a total score being 8 marks.
The attitude of asthma was assessed whether it affects the social life,
attitude towards medications used in asthma. Responses were recorded in a 5
point scale, highest being strongly agree (scored as 5) the total being 30. Higher
scores meant better attitude towards the disease.
The study included all cases of Bronchial Asthma and caregivers, aged
upto 60 years of age and patients on inhaler device. The exclusion criteria
included patients having
on going or past history of tuberculosis, COPD and ILD, patients with recent
history of haemoptysis and those with evidence of infective exacerbation e.g.,
fever, purulent expectoration, loss of smell , loss of taste. The patient information
confidentiality is maintained.
The study was carried out for a period of one and half years under the
supervision of the guide. The methodology of the study was:
• Patients presenting with asthma and following the inclusion criteria were
considered.
• Patient’s demographic details were considered and all contributed history
were collected through a proforma.
• Asthma knowledge questionnaire and Asthma attitude questionnaire was
distributed and the patients were asked to fill it up.
• The results were tabulated and sent to a statistician for analysis
ETHICAL CONSIDERATION:-
Proposal for the study was submitted to the Institutional Ethics Committee (IEC)
and approval was obtained on 12.03.2021 from Sree Balaji Medical College and
Hospital, Chrompet. All subjects participating in this study adhered to the Ethical
Committee guidelines. Participants fitting into the inclusion criteria were
selected after getting informed and written consent. The scientific person
maintained strict secrecy of the participant details. The data obtained was
handled with confidentiality and the researcher would dispose the same after
publication of this study. This study included known cases of Bronchial asthma
and their caregivers meeting the inclusion criteria.

STUDY OUTLINE:
• The protocol was prepared according to the guidelines provided by
Bharath University and presented to the department of Respiratory
1 Medicine, Sree Balaji Medical College.
• Final protocol was submitted to the Institutional Ethical committee

(IEC) of Sree Balaji Medical college. After ethical clearance, the
2 protocol was submitted to the university.
• All study participants were enrolled in the study after explaining

the purpose and importance of the study.
3
• Informed consent was obtained from all the participants.

4
• Data collection was done

5
• The tabulated data was verified and analyzed by means of a

Statistical software.
6
RESULTS
The present cross- sectional questionnaire study was done
among 150 study participants where 2 Questionnaires were used to assess
Knowledge and Attitude of participants towards Asthma.
The quantitative data that was obtained was described using mean
and standard deviation. All continuous variables were tested for
normality using Kolmogorov-Smirnov test and the data was found to
be normally distributed. Hence, within and between comparisons
were made using parametric tests of significance.
DISTRIBUTION OF STUDY PARTICIPANTS:
The distribution of the study participants in the current study is given
below in table 1. Out of the total 150 study participants, there were
66 number of females and 84 number of males that accounts for 44%
and 56% respectively.
Table 1: Gender distribution of the study samples
Gender Frequency (n = 150) Percentage (%)
Females 66 44
Males 84 56
Figure 1: Pie diagram depicting the gender distribution among the study
sample
Gender
44%
56%
Males Females
Inference: With reference to table 1, and figure 1, there were 56%
of male participants and 44% of female participants in the current
study.
Table 2: Descriptive statistics depicting the age range of the study

participants:
Age Range Frequency (n = 150) Percentage (%)
18- 30 yrs 46 30.6%
31-50 yrs 70 46.6%
>51 yrs 34 22.6%

Age range of the study
70
60
50
40
30
20
10
0
18- 30 yrs 31-50 yrs >51 yrs
Figure 2: Bar graph representing the age range of the current study.
Inference: With reference to table 2, and figure 2, there were 30.6%
of participants between the age group 18- 30 years, 46.6% between
31 – 50 years and 22.6% above 51 years of age.
The next parameter being the educational qualification, the
table 3 represents the educational qualification gender wise .
EDUCATION
GENDER Frequency Percent
F 10th 35 53
Graduate 31 47
Total 66 100
M 10th 54 64.3
Graduate 30 35.7
Total 84 100
Table 3: representing the educational qualification of the study participants.
Edcational qualification of the study participants
90
80
70
60
50
40
30
20
10
0
10th Graduate Total 10th Graduate Total
F M
Figure 3: Bar graph representing the educational qualification of the study

participants.
Inference: With reference to table3, and figure 3, with repect to female
participants, there were 53% of who were 10 t h graduates, and 47%
were graduates and with respect to male participants, 64.3% were
10 t h graduates and 35.7% were graduates.
While questioned about the duration of asthma, the below table
4 depicts the collected data with respect to the same.

Female <1 17 25.8
1-2 yrs 11 16.7
10 1 1.5
13 1 1.5
3-5 yrs 15 22.7
6-10 yrs 21 31.8
Total 66 100.0
Male <1 14 16.7
1-2 yrs 7 8.3
10 5 6.0
12 1 1.2
13 3 3.6
14 1 1.2
16 1 1.2
3-5 yrs 25 29.8
6-10 yrs 27 32.1
Total 84 100.0
Table 4: representing the seasonal variation of asthma in the study participants
Inference: With reference to table 4, with respect to female
participants, 25.8 % of participants had a duration of less than 1
year, 16.7% of participants had duration of 1 -2 years, 22.7% of
participants had a duration of 3 - 5 years, 31.8% of participants had
a duration of 6-8 years, 3% of participants had duration of more than
10 years. With respect to male participants, 16.7 % of participants
had a duration of less than 1 year, 8.3% of participants had duration
of 1-2 years, 29.8% of participants had a duration of 3 - 5 years,
32.1% of participants had a duration of 6-8 years, 13.2% of
participants had duration of more than 10 years.
While questioned about the knowledge of asthma amongst study
participants, a total of 62.1% of female participants and 79.8% of
male participants had knowledge of Asthma however, 37.9% of
female participants and 20.2% of male participants had no knowledge
of asthma or its treatment plan. Figure 4 depicts the above data in a
graphical formal.
KNOWLEDGE OF ASTHMA
79.8
62.1
37.9
20.2
Known Unknown Known Unknown

F M
Figure 4: Bar graph representing Knowledge of Asthma amongst study
participants.
While questioned about the history of breathlessness amongst
study participants, a total of 89.4% of female participants and 90.5%
of male participants had history of breathlessness, however, 10.6%
of female participants and 9.5% of male participants had n o history
of breathlessness.
While questioned about the history of wheeze amongst study
participants, a total of 92.4% of female participants and 81% of male
participants had history of wheeze; however, 7.6% of female
participants and 19% of male participa nts had no history of wheeze.

While questioned about the history of cough amongst study
participants, a total of 77.3% of female participants and 75% of male
participants had history of cough; however, 22.7% of female
participants and 25% of male participants had no history of cough.
While questioned about the history of seasonal variation
amongst study participants, a total of 45.5% of female participants
and 23.8% of male participants had history of seasonal variation in
monsoon, 6.1% of female participants and 23.8% of male participants
had history of seasonal variation in summer, 48.5% of female
participants and 52.4% of male participants had history of seasonal
variation in winter.
Frequency
80
70
60
50
Frequency
40
30
20
10
0
Monsoon Summer Winter
Figure 5: Bar graph representing Seasonal variation seen amongst
study participants
BREATHLESSNESS
Female Absent 7 10.6
Present 59 89.4
Total 66 100.0
Male Absent 8 9.5
Present 76 90.5
Total 84 100.0
Table 5: Represents the history of breathlessness in the study participants
WHEEZE
Female Absent 5 7.6
Present 61 92.4
Total 66 100.0
Male Absent 16 19.0
Present 68 81.0
Total 84 100.0
Table 6: Represents the history of wheeze in the study participants
COUGH
Female Absent 15 22.7
Present 51 77.3
Total 66 100.0
Male Absent 21 25.0
Present 63 75.0
Total 84 100.0
Table 7: Represents the history of cough in the study participants
We evaluated the other common variables during history taking
like family history of Asthma, physical activity limitation, history of
allergy.
Family History
F Absent 7 10.6
Present 59 89.4
Total 66 100.0
M Absent 12 14.3
Present 72 85.7
Total 84 100.0
Table 8: Represents the family history of asthma in the study participants
PHYSICAL ACTIVITY LIMITATION

F Absent 5 7.6
Present 61 92.4
Total 66 100.0
M Absent 6 7.1
Present 78 92.9
Total 84 100.0
Table 9: Represents the physical activity limitation in the study participants
ALLERGY HISTORY
F Absent 10 15.2
Present 56 84.8
Total 66 100.0
M Absent 12 14.3
Present 72 85.7
Total 84 100.0
Table 10: Represents the allergy history of asthma in the study participants
Moving on to the next parameter being the medications taken by the
study participants, they were given options namely Breath actuated inhalers
(BAI), Dry powder inhalers (DPI) , Metered dose inhalers(MDI), tablets and
nebulizer. Considering the female participants, 10.6% used BAI, 27.3 % used
DPI, 12.1 % used MDI, 39.4% used Nebulizers and similar to BAI only 10.6%
used tablets as medication for asthma. Considering the male participants, 9.5%
used BAI, 20.2 % used DPI, 19% used MDI, 28.6% used nebulizer therapy,
however 22.6% used tablets as medication for asthma.
Figure 6: Pie graph representing Representing the asthma treatment measures
undertaken by the study participants.

Evaluation of the most necessary parameter, namely the technique of
inhaler usage, there was a positive response of 71.2% from female participants
and 75% from male participants, a negative response where the participants did
not know to use the inhalers was given by 25.8% of female participants and
16.7% of male participants. However, 3% of female participants and 8.3% of
male participants did not have any idea about the inhaler technique.
The other parameters that were included in the study were allergy triggers,
awareness of asthma as a curable or fatal disease, knowledge on asthma
treatment, exacerbations per year, knowledge about the treatment continuation
and finally the reasons for discontinuation of inhaler treatment. The data is
tabulated in the below table 8.
Table 8: Bar graph representing the data about allergy triggers, awareness of
asthma as a curable or fatal disease, knowledge on asthma treatment, and finally
the reasons for discontinuation of inhaler treatment.

The prime motto of the current study being the questionnaire, the knowledge
questionnaire resulted in the following data.
NUMBER OF PARTICIPANTS
2 2
3 0
4 59
5 54
6 15
7 20
Figure 7: Bar graph representing number of participants (y axis) versus the
score obtained by them (x axis) in the knowledge questionnaire assessment.
DISTRIBUTION OF THE STUDY RESULTS OF THE KNOWLEDGE
QUESTIONNAIRE AMONG THE STUDY POPULATION:
1. With respect to question 1 which states that “Lungs and air pipes
affected?”, 68(45.3%) answered yes and 82 (54.6%) answered no and this
difference was said to be statistically significant (p<0.001).
2. With respect to question 2 which states that “No disadvantages for
Asthmatic patients to be in close contact with pets or dust exposure”,
126(84%) answered “Yes” and 24 (16%) answered “ No” and this
difference was said to be statistically significant (p<0.001).

3. With respect to question 3 which states that “Patients have increased
asthma attacks in cold climate”, 71 (47.3%) answered “yes”, 79 (52.6%)
answered “no”, and this difference was said to be statistically significant
(p<0.001).
4. With respect to question 4 which states that “Cough and breathlessness are
the most common symptoms in asthma”, 74 (49.3%) answered yes and 76
(50.6%) answered no and this difference was said to be statistically very
highly significant (p<0.001)
5. With respect to question 5 which states that “Smoking worsens asthma”,
39 (26%) answered yes and 111 (74%) answered no and this difference
was said to be statistically very highly significant (p<0.001).
6. With respect to question 6 which states that “Inhalers used for Asthma
constrict airways” 9 (6%) answered yes and 141 (94%) answered no and
this difference was said to be statistically very highly significant
(p<0.001***)
7. With respect to question 7 which states that “Medicines used helps in
reducing inflammation of airways”, 27 (18%) answered yes and 123 (82%)
answered no and this difference was said to be statistically very highly
significant (p<0.001***)
8. With respect to question 8 which states that “Inhaler therapy should be
continued even if no symptoms present”, 8 (5.3%) answered yes and 142
(94.6%) answered no and this difference was said to be statistically very
highly significant (p<0.001***)
Out of 150 participants in the study, a total of 20 of them were able to answer 7
questions with correct answers, 15 of them were able to answer 6 questions with
correct answers, 54 of them were able to answer 5 questions with correct answers,
59 of them were able to answer 4 out of 8 questions with correct answers, and 2
of them were able to answer only 2 questions with correct answers. This thus
proves that the mean of the knowledge questionnaire score assessed was 4 out of
8.
NUMBER OF PARTICIPANTS WHO ASSESSED THE KNOWLEDGE
QUESTIONNAIRE WITH CORRECT ANSWERS
71 74
68
39
24 27
9 8
Figure 8: Bar graph representing the percentage of participants (y axis) who
assessed the Knowledge questionnaire (x axis) with correct answers

NUMBER OF PARTICIPANTS
26 17
24 20
21 35
19 24
18 37
16 17
Figure 9: Bar graph representing number of participants (y axis) versus the score
obtained by them (x axis) in the attitude questionnaire assessment.
DISTRIBUTION OF THE STUDY RESULTS OF THE ATTITUDE
QUESTIONNAIRE AMONG THE STUDY POPULATION:
Figure 10: Bar graph representing percentage of participants (y axis) versus
the score obtained by them in the attitude questionnaire (x axis) assessment.
1. With respect to question 1 which states that “Asthma does not affect
pleasures in life”, 34(22.66%) answered yes and 116 (77.3%) answered no
and this difference was said to be statistically significant (p<0.001).
2. With respect to question 2 which states that “Social stigma about asthma
is still present”, 114 (76%) answered “Yes” and 36 (24%) answered “ No”
and this difference was said to be statistically significant (p<0.001).

3. With respect to question 3 which states that “I feel all medications
prescribed are essential for asthma treatment”, 117 (78%) answered “yes”,
33 (22%) answered “no”, and this difference was said to be statistically
significant (p<0.001).
4. With respect to question 4 which states that “I am confident regular
medications for Asthma can help live a normal life”, 87 (58%) answered
yes and 63 (42%) answered no and this difference was said to be
statistically very highly significant (p<0.001)
5. With respect to question 5 which states that “I feel taking Inhalers in public
is not embarrassing”, 39 (26%) answered yes and 111 (74%) answered no
and this difference was said to be statistically very highly significant
(p<0.001).
6. With respect to question 6 which states that “I fear medications for Asthma
have to be taken life long” 127 (84%) answered yes and 23 (15.3%)
answered no and this difference was said to be statistically very highly
significant (p<0.001***)
Out of 150 participants in the study, a total of 17 of them were able to get a score
of 16, 37 of them were able to get a score of 18, 24 of them were able to get a
score of 19, 35 of them were able to get a score of 21, 20 of them were able to get
a score of 24, 17 of them were able to get a score of 26. This thus proves that on
an average, the attitude questionnaire score assessed was 20.6.

NUMBER OF PARTICIPANTS WHO ASSESSED THE ATTITUDE
QUESTIONNAIRE WITH CORRECT ANSWERS
84.66666667
76 78
58
22.66666667 26
Asthma does Social stigma I feel all I am confident I feel taking I fear
not affect about asthma medications regular Inhalers in medications
pleasures in is still present prescribed are medications public is not for Asthma
life essential for for Asthma embarassing have to be
asthma can help live a taken life long
treatment normal life
Figure 10: Bar graph representing the percentage of participants (y axis) who
assessed the Attitude questionnaire (x axis) with correct answers

DISCUSSION
DISCUSSION:
In general, the appropriate management of asthma depends on health
education. Exacerbations of childhood asthma can be avoided by learning more
about the condition, recognising the symptoms and triggering circumstances, and
taking the appropriate precautions in between attacks. However knowledge alone
will not help in controlling the disease and when combined with behavioural
therapy, there is significant improvement of the disease prognosis. Patients who
dislike taking medication will be at greater risk for severe episodes of
breathlessness. There should be better understanding of attitudes towards
medications which will be helpful for good patient adherence to treatment plan
according to previous studies.
Anxiety and depression are more prone among asthmatic patients due to the
fact of poor attitude of family which in turn affect compliance to medication.
The current study revealed that the parents of asthmatic children had
insufficient knowledge regarding asthma management. The most important
reason being falsified information or knowledge about the disease process which
in turn leads to multiple problems related to the asthma management. According
to WHO, in India, the incidence of bronchial asthma is over 300 million and over
80% asthma deaths are recorded in low and middle income countries.
An Indian study INSEARCH stated that the national burden of Bronchial
asthma is 17.23 million with an overall prevalence rate of 2.05 % and the global
burden (GBD-1990-2019) is 34.3 million being 13.09 %. 21,23,41,42
Considering the prevalence of asthma in adolescents and children, air
pollution and urbanization were quoted as the prime reasons. In this study,
asthmatic patients and care givers are known to lack knowledge about the disease
etiology, management and had misconceptions about the illness and its treatment
plan. This should be overcome by increasing the awareness about the disease and
the management protocols.
The evidence of treatment success rate depends on early knowledge of the
disease, early recognition of the symptoms and provision of appropriate
treatment. Secondly, attitude towards the treatment plan should be considered
where the patient’s consent should be taken into consideration. Due to the
globally increasing rate of the condition, patients are being ignorant about the
disease and refuse to accept the diagnosis due to poor knowledge about the
disease etiology and treatment.
Patients and caregivers still have misconceptions about the inhaler usage and
its continuation in patients without symptoms. Inhaler therapy is the first line of
treatment in developed countries however its acceptance in our country is poor.
There are three types of inhaler therapy namely Dry powder inhaler that
accounted for 53% in our study, Metered Dose Inhaler that accounted for 41 %
in our study and Breath Actuated Inhaler that accounted for 6% in our study. The
Breath Actuated Inhaler was less preferred due to less oropharyngeal deposition
and therefore the patients had inadequate feeling of inhaler therapy. In case of
acute exacerbations of asthma, people preferred nebulisation and injectable
corticosteroids for quick relief only and did not prefer hospital admission.
The inhaler technique which is the proper and gold standard technique was
seen only in 46% of patients. In our study, every patient’s inhaler technique was
monitored at our out patient department and the result was tabulated. For the dry
powder device, a rotacap capsule was inserted in the device. Later the patient was
asked to exhale completely following which they were asked to grip the mouth
piece, seal the lips around it and take a deep breath. While inhaling, the patients
were asked to tilt their head slightly backwards and were asked to inhale
maximum through the mouth. Once the inhalation was complete, they were asked
to remove the device from the mouth, hold the breath for 10 seconds or as long
as the patient was comfortable and then breathe out. Following this, the patient
was asked to rinse their mouth thoroughly to prevent fungal infections due to
oropharyngeal deposition of the medicine.
For MDI (Metered Dose Inhaler) the patient was asked to shake the device
for 5 seconds initially. Then similar to the inhaler technique, the patient was asked
to exhale, following which they were asked to grip the mouth piece, seal the lips
around it and take a deep breath. While inhaling, the patients were asked to tilt
their head slightly backwards and were asked to inhale maximum through the
mouth. The remaining instructions were similar to the previous technique.

For Breath Actuated Inhalers, the prerequisites were similar to the previous
technique, however while the medicine comes out of the inhaler, a click sound is
heard following which the patient was asked to hold their breath for 10 seconds
and then relax. It was hence suggested that a correct usage of the inhaler was the
best way to prevent frequent exacerbations and control the disease. Thus it is
necessary to teach and educate the patients and caregivers about the correct
inhaler technique in order to have control of the disease.
DISCUSSION ABOUT THE KNOWLEDGE OF PATIENTS AND CARE
GIVERS RELATED TO ASTHMA:
Knowledge questionnaire dealt with 8 questions testing knowledge about
asthma in participants. 54.6% participants had no idea about the site affected in
asthma.84% believed asthmatics can be in close contact with pets and had no
disadvantage with dust exposure. Asthma attacks are commonly triggered with
increase in humidity. Only 47.3% knew that change in weather (monsoon and
winter) triggered the disease. The most common symptoms associated with
asthma are cough, breathlessness and wheeze. 49.3% population were aware
about the clinical presentation and the rest had no idea about the same , which
can make it difficult to identify an exacerbation and therefore, explains the
delayed presentation of such patients ultimately requiring hospital
admission.74% of study population was of the opinion that smoking does not
worsen asthmatic symptoms. Only 6% people opined inhalers used in asthma can
constrict airways indicating that a wrong belief system about treatment still
exists.18% of study participants accepted that medications prescribed for asthma
reduces airway inflammation. Most patients do not prefer inhaler therapy for long
term usage. In this study, only 5.3% believed inhalers should be continued even
when patients are asymptomatic, explaining the prevalence of low compliance to
inhaler therapy, and therefore, increasing the risk of exacerbations. This indicates
the need for improvement in provision of asthma education to patients and
caregivers alike.
DISCUSSION ABOUT THE ATTITUDE OF PATIENTS AND CARE
GIVERS RELATED TO ASTHMA:
This questionnaire dealt with 6 questions assessing attitude of participants
towards the illness. 77.3% believed asthmatic patients won’t be able to enjoy a
normal life. Social stigma centered around asthma is still present in the
community with patients trying to conceal the disease. This stigma against the
disease will ultimately lead to non- compliance to medications, elevated anxiety
levels, poor symptom control, avoidance of inhaler use in public and therefore,
hindering active participation in society. In this study, only 26% felt inhaler use
in a public setting is not embarrassing which meant majority of the participants
would rather skip a dose of inhaler medication if it is to be taken in public,
indicating reduced adherence to therapy.78% population was of the notion that
all medications prescribed by doctors were essential for recovery and 58%
believed regular medications for asthma will help people to live a normal life.
84% participants were convinced that medications have to be taken life long and
feared that it will negatively impact their life. This puts forward a need to improve
the attitude of the population towards the disease to improve compliance to
inhaler therapy.
CONCLUSION
Our findings suggest that patients with asthma and their
caregivers, particularly those with lower education levels had concerns
about the negative effects of treatment, addiction to inhaler therapy
clubbed with a lack of awareness about triggers in asthma, correct
inhaler techniques and hesitancy to use inhalers long term complicated
the final outcome. There is now a need for bringing about awareness in
a developing country like India because in order to prevent
exacerbations, it is vital to convey details about the illness to patients
and caregivers and clarify the rationale for management of the same.
There are many complicated elements including psychological,
social and cultural ones that contribute to non-compliance with asthma
treatment. The disease influences varied aspects of the patients and
caregivers’ lives creating functional issues, emotional turmoil,
medication related and financial burdens which will critically impact
the quality of life. A key contributing factor might be a lack of
awareness about asthma control strategies and a poor attitude towards
the disease.
Patients and caregivers’ perspectives about the disease can be
improved by implementing management strategies targeting individual

needs. Doctors should take initiative to propagate accurate information
about the illness to patients and their caregivers at their initial visit
itself, which may contribute to minimization of disease related burden.
Furthermore, at every visit doctor should ask patients to demonstrate
inhaler technique and explain the correct technique to promote
compliance.
It is vital to communicate about patients’ difficulties related to the
disease, anxieties about prognosis even with treatment, financial issues
and base treatment according to their affordability which is beneficial
to adherence to treatment and preventing recurrent exacerbations.
Therefore, educating patients and their caregivers about the
disease and shifting their attitude towards the same in a positive
direction to avail early treatment and minimize recurrence will
contribute to reduction in disease burden on healthcare system resulting
in lower mortality rates.

REFERENCES
REFERENCES:
1. Hammad, Hamida et al; The basic immunology of asthma; Cell, Volume
184, Issue 6, 1469 – 1485
2. Gaude Gajanan, Nicasia Fernandes, Sindhury Avuthu, Jyothi Hattiholi.
“Assessment of Knowledge and Attitude of Bronchial Asthma Patients
towards their Disease”. Journal of Evolution of Medical and Dental
Sciences 2015; Vol. 4, Issue 90, November 09; Page: 15508-15514
3. Ukena D, Fishman L, Niebling WB. Bronchial asthma: diagnosis and long-
term treatment in adults. Dtsch Arztebl Int. 2008 May;105(21):385-94. doi:
10.3238/arztebl.2008.0385. Epub 2008 May 23. PMID: 19626179;
PMCID: PMC2696883.
4. Rai SP, Patil AP, Vardhan V, Marwah V, Pethe M, Pandey IM. Best
Treatment Guidelines For Bronchial Asthma. Med J Armed Forces India.
2007 Jul;63(3):264-8. doi: 10.1016/S0377-1237(07)80151-1. Epub 2011
Jul 21. PMID: 27408013; PMCID: PMC4922741.
5. McCracken JL, Veeranki SP, Ameredes BT, Calhoun WJ. Diagnosis and
Management of Asthma in Adults: A Review. JAMA. 2017 Jul
18;318(3):279-290. doi: 10.1001/jama.2017.8372. Erratum in: JAMA.
2017 Oct 24;318(16):1615. Dosage error in article text. PMID: 28719697.
6. Michael P. Hunter1 , Suman Vaddi1 , Armin Krvavac1 , Hariharan
Regunath1,2, Vamsi P. Guntur3; Inpatient Management of Bronchial

Asthma for the Hospitalist – A Concise Review; Am J Hosp Med 2019
Oct-Dec;3(4):2019.015
7. Kudo Makoto, Ishigatsubo Yoshiaki, Aoki Ichiro;Pathology of
asthma;Frontiers in Microbiology; VOLUME-4,2013
8. Kaufman G; Asthma: pathophysiology, diagnosis and management.
Nursing Standard; (2011);26, 5, 48-56
9. James W. Mims, MD; Asthma: definitions and pathophysiology;
International Forum of Allergy & Rhinology, Vol. 5, No. S1, September
2015.
10. Bousquet, J., Wenzel, S., Holgate, S., Lumry, W., Freeman, P., and Fox,
H. (2004). Predicting response to omalizumab, an anti-IgE antibody, in
patients with allergic asthma. Chest 125, 1378–1386.
11. Alfvén, T., Braun-Fahrländer, C., Brunekreef, B., von Mutius, E., Riedler,
J., Scheynius, A., et al. (2006). Allergic diseases and atopic sensitization
in children related to farming and anthroposophic lifestyle-the PARSIFAL
study. Allergy 61, 414–421. doi: 10.1111/j.1398-9995.2005.00939.x
12. Wijesinghe, M., Weatherall, M., Perrin, K., Crane, J., and Beasley, R.
(2009). International trends in asthma mortality rates in the 5- to 34-year
age group: a call for closer surveillance. Chest 135, 1045–1049. doi:
10.1378/chest.08-2082
13. Masoli, M., Fabian, D., Holt, S., Beasley, R., and Global Initiative for
Asthma (GINA) Program. (2004). The global burden of asthma: executive
summary of the GINA dissemination committee report. Allergy 59, 469–
478. doi: 10.1111/j.1398-9995.2004.00526.x
14. Ward JPT, Ward J, Leach RM (2010) The Respiratory System at a Glance.
Third edition. Blackwell, Chichester.
15. Townshend J, Hails S, Mckean M (2007) Diagnosis of asthma in children.
British Medical Journal. 335, 7612, 198-202
16. Diamant Z, Diderik Boot JD, Virchow JC (2007) Summing up 100 years
of asthma. Respiratory Medicine. 101, 3, 378-388.
17. Anderson HR (2005) Prevalence of asthma. British Medical Journal. 330,
7499, 1037
18. Jeffery, P. K. (1992). Histopathology of Bronchial Asthma and the Effects
of Treatment. Asthma Treatment, 1–7. doi:10.1007/978-1-4615-3446-4_1
19. A. B. Kay; Pathology of Mild, Severe, and Fatal Asthma." American
Journal of Respiratory and Critical Care Medicine, 154(2_pt_2), pp. S66–
S69.
20. Hough Kenneth P., Curtiss Miranda L., Blain Trevor J., Liu Rui-Ming,
Trevor Jennifer, Deshane Jessy S., Thannickal Victor J; Airway
Remodeling in Asthma; Frontiers in Medicine; VOLUME=7,
2020;DOI=10.3389/fmed.2020.00191
21. Ingawale, Deepa & Mandlik, Satish. (2020). New insights into the novel
anti-inflammatory mode of action of glucocorticoids.
Immunopharmacology and Immunotoxicology. 42. 1-15.
10.1080/08923973.2020.1728765.
22. Bianchi, Andrea. (2014). Magnetic resonance imaging techniques for pre-
clinical lung imaging; Research gate; March 2014.
23. Blanca Camoretti-Mercado, Richard F. Lockey,Airway smooth muscle
pathophysiology in asthma, Journal of Allergy and Clinical Immunology,
Volume 147, Issue 6, 2021, Pages 1983-1995
24. Gaude Gajanan, Nicasia Fernandes, Sindhury Avuthu, Jyothi Hattiholi.
“Assessment of Knowledge and Attitude of Bronchial Asthma Patients
towards their Disease”. Journal of Evolution of Medical and Dental
Sciences 2015; Vol. 4, Issue 90, November 09; Page: 15508-15514, DOI:
10.14260/jemds/2015/2219
25. Deepa Rastogi, MBBS, MS, Neha Madhok, MD, and Stacy Kipperman,
NP; Caregiver Asthma Knowledge, Aptitude, and Practice in High
Healthcare Utilizing Children: Effect of an Educational Intervention;
Pediatric Allergy, Immunology, And Pulmonology Volume 26, Number 3,
2013
26. Abeer Alatawi, Ali Alghamdi; An Investigation of Knowledge, Attitudes,
and Practices Concerning Asthma among Patients in Tabuk, Saudi Arabia;

International Journal of Research Studies in Medical and Health Sciences
Volume 5, Issue 5, 2020, PP 20-27
27. Kosisochi Chinwendu Amorha, Emilia Ayogu, Blessing Adaora Ngwoke,
Eleje Oboma Okonta; Knowledge, attitudes, and quality of life of
caregivers toward asthma in their children: A Nigerian perspective. Journal
of Health Sciences 2020;10(1):47-57.
28. Sodhi R, Prasad R, Kushwaha R, Kant S, Verma SK, Garg R, et al. A study
to know the knowledge, attitude, and practices of patients of bronchial
asthma. Int J Med Public Health 2013;3:159-62.
29. Donques AA, Alaki E, Almazyad W, Almutairi A (2017) Knowledge and
Perception of Asthmatic Patients and their Family towards Asthma Disease
and Management in King Saud Medical City, Riyadh, KSA. J Clin Respir
Dis Care 3: 128.
30. Gulnur Com, Raid Amin, Mohini Gunnett, Callah Antonetti; Patient
Characteristics and Caregiver Asthma Knowledge of Children with Well-
Controlled and Poorly Controlled Asthma; Journal of Asthma and Allergy
2022:15 793–802.
31. Hala Mostafa Elhady Hashim, Ahmady Mohammed Ismail, Marwa Salah
El dien Abd Elraouf, Mai Magdy Anwer Saber, Hala Ali Abed Hassan;
Knowledge and Self-Care Management Practice Among Asthmatic
Children (6-12 Years): An Educational Intervention Study; The Egyptian
Journal of Hospital Medicine (July 2022) Vol. 88, Page 2599-2605.

32. Assiri HA, Alkhaldi YM, Alsaleem SA, Alqarni HM. Knowledge, attitude
and practices of PHC physicians in Aseer region regarding management of
acute asthma. J Family Med Prim Care 2021;10:1882-9.
33. Sirasuda Sommanus , Raweerat Sitcharungsi and Saranath Lawpoolsri;
Effects of an Asthma Education Camp Program on Quality of Life and
Asthma Control among Thai Children with Asthma: A Quasi-
Experimental Study; Healthcare 2022, 10, 1561.
34. Dr. Farihan Farouk Helmy, Dr Adnan Amin Alsulaimani, Dr Sanaa
Mahmoud, Al-hanouf Al-Malki, Yara Maroof, "Knowledge and Attitude
of Care-Givers about their Children S Bronchial Asthma in Taif Region
KSA", International Journal of Science and Research (IJSR), Volume 6
Issue 2, February 2017, pp. 358-362
35. Divecha C, Tullu MS, Jadhav DU. Parental knowledge and attitudes
regarding asthma in their children: Impact of an educational intervention
in an Indian population. Pediatric Pulmonology. 2020;1–9
36. Gajanan G, Padbidri VS, Chaudhury A. Assessment of Knowledge and
Attitude of Parents Towards the Allergy and Bronchial Asthma in Their
Children. Inter. J. Med. Public Health, 2016; 6(3):121-5
37. A.M. Al-Binali,1 A.A. Mahfouz,2 S. Al-Fifi,1 S.M. Naser3 and K.S. Al-
Gelban; Asthma knowledge and behaviours among mothers of asthmatic
children in Aseer, south-west Saudi Arabia; Eastern Mediterranean Health
Journal; Vol. 16 No.11; 2010.

38. Venugopal S, Namboodiripad A. Effect of parental knowledge and attitude
in the control of childhood asthma. Int J Contemp Pediatr 2016;3:1385-8
39. Abu-Shaheen AK, Nofal A, Heena H. Parental Perceptions and Practices
toward Childhood Asthma. Biomed Res Int. 2016;2016:6364194. doi:
10.1155/2016/6364194. Epub 2016 Oct 23. PMID: 27843948; PMCID:
PMC5097792.
40. Dhirja, Sharma MC, Goyal JP, Remiya M. Knowledge and practices
among parents of asthmatic children: a quasi-experimental study
conducted at tertiary care center of Western India. Int J Community Med
Public Health 2021;8:3430-9
41. Awan AS, Munir SS. Asthmatic children; knowledge, attitude and
practices among caregivers. Professional Med J 2015;22(1):130-136
42. Albarraq AA. Assessment of caregivers’ knowledge and behavior in the
management of pediatric asthma in Jazan, Saudi Arabia. Saudi J Health Sci
2019;8:98-104.
43. Paul P, Singh Y, Gupta N, Agarwal P, Sachdev A, Gupta D. Knowledge
assessment among caregivers about various allergic disorders in a hospital-
based pediatric outpatient department in North India. Indian J Allergy
Asthma Immunol 2020;34:112-6
44. Mohammed Mahmood Mohammed, Ashwaq Najemaldeen Abbas, Abeer
Abdulhadi Rashid; Estimating the Knowledge and Attitude of Parents
about their Children’s Asthma and Evaluating the Impact of their

Education Status in Baghdad/ Iraq; Systematic Reviews in Pharmacy Vol
11, Issue 8, Aug-Sept 2020.
45. Franken MMA, Veenstra-van Schie MTM, Ahmad YI, Koopman HM,
Versteegh FGA. The presentation of a short adapted questionnaire to
measure asthma knowledge of parents. BMC Pediatr 2018;18(1):1–6.
46. Helen K. Reddel, Leonard B. Bacharier, Eric D. Bateman, Christopher E.
Brightling, Guy G. Brusselle, Roland Buhl, Alvaro A. Cruz, Liesbeth
Duijts, Jeffrey M. Drazen, J. Mark FitzGerald, Louise J. Fleming,
Hiromasa Inoue, Fanny W. Ko, Jerry A. Krishnan, Mark L. Levy, Jiangtao
Lin, Kevin Mortimer, Paulo M. Pitrez, Aziz Sheikh, Arzu A.
Yorgancioglu, Louis-Philippe Boulet; European Respiratory Journal 2022
59: 2102730; DOI: 10.1183/13993003.02730-2021

ANNEXURES
ANNEXURE - I
SREE BALAJI MEDICAL COLLEGE & HOSPITAL CHENNAI
PATIENT INFORMATION SHEET
Title of Research Study: Assessment of Knowledge and attitude of asthmatic patients and
their care givers regarding the disease using an Asthma Knowledge Questionnaire in a tertiary
care hospital in Chennai.
Place of Study: Sree Balaji Medical College and Hospital, Chennai
Investigator: Dr Francis Ankita
Introduction: You are being asked to participate in a research study. Before you agree,
however, you must be fully informed about the purpose of the study, the procedures to be
followed, and any benefits, risks or discomfort that you may experience as a result of your
participation. This form presents information about the study so that you may make a fully
informed decision regarding your participation.
Purpose of the study: Assessment of Knowledge and attitude of asthmatic patients and their
care givers regarding the disease using an Asthma Knowledge Questionnaire in a tertiary care
hospital in Chennai.
Procedures to be followed:.
Risks to study participants: There is no risk to study participants
Benefits to research participants and others: None
Record keeping and confidentiality: Records of your participation in this study will be held
confidential so far as permitted by law. Any publication or presentation of the data will not
identify you.
For more information about this research or about the rights of research participants contact:
Dr FRANCIS ANKITA ,PhNo:7507625155,E-mail- francisankita27@gmail.com.
Your participation in this research is voluntary: Your refusal to participate will not result in
any penalty to you or any loss of benefits to which you may otherwise be entitled. You may
decide to stop participating in the research at any time without penalty or loss of other benefits.
The project investigators retain the right to cancel or postpone the experimental procedures at
any time they see fit.
By signing below, you acknowledge that you have been informed about and consent to be a
participant in the study described above. Make sure that your questions are answered to your
satisfaction before signing. You are entitled to retain a copy of this consent agreement.
___________________________________________ Date:___________________
Study Participant Signature & Name
___________________________________________ Date:___________________
Witness Signature & Name
___________________________________________ Date:___________________
Signature & Name of Person who explained this study

ந ோயோளி தகவல் தோள்
ஆரோய் ச்சி ஆய் வின் தலலப் பு- : சசன்லனயில் உள் ள மூன்றோம் ிலல பரோமரிப் பு
மருத்துவமலனயில் ஆஸ்துமோ அறிவு நகள் வித்தோலளப் பயன்படுத்தி ஆஸ்துமோ ந ோயோளிகள்
மற் றும் அவர்களின் பரோமரிப் பு அளிப் பவர்களின் அறிலவ மதிப் பீடு சசய் தல்
படிக்கும் இடம் : ஸ்ரீ போலோஜி மருத்துவக் கல் லூரி மற் றும் மருத்துவமலன, சசன்லன
புலனோய் வோளர்: டோக்டர் பிரோன்சிஸ் அங் கிதோ
அறிமுகம் : ஒரு ஆரோய் ச்சி ஆய் வில் பங் நகற் கும் படி நகட்கப் படுகிறீர்கள் . எவ் வோறோயினும் , ீ ங் கள்
ஒப் புக்சகோள் வதற் கு முன், ஆய் வின் ந ோக்கம் , பின்பற் ற நவண்டிய லடமுலறகள் மற் றும் உங் கள்
பங் நகற் பின் விலளவோக ீ ங் கள் அனுபவிக்கும் ஏநதனும் ன்லமகள் , அபோயங் கள் அல் லது அச om
கரியங் கள் குறித்து உங் களுக்கு முழுலமயோகத் சதரிவிக்கப் பட நவண்டும் . இ ்த படிவம் ஆய் லவப்
பற் றிய தகவல் கலள அளிக்கிறது, இதன் மூலம் ீ ங் கள் முழுலமயோக உருவோக்க முடியும் உங் கள்
பங் நகற் பு சதோடர்போன தகவலறி ் த முடிவு.
ஆய் வின் ந ோக்கம் : சசன்லனயில் உள் ள மூன்றோம் ிலல பரோமரிப் பு மருத்துவமலனயில்
ஆஸ்துமோ அறிவு நகள் வித்தோலளப் பயன்படுத்தி ஆஸ்துமோ ந ோயோளிகள் மற் றும் அவர்களின்
பரோமரிப் பு வழங் கு ர்களின் அறிலவ மதிப் பீடு சசய் தல் .
பின்பற் ற நவண்டிய லடமுலறகள் :.பங் நகற் போளர்கலளப் படிப் பதற் கோன அபோயங் கள் :
பங் நகற் போளர்கலளப் படிக்க எ ் த ஆபத்தும் இல் லலஆரோய் ச்சி பங் நகற் போளர்களுக்கும்
மற் றவர்களுக்கும் ன்லமகள் : எதுவுமில் லல
பதிவு லவத்தல் மற் றும் ரகசியத்தன்லம: இ ்த ஆய் வில் ீ ங் கள் பங் நகற் றதற் கோன பதிவுகள்
சட்டத்தோல் அனுமதிக்கப் பட்டவலர இதுவலர ரகசியமோக லவக்கப் படும் . தரவின் எ ்த சவளியீடும்
அல் லது விளக்கக்கோட்சியும் உங் கலள அலடயோளம் கோணோது.
இ ் த ஆரோய் ச்சி பற் றிய கூடுதல் தகவலுக்கு அல் லது ஆரோய் ச்சி பங் நகற் போளர்களின் உரிலமகள்
பற் றி சதோடர்புசகோள் ளவும் :டோக்டர் ஃபிரோன்சிஸ் அங் கிதோ, பி.என்: 7507625155,
மின்னஞ் சல் - francisankita27@gmail.com.
இ ் த ஆரோய் ச்சியில் ீ ங் கள் பங் நகற் பது தன்னோர்வமோனது: ீ ங் கள் பங் நகற் க மறுத்தோல்
உங் களுக்கு எ ்த அபரோதமும் ஏற் படோது அல் லது உங் களுக்கு உரிலமயுள் ள ன்லமகள்
இழக்கப் படோது. அபரோதம் அல் லது பிற ன்லமகலள இழக்கோமல் எ ்த ந ரத்திலும் ஆரோய் ச்சியில்
பங் நகற் பலத ிறுத்த ீ ங் கள் முடிவு சசய் யலோம் . எ ்த ந ரத்திலும் சபோருத்தமோக இருக்கும் நபோது
நசோதலன லடமுலறகலள ரத்துசசய் ய அல் லது ஒத்திலவக்கும் உரிலமலய திட்ட ஆய் வோளர்கள்
தக்க லவத்துக் சகோள் கிறோர்கள் .
கீநழ லகசயோப் பமிடுவதன் மூலம் , உங் களுக்கு அறிவிக்கப் பட்டலத ீ ங் கள் ஒப் புக்சகோள் கிறீர்கள்
மற் றும் நமநல விவரிக்கப் பட்ட ஆய் வில் பங் நகற் போளரோக ஒப் புக்சகோள் கிறீர்கள் .
லகசயோப் பமிடுவதற் கு முன்பு உங் கள் நகள் விகளுக்கு உங் கள் திருப் திக்கு பதிலளிக்கப் படுவலத
உறுதிசசய் க. இ ்த ஒப் புதல் ஒப் ப ்தத்தின் கலலத் தக்க லவத்துக் சகோள் ள உங் களுக்கு உரிலம
உண்டு.
___________________________________________ நததி: ___________________
பங் நகற் போளர் லகசயோப் பம் & சபயர் படிக்கவும்
___________________________________________ நததி: ___________________
சோட்சி லகசயோப் பம் & சபயர்
___________________________________________ நததி: ___________________
இ ்த ஆய் லவ விளக்கிய பரின் லகசயோப் பம் மற் றும் சபயர்

ASTHMA KNOWLEDGE QUESTIONNAIRE
Sno: Lungs and air pipes affected
1. No disadvantages for Asthmatic patients to be in close contact
with pets or dust exposure
2. Patients have increased asthma attacks in cold climate
3. Cough and breathlessness are the most common symptoms in

asthma
4. Smoking worsens asthma
5. Inhalers used for Asthma constrict airways
6. Medicines used helps in reducing inflammation of airways
7. Inhaler therapy should be continued even if no symptoms

present
ASTHMA ATTITUDE QUESTIONNAIRE
S. Questions Strongly Agree Disagree- Strongly Don’t

No Agree 4 3 Disagree know
5 2 1
1. Asthma does not
affect pleasures in
life
2. Social stigma
about asthma is
still present
3. I feel all
medications
prescribed are
essential for
asthma treatment
4. I am confident
regular
medications for
Asthma can help
live a normal life
5. I feel taking
Inhalers in public
is not embarassing
6. I fear medications
for Asthma have to
be taken life long
MASTER CHART
PART- 1
SN Durati Knowledge Whee Coug Season Family Physic Aller

o. on of about Breathless ze in h in al History al gy
Asthm asthma ness in asthm Asth variati of activity histo
a etiology(air asthma a ma on ( Bronch limitati ry
way summe ial on
constriction r/ asthma
) winter
Name(Patients/ Se Ag Educati Occupat /
Care givers) x e on ion monso
on)
6-10 Prese Prese Winter Present Present Prese

Patie Housewi yrs nt nt nt
1 Tamil selvi F 55 Unknown Present
nt 10th fe
Graduat Employe 6-10 Absen Prese Monso Absent Present Prese

2 Raja CG M 35 yrs Known Present t nt on nt
e d
Employe <1 Prese Prese Summe Present Present Prese
Selvaraj CG M 42 10th Unknown Absent nt nt r nt
d
6-10 Prese Absen Monso Present Absent Abse
Employe yrs nt t on nt
4 Rajeshwari CG F 25 10th Known Absent
d
Patie Housewi 6-10 Prese Prese Monso Present Present Prese

5 Radha F 58 10th yrs Known Present nt nt on nt
nt fe
Patie Employe 6-10 Absen Absen Winter Absent Present Abse
6 Manikkam M 52 10th yrs Unknown Present t t nt
nt d
Employe 3-5 yrs Prese Prese Summe Present Present Prese
7 E.Ganesan CG M 44 10th Known Present nt nt r nt
d
3-5 yrs Prese Prese Winter Present Present Prese
Chaitthanya A V Patie Graduat Employe nt nt nt
8 F 23 Known Present
S nt e d
3-5 yrs Prese Prese Summe Present Present Prese

Sanmuga Priya Graduat Employe nt nt r nt
9 CG F 27 Known Present
M. e d
Patie Employe 6-10 Prese Prese Winter Present Present Prese

10 M.Sunitha F 54 10th yrs Known Present nt nt nt
nt d
Patie Employe <1 Prese Prese Monso Present Present Prese
11 K. Suganya F 36 10th Unknown Present nt nt on nt
nt d
3-5 yrs Prese Prese Summe Present Present Abse
Patie Graduat Employe nt nt r nt
12 Priyanka. G F 22 Known Present
nt e d
<1 Prese Absen Monso Present Absent Prese

Employe nt t on nt
13 Jones EbenRaj CG M 34 10th Unknown Present
d
Graduat Employe <1 Absen Prese Monso Present Present Prese

14 Harini Valli N CG F 23 Unknown Present t nt on nt
e d
Graduat Employe 6-10 Prese Absen Winter Present Present Abse
15 Nanshu Shri M. CG F 54 yrs Known Present nt t nt
e d
<1 Prese Prese Monso Present Present Prese
Patie Graduat Housewi nt nt on nt
16 Harini F 26 Unknown Present
nt e fe
Graduat Employe 6-10 Prese Prese Winter Present Present Prese

17 Sathish Babu M. CG M 61 yrs Known Present nt nt nt
e d
Graduat Employe <1 Prese Absen Monso Present Absent Abse
18 Deepika I CG F 27 Unknown Present nt t on nt
e d
Patie Graduat Employe 10 Prese Prese Winter Present Present Prese
19 Jaansi S F 24 Known Present nt nt nt
nt e d
Housewi 6-10 Prese Absen Winter Present Present Prese
20 Sharmila L. CG F 41 10th yrs Known Present nt t nt
fe
1-2 yrs Prese Prese Monso Present Present Prese
Housewi nt nt on nt
21 R.Tamilselvi CG F 29 10th Unknown Present
fe
Employe 1-2 yrs Prese Prese Monso Present Present Prese

22 CG M 29 10th Unknown Present nt nt on nt
Sarath Kumar d
Employe 3-5 yrs Prese Prese Winter Present Present Prese
23 Ram Prasad S. CG M 55 10th Known Present nt nt nt
d
Employe 1-2 yrs Prese Absen Monso Present Present Prese
24 Divoshini CG F 31 10th Unknown Absent nt t on nt
d
Employe nt nt r nt
25 CG M 30 10th Known Present
d
Vivek
Patie Employe 3-5 yrs Absen Absen Summe Present Present Prese
26 M 41 10th Known Absent t t r nt
Ashok Kumar nt d
<1 Prese Prese Monso Absent Present Prese
Employe nt nt on nt
27 Dinesh CG M 28 10th Unknown Present
d
10 Prese Prese Winter Present Present Prese

Employe nt nt nt
28 Murugan CG M 42 10th Known Present
d
Employe 1-2 yrs Prese Absen Monso Present Present Prese

29 Shanmugam CG M 30 10th Unknown Present nt t on nt
d
Graduat Employe 1-2 yrs Prese Absen Monso Present Present Prese
30 Nishaj CG M 31 Unknown Present nt t on nt
e d
3-5 yrs Prese Prese Winter Absent Present Prese
Patie Graduat Employe nt nt nt
31 Naresh M 71 Known Present
nt e d
1-2 yrs Prese Absen Monso Present Present Prese

Graduat Employe nt t on nt
32 Nirmal CG M 32 Unknown Present
e d
Employe 6-10 Prese Prese Winter Present Present Prese

33 Karthik CG M 44 10th yrs Known Present nt nt nt
d
Patie Employe 3-5 yrs Prese Prese Summe Present Present Prese
34 Saravanan M 36 10th Known Present nt nt r nt
nt d
Employe nt nt r nt
35 Subbramaniam CG M 28 10th Known Present
d
6-10 Prese Absen Winter Present Present Prese

Employe yrs nt t nt
36 Radhakrishnan CG M 39 10th Known Present
d

Graduat Employe nt nt r nt
37 Balakrishnan CG M 25 Known Present
e d
Employe 3-5 yrs Absen Prese Summe Present Absent Prese

38 Ravi CG M 55 10th Known Present t nt r nt
d
Employe 3-5 yrs Prese Prese Winter Present Present Prese
39 Gopi CG M 27 10th Known Present nt nt nt
d
Employe <1 Prese Prese Monso Absent Present Prese
40 Boominathan CG M 41 10th Unknown Present nt nt on nt
d
Employe yrs nt nt nt
d
Vivek Kumar
Graduat Housewi 3-5 yrs Prese Prese Winter Absent Present Prese
42 Anitha. D CG F 51 Known Present nt nt nt
e fe
Patie Graduat Employe 6-10 Prese Prese Winter Present Present Abse
43 Saranya C.M. F 43 yrs Known Present nt nt nt
nt e d
Ramachandran Employe 6-10 Prese Prese Winter Present Absent Prese
44 CG M 53 10th yrs Known Present nt nt nt
M. d
6-10 Absen Prese Winter Present Present Abse
Employe yrs t nt nt
45 Sabarinathan A. CG M 64 10th Known Present
d
Kavitha Akshaya Employe 3-5 yrs Absen Prese Winter Present Present Prese
46 CG F 58 10th Known Present t nt nt
A d
Aravinth Patie Employe 10 Prese Prese Summe Present Present Prese
47 M 59 10th Known Present nt nt r nt
Bharathy M. nt d
Patie Graduat Housewi 1-2 yrs Prese Prese Monso Present Present Prese
48 Kokila R F 31 Unknown Present nt nt on nt
nt e fe
3-5 yrs Prese Prese Winter Present Present Abse
Patie Employe nt nt nt
49 M 46 10th Known Present
nt d
Ramshankar
Patie Graduat Employe 3-5 yrs Prese Absen Summe Present Present Prese
50 M 31 Known Present nt t r nt
Mahesh Kumar nt e d
3-5 yrs Prese Prese Winter Absent Present Prese
51 Ashwini. Y F 34 10th Known Present
nt d

Patie Graduat Employe nt nt on nt
52 Janardhanan F 36 Unknown Present
nt e d
Patie Employe 3-5 yrs Prese Prese Winter Present Present Prese
53 Raj Kumar R.. M 47 10th Known Present nt nt nt
nt d
54 Abdul Majith S. M 37 10th Known Present
nt d
Employe <1 Prese Prese Monso Present Present Prese

55 Aravind CG M 28 10th Unknown Present nt nt on nt
d
<1 Absen Prese Monso Absent Present Prese
Employe t nt on nt
56 CG M 25 10th Unknown Present
d
Vimal Sharma
3-5 yrs Prese Absen Winter Present Present Prese
Employe nt t nt
57 E.Ganesan CG M 48 10th Known Absent
d
Graduat Employe 10 Prese Prese Summe Present Present Prese

58 CG M 53 Known Present nt nt r nt
Girish e d
<1 Prese Prese Monso Present Absent Prese
59 Reshmi M. F 29 Unknown Present
nt e d

60 Aravind M 48 10th yrs Known Present nt nt nt
nt d
61 M 55 10th yrs Known Present nt nt nt
Ganapathy nt d
Dinesh Kumar Employe <1 Prese Absen Monso Absent Present Abse
62 CG M 26 10th Known Present nt t on nt
R. d
6-10 Absen Absen Winter Present Present Prese
Patie Employe yrs t t nt
63 Akshay S. M 30 10th Known Absent
nt d
Graduat Employe 3-5 yrs Prese Prese Summe Present Present Prese
64 Naveenraj S.S CG M 29 Known Present nt nt r nt
e d
Lalu Krishna. Graduat Employe 1-2 yrs Prese Prese Monso Present Absent Prese
65 CG M 34 Known Present nt nt on nt
K.N. e d
6-10 Absen Prese Winter Present Present Abse
Employe yrs t nt nt
d
Vishwesh
<1 Prese Absen Monso Present Present Prese
Patie Employe nt t on nt
67 Geena Augustine F 31 10th Known Present
nt d

68 Deepthi.T F 39 10th Known Present
nt fe

Patie Employe yrs nt t nt
69 Aneesh P M 38 10th Known Present
nt d

Graduat Housewi nt nt on nt
70 Anbarasi. E CG F 35 Known Present
e fe
Graduat Employe 6-10 Prese Absen Winter Present Present Prese

71 CG M 63 yrs Known Present nt t nt
Venkat Hari e d
Graduat Employe 6-10 Prese Prese Winter Present Absent Prese
72 Ajith Kumar CG M 47 yrs Known Present nt nt nt
e d
73 Martin K.John M 26 10th Known Present
nt d
Patie Graduat Employe 6-10 Prese Prese Winter Present Present Prese
74 Sreesha S.R F 63 yrs Known Present nt nt nt
nt e d
Patie Employe 3-5 yrs Prese Prese Winter Present Present Prese
75 John KJ M 30 10th Known Present nt nt nt
nt d
<1 Absen Prese Summe Present Present Prese
Gunasekar Patie Graduat Employe t nt r nt
76 M 36 Known Present
Ramanathan nt e d

77 T.Prabhakaran M 45 10th Known Present
nt d
M.S.Viswanatha Employe 6-10 Prese Prese Winter Present Present Abse

78 CG M 39 10th yrs Known Present nt nt nt
n d
Employe 3-5 yrs Prese Absen Winter Present Present Prese
79 Vasantha Priya.J CG F 48 10th Known Present nt t nt
d
3-5 yrs Prese Prese Summe Present Absent Prese
Housewi nt nt r nt
80 Poongodi CG F 42 10th Known Present
fe
Patie Employe 3-5 yrs Prese Prese Summe Present Present Prese
81 M 37 10th Known Present nt nt r nt
Harikrishnan nt d
Employe nt nt r nt
d
Deepak
Ajay Employe <1 Prese Absen Monso Present Present Prese
83 CG M 29 10th Known Absent nt t on nt
Venkatraman S. d
Navaneth Kumar Patie Graduat Employe nt t on nt
84 M 27 Known Absent
B.V. nt e d

Patie Graduat Housewi nt nt nt
85 Priyanka. G F 26 Known Present
nt e fe
Patie Employe 1-2 yrs Prese Prese Monso Present Present Abse
86 Akshya M.K. F 31 10th Unknown Present nt nt on nt
nt d
Employe 6-10 Prese Prese Winter Present Present Prese
87 Sreekartthik A. CG M 47 10th yrs Known Present nt nt nt
d
Patie Graduat Employe 3-5 yrs Prese Prese Winter Present Present Prese
88 Aravindasami B. M 27 Known Present nt nt nt
nt e d
14 Absen Prese Summe Absent Present Prese
Employe t nt r nt
89 Aravindhan A. CG M 58 10th Known Present
d

Naveen Prasad Patie Employe nt nt nt
K.V. nt d
13 Absen Prese Summe Present Present Prese

Dheepak Kumar Patie Employe t nt r nt
A. nt d
Employe 12 Prese Prese Summe Absent Present Prese

92 Naveen R. CG M 53 10th Known Present nt nt r nt
d
Employe nt nt r nt
93 Srinithi V.R CG F 29 10th Known Present
d
Employe 6-10 Prese Absen Winter Present Present Prese

94 Dhivya R. CG F 48 10th yrs Known Present nt t nt
d
6-10 Prese Prese Winter Present Absent Prese
95 K. Suganya F 55 10th Known Present
nt fe
Patie Graduat Housewi <1 Prese Prese Monso Present Present Prese
96 Abinaya C. F 29 Unknown Present nt nt on nt
nt e fe
Patie Employe 1-2 yrs Absen Prese Monso Present Present Prese
97 Sivaraman G. M 30 10th Unknown Present t nt on nt
nt d
Patie Employe <1 Prese Absen Monso Present Present Prese
98 Aarthi. S F 29 10th Unknown Absent nt t on nt
nt d
1-2 yrs Prese Prese Monso Present Present Abse
Patie Housewi nt nt on nt
99 Divya F 34 10th Unknown Present
nt fe

Employe nt nt nt
100 Rajeshwari CG F 47 10th Known Present
d

101 Anjugam. S CG F 31 Unknown Present
e fe
Graduat Employe 3-5 yrs Prese Prese Summe Present Present Prese
102 Aravind CG M 39 Known Present nt nt r nt
e d
Employe nt t on nt
103 S.Swetha CG F 31 10th Unknown Absent
d
Patie Employe 6-10 Prese Absen Winter Present Present Prese

104 Adithyan N. M 71 10th yrs Known Absent nt t nt
nt d
Patie Graduat Employe 1-2 yrs Absen Prese Monso Present Present Prese
105 Sowmya R. F 32 Unknown Present t nt on nt
nt e d
3-5 yrs Absen Absen Winter Present Present Prese
Graduat Employe t t nt
106 Dinesh R. CG M 44 Known Present
e d
Graduat Employe 1-2 yrs Prese Prese Monso Absent Present Prese
107 Fayiz.K CG M 36 Unknown Present nt nt on nt
e d
108 Sriram T.R. CG M 58 10th Known Present
d

Patie Graduat Employe yrs nt nt nt
109 Naresh kumar C. M 39 Known Present
nt e d
<1 Absen Prese Monso Present Present Prese

Patie Graduat Employe t nt on nt
110 Aishwarya R. F 25 Known Present
nt e d
111 S.Prdeep kumar M 55 Known Present
nt e d
<1 Prese Prese Monso Present Present Abse

Graduat Employe nt nt on nt
112 P.A.Justin CG M 27 Unknown Present
e d

113 Raja CG M 41 Unknown Present
e d
6-10 Prese Prese Winter Absent Present Prese

Patie Graduat Housewi yrs nt nt nt
114 Nandhini F 45 Known Present
nt e fe
Patie Graduat Employe 1-2 yrs Prese Prese Monso Absent Present Prese
115 Suba lakshmi F 30 Unknown Present nt nt on nt
nt e d
13 Prese Absen Winter Present Present Prese
Adithya Dhanraj Patie Graduat Employe nt t nt
116 M 43 Known Present
V. nt e d

Patie Housewi nt nt nt
117 R.Vimala F 53 10th Known Present
nt fe
16 Prese Prese Summe Present Present Prese

Patie Employe nt nt r nt
118 Selvaraj M 64 10th Known Present
nt d
1-2 yrs Prese Absen Monso Present Present Abse

Graduat Employe nt t on nt
119 Divya Priya S.S CG F 34 Unknown Absent
e d
3-5 yrs Absen Absen Winter Present Present Prese

Employe t t nt
120 N.Nandhini CG F 36 10th Known Present
d
3-5 yrs Prese Absen Winter Present Present Prese

Graduat Employe nt t nt
121 R.Suba lakshmi CG F 47 Known Absent
e d

Housewi nt nt on nt
122 R.Divya CG F 27 10th Unknown Present
fe

123 A.Kalanidhi CG F 28 Unknown Present
e d

124 G.Pavithra F 25 Unknown Present
nt e d

Employe nt nt nt
125 Deepika I CG F 48 10th Known Present
d
6-10 Prese Absen Winter Present Present Abse

Employe yrs nt t nt
126 Shankar CG M 53 10th Known Present
d
<1 Absen Prese Monso Present Present Abse

127 Moorthy M 29 Unknown Present
nt e d

128 Jayalakshmi CG F 48 10th Known Present
d

Patie Employe yrs nt nt nt
129 Divyabharathi F 55 10th Known Present
nt d
6-10 Prese Prese Winter Absent Present Prese

Graduat Employe yrs nt nt nt
130 Murali CG M 43 Known Present
e d

131 Vashisth M 53 Known Present
nt e d
10 Absen Prese Winter Present Present Prese

Patie Employe t nt nt
132 Venkat M 64 10th Known Present
nt d
133 Nanicy Sri CG F 27 Unknown Present
e fe

Graduat Employe nt nt nt
134 Vijaylakshmi CG F 28 Known Present
e d

Radhakrishnamo Graduat Employe nt nt nt
135 CG M 25 Known Present
orthy e d

Patie Employe yrs nt nt nt
136 Sundar M 48 10th Known Present
nt d
Patie Employe 6-10 Prese Absen Winter Present Present Prese

137 Raj Kumar R.. M 47 10th yrs Known Absent nt t nt
nt d
138 Radhika F 31 Unknown Present
nt e d

Patie Graduat Housewi yrs nt nt nt
139 Bhairavi F 71 Known Present
nt e fe
Patie Graduat Employe 1-2 yrs Prese Prese Monso Present Present Prese
140 Sandhya F 32 Unknown Present nt nt on nt
nt e d
141 Priyanka. G CG F 44 10th Known Present
d

142 Padma CG F 36 10th Known Present
d
3-5 yrs Prese Absen Winter Absent Present Prese

Graduat Employe nt t nt
143 Ramakrishnan CG M 28 Known Present
e d

Patie Employe yrs nt t nt
144 Aarthy F 39 10th Known Absent
nt d
<1 Absen Prese Monso Present Present Abse

145 Srinivasan M 25 Unknown Present
nt e d

Housewi yrs nt t nt
146 Jayalakshmi CG F 55 10th Known Present
fe

Patie Employe nt nt on nt
147 Chandra F 27 10th Known Present
nt d
6-10 Prese Prese Winter Present Absent Prese

Graduat Employe yrs nt nt nt
148 Adhitya CG M 41 Known Present
e d

149 Akshaya CG F 45 10th Known Present
d
6-10 Prese Prese Winter Present Present Abse

Housewi yrs nt nt nt
150 Subbulakshmi CG F 51 10th Known Present
fe
PART- 2
SN Asthma Knowl Asthma triggers( Exacerba Reasons for Knowled Attitude

o. treatment edge of Food/insecticide/perfumes/exercise/Co Cura Knowledge tions per Knowle discontinuation of ge Question
measures( inhaler ld/Smoke/Dust/Pets) ble on Asthma year dge of inhaler therapy Question naire
Metered Dose techniq or treatment( treatme (Ineffective/fear of naire Score
Inhalers(MDI)/ ue Fatal Bronchodil nt side effects/Distant score (Maximu
Dry Powder disea atation and continu pharmacy/Dislike (Total 8) m- 30)
Inhalers(DPI)/ se reduction ation in medication/Addictive/ (Yes - (Strongly
Breath of patients Cost/Social 1,No- 0) agree - 5,
actuated inflammati without stigma/Difficult to Agree- 4,
inhaler(BAI)/N on) sympto use/Difficult to Disagree
ebulizer ms carry/Emergency use - 3,
therapy/Tablet only Strongly
s) Disagree
- 2, Don't
know- 1)
1 Nebulizer Nil Fatal Nil 3 No 2
therapy and
Tablets Dust Cost 18
2 MDI Yes Cura No 1 No 6

Exercise ble Fear of side effects 21
Tablets Nil Nil 2 No 4
Food Social stigma 19
4 DPI, Nebulizer Yes Cura No 0 No 7
therapy and ble
tablets Pets Emergency use only 24
5 BAI No Fatal Yes 3 No 6

Dust Ineffective 26
6 BAI No Cura Yes 2 No 5
Smoke ble Cost 16
7 BAI Yes Cura Yes 3 Yes 4
Dust ble Fear of side effects 18
8 Nebulizer Yes Cura No 3 No 4
therapy and ble
Tablets Pets Cost 21
9 DPI, Nebulizer Yes Cura Yes 3 No 4

therapy and ble
tablets Exercise Cost 18
10 MDI Yes Cura No 2 Yes 4

Exercise ble Cost 21
11 Tablets Yes Cura No Yes 4
12 DPI, Nebulizer Yes Cura Yes 2 Yes 4
therapy and ble
tablets Pets Emergency use only 24
13 Nebulizer No Cura Yes 3 No 4

therapy and ble
Tablets Pets Emergency use only 18
14 BAI Yes Cura No 2 Yes 5

Smoke ble Cost 19
16 Nebulizer Yes Cura No 2 Yes 6
therapy and ble
Tablets Smoke Fear of side effects 24

Pets ble Cost 26
18 MDI Yes Cura No No 6
Dust ble Emergency use only 16
Dust ble Cost 18
therapy and ble
Tablets Dust Fear of side effects 26
22 BAI Nil Cura Nil 2 No 5

Dust ble Cost 16
Dust ble Cost 18
24 MDI No Cura Yes 2 No 5
Dust ble Cost 21
25 Nebulizer No Cura No 2 No 4
therapy and ble
26 BAI Yes Cura Yes 2 No 4

27 Nebulizer Yes Fatal No 3 No 4
therapy and

therapy and ble

Smoke ble Cost 24
30 Tablets Yes Cura No No 4
Dust ble Cost 26
31 DPI, Nebulizer Yes Fatal No 3 No 4
therapy and
tablets Smoke Emergency use only 16
32 Nebulizer Yes Cura No Yes 4

therapy and ble
Tablets Dust Emergency use only 18
33 BAI Yes Cura No Yes 5

Pets ble Cost 21
34 Tablets Yes Cura Yes 2 No 4
Smoke ble Cost 26
therapy and ble
tablets Dust Cost 16

therapy and ble
37 Nebulizer Yes Cura Yes 2 No 4

therapy and ble
38 MDI Yes Cura Yes 2 No 7

Smoke ble Emergency use only 19
39 BAI Nil Cura Nil 2 No 6
Exercise ble 18
Social stigma
40 BAI Nil Cura Nil No 4
Pets ble Cost 21
therapy and ble
Tablets Smoke Cost 19
42 BAI Yes Cura No Yes 7

Dust ble Cost 24
44 MDI No Cura Yes No 4
45 Nebulizer Yes Fatal No 3 Yes 5
therapy and
Tablets Smoke Emergency use only 18
46 MDI No Cura Yes No 5

47 BAI No Cura No 2 No 7
Smoke ble Fear of side effects 21
48 MDI Nil Cura Nil No 7
Exercise ble Fear of side effects 19
therapy and ble
50 BAI Yes Cura Yes Yes 5

therapy and ble

therapy and ble
tablets Dust Emergency use only 24

therapy and ble
55 Tablets Nil Cura Nil No 5

56 DPI, Nebulizer Yes Cura No 2 Yes 6
therapy and ble

therapy and ble
tablets Pets Cost 18
58 BAI Yes Fatal Yes 3 Yes 5

Dust Fear of side effects 21
therapy and ble
60 Tablets Yes Cura No 2 No 7

61 BAI Yes Cura No 2 No 4
Smoke ble Cost 16
63 Nebulizer Nil Cura Nil 2 No 7
therapy and ble
64 BAI No Cura No 2 No 5
Dust ble Cost 21
Smoke ble 19
Social stigma
therapy and ble
tablets Pets 24
Social stigma
67 Nebulizer Yes Cura No No 7
therapy and ble

therapy and ble
69 DPI, Nebulizer Yes Cura No No 4

therapy and ble
tablets Exercise Emergency use only 18
70 DPI, Nebulizer No Cura Yes 2 No 4

therapy and ble
tablets Dust Fear of side effects 21
71 Tablets No Cura Yes No 5

Pets ble Fear of side effects 21
72 Tablets No Cura Yes 2 No 5
therapy and ble
74 Tablets Yes Fatal No 3 Yes 6

Dust Cost 18
75 Tablets Nil Cura Nil No 4
Smoke ble Cost 21
76 DPI, Nebulizer No Cura No No 4
therapy and ble

therapy and ble

80 DPI, Nebulizer Yes Cura Yes 2 Yes 5
therapy and ble
81 Tablets Yes Cura Yes Yes 4

Pets ble Fear of side effects 21
82 Nebulizer Yes Cura Yes No 4
therapy and ble

Smoke ble Cost 21
ble
Dust Cost 19

therapy and ble
86 Tablets Yes Cura No 2 Yes 4

Pets ble Emergency use only 18
Smoke ble Cost 19
89 Nebulizer Yes Fatal Yes 3 No 5
therapy and

ble
Dust Emergency use only 26

ble
Dust Cost 16

therapy and ble
tablets Exercise Fear of side effects 21

Dust ble Cost 19
95 Nebulizer Yes Fatal No 3 Yes 5
therapy and

Dust ble Cost 16
Dust ble Cost 18
therapy and ble
10 Nebulizer No Cura Yes No 4

0 therapy and ble

1 therapy and ble
10 Tablets No Cura No 2 No 7
2 Dust ble Cost 24
3 therapy and ble

4 Exercise ble Cost 16
5 Dust ble Cost 18
6 therapy and ble

7 Dust ble Cost 18
8 therapy and ble

9 therapy and ble
tablets Dust 19
Social stigma
0 therapy and ble
1 therapy and ble

2 therapy and ble
11 DPI, Nebulizer Yes Cura No Yes 4

3 therapy and ble

4 therapy and ble

5 Dust ble Cost 26
6 therapy and ble

7 therapy and ble
11 DPI, Nebulizer Yes Fatal Yes 3 Yes 4

8 therapy and

9 therapy and ble

0 therapy and ble

1 therapy and ble

2 therapy and ble

3 therapy and ble

4 therapy and ble

5 therapy and ble

6 therapy and ble

7 therapy and ble
tablets Exercise 21
Social stigma
8 therapy and ble

9 therapy and ble

0 therapy and ble
13 DPI, Nebulizer Yes Cura No Yes 4

1 therapy and ble
13 DPI, Nebulizer Yes Fatal No 3 Yes 4

2 therapy and
3 therapy and ble
13 Nebulizer No Cura Yes No 4

4 therapy and ble

5 therapy and ble

6 therapy and ble
tablets Exercise 26
Social stigma
13 MDI Yes Cura No Yes 5
7 Dust ble 16
Social stigma
13 DPI, Nebulizer No Cura Yes No 5
8 therapy and ble

9 therapy and
14 MDI Yes Cura No No 5

0 Smoke ble Fear of side effects 18
1 therapy and ble

2 therapy and ble

3 therapy and ble
Tablets Smoke Emergency use only 24

4 therapy and ble

5 therapy and ble

6 therapy and ble

7 therapy and ble
tablets Exercise Fear of side effects 24

8 therapy and
14 DPI, Nebulizer Yes Fatal No 3 Yes 5

9 therapy and

0 therapy and ble

Thesis - Dr. Francis Ankitha 08.02.23-1

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Thesis - Dr. Francis Ankitha 08.02.23-1

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ASSESSMENT OF KNOWLEDGE AND ATTITUDE OF

ASTHMATIC PATIENTS AND THEIR CARE GIVERS

Dr. Francis Ankita

In partial fulfillment of the requirement for the degree of

SREE BALAJI MEDICAL COLLEGE & HOSPITAL

I hereby declare that this dissertation entitled “Assessment of knowledge

Date: Signature of the candidate

Place: Dr. Francis Ankita

This is to certify that this dissertation entitled “Assessment of knowledge

disease using an Asthma Knowledge Questionnaire in a tertiary care

hospital in Chennai” is a bonafide research work carried out by Dr. Francis

Ankita in partial fulfillment of the requirement for the degree of

M.D in Respiratory Medicine.

Date: Signature of the Guide

Dr. Ghanshyam Verma

This is to certify that this dissertation entitled “ASSESSMENT OF KNOWLEDGE

AND ATTITUDE OF ASTHMATIC PATIENTS AND THEIR CARE GIVERS

REGARDING THE DISEASE USING AN ASTHMA KNOWLEDGE

QUESTIONNAIRE IN A TERTIARY CARE HOSPITAL IN CHENNAI” is a

requirement for the degree of M.D in Respiratory Medicine.

Date: Signature of the Co-guide

This is to certify that this dissertation entitled “ASSESSMENT OF

SEAL AND SIGNATURE OF SEAL AND SIGNATURE HEAD

DECLARATION BY THE CANDIDATE

I hereby declare that the Bharath Institute of Higher Education and

this thesis in print or electronic format for academic / research purposes.

Date: Signature of the Candidate

I express my deep sense of gratitude to my guide and teacher, Dr.

GHANSHYAM VERMA Professor and Head of the Department who helped

My special thanks to DR JAYAMOL REVENDRAN, Co-guide who has

constantly supported and guided me for the completion of my thesis.

I express my utmost gratitude to my Dean DR. JOHNSON for providing

me an opportunity to conduct this study. I also express my sincere thanks to the

I'm also thankful to my professor Dr. RAJA AMARNATH.G, Dr O.R

Krishnarajasekhar my associate professor Dr.Harish.M, my Assistant

Professors Dr.Sreenivasan, Dr.Rajasekharam.G, Dr.Sabarinath.R, Dr

Mohanakrishnan, Dr Jayamol, DR.Jince and my Senior Residents Dr. Rowhit

Y, Dr Ashwin Kailash, Dr Sahana MK for their valuable suggestions.

I thank my parents FRANCIS K.L and BEENA FRANCIS for their

constant support throughout my PG period.

I thank my Seniors Dr. Aravind, Dr. Saravanan MC for their constant

Pavithra, Dr. Akhhil, Dr. Raagavi, Dr. Keerthana, Dr. Mounika.

whom this study would not have been possible.

blessings on me and my family.

DR. FRANCIS ANKITA

S.No Chapters Page No.

3 AIM & OBJECTIVES OF THE 46

Asthma is a major non- communicable disease which affects both children

estimated to be affecting 300 million individuals globally with increasing

prevalence in developing countries associated with increasing cost of treatment

productivity, seriously affects children, disrupts family which turn contributes to

an unacceptable burden on health care system and results in higher mortality

especially among children.

Asthma, defined by GINA (Global Initiative for Asthma) as a heterogenous

disease is usually characterized by chronic airway inflammation. It is defined by

the history of respiratory symptoms, such as wheeze, shortness of breath, chest

expiratory airflow limitation. Airflow limitation may later become persistent.

The clinical phenotypes of asthma are recognizable clusters of

demographic, clinical and/or pathophysiological characteristics. Some of the

most common phenotypes are

1. Allergic asthma: This category is easily recognized phenotype and it

begins in childhood. It is associated with a past and/ or family history

of allergic disorder such as eczema, allergic rhinitis, food or drug