Correlation of Respiratory Symptoms and Spirometric Lung Patterns in a Rural Community Setting, Sindh, Pakistan: a Cross Sectional Survey

Background: Symptom-based questionnaires can be a cost effective tool enabling identification and diagnosis of patients with respiratory illnesses in resource limited setting. This study aimed to determine the correlation of respiratory symptoms and spirometric lung patterns and validity of ATS respiratory questionnaire in a rural community setting.

Methods: This cross sectional survey was conducted between January - March 2009 on a sample of 200 adults selected from two villages of district Khairpur, Sindh, Pakistan. A modified version of the American thoracic society division of lung disease questionnaire was used to record the presence of respiratory symptoms. Predicted lung volumes i.e. forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and their ratio (FEV1/FVC) were recorded using portable spirometer.

Results: In the study sample there were 91 (45.5%) males and 109 (54.5%) females with overall mean age of 34 years (±11.69). Predominant respiratory symptom was phlegm (19%) followed by cough (17.5%), wheeze (14%) and dyspnea (10.5%). Prevalence of physician diagnosed and self-reported asthma was 5.5% and 9.5% respectively. Frequency of obstructive pattern on spirometry was 28.72% and that of restrictive pattern was 19.68%. After adjustment for age, gender, socioeconomic status, spoken dialect, education, smoking status, height, weight and arsenic in drinking water, FVC was significantly reduced for phlegm (OR 3.01; 95% CI: 1.14 - 7.94), wheeze (OR 7.22; 95% CI: 2.52 - 20.67) and shortness of breath (OR 4.91; 95% CI: 1.57 - 15.36); and FEV1 was significantly reduced for cough (OR 2.69; 95% CI: 1.12 - 6.43), phlegm (OR 3.01; 95% CI: 1.26 - 7.16) and wheeze (OR 10.77; 95% CI: 3.45 - 33.6). Presence of respiratory symptoms was significantly associated with restrictive and/or obstructive patterns after controlling for confounders. Similar findings were observed through linear regression where respiratory symptoms were found to be significantly associated with decrements in lung volumes. Specificity and positive predictive values were found to be higher for all the symptoms compared to sensitivity and negative predictive values.

Conclusion: Symptoms based respiratory questionnaires are a valuable tool for screening of respiratory symptoms in resource poor, rural community setting.