Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Asthma Exacerbation in Indonesia: Analysis of Mental, Socio-demographic, Behavioral, and Biological Risk Factors Using the 2018 Indonesian Basic Health Research

  • Siti Isfandari (Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency) ;
  • Sulistyowati Tuminah (Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency) ;
  • Laurentia Konadi Miharja (Research Center for Pre-Clinical and Clinical Medicine, Research Organization for Health, National Research and Innovation Agency)
  • Received : 2024.11.23
  • Accepted : 2024.12.16
  • Published : 2025.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: Asthma represents a significant global health burden, with exacerbations impacting quality of life. Although risk factors for asthma exacerbation (AE) have been identified, data specific to Indonesia remain scarce. We investigated risk factors for AE among Indonesian adolescents and adults. Methods: A cross-sectional analysis of the 2018 National Health Survey was conducted, including Indonesian participants aged 15 and older with diagnosed asthma. Logistic regression was employed to identify risk factors for AE. Results: A total respondents aged 15 years or older were 706 689 participants. The prevalence of asthma was 2.6% (18 574 participants). Among individuals with asthma, 59.7% experienced exacerbation, and 21.4% reported symptoms indicating emotional distress (ED). Both ED and diagnosed heart disease (DHD) were linked to increased odds of AE, with adjusted odds ratios (aORs) of 1.27 (95% confidence interval [CI], 1.18 to 1.37) and 1.21 (95% CI, 1.06 to 1.38), respectively. Being diagnosed with asthma at age 15 or older was associated with an aOR of 1.56 (95% CI, 1.45 to 1.66). Those with lower socioeconomic status (SES) also faced comparatively high risk (aOR, 1.37; 95% CI, 1.23 to 1.52). In contrast, physical activity was inversely related to AE (aOR, 0.72; 95% CI, 0.64 to 0.81). Conclusions: ED, DHD, lower SES, and later-onset asthma were identified as significant risk factors for AE. This underscores the need for comprehensive asthma management strategies that prioritize mental health, cardiovascular health, and early intervention. Addressing these factors could substantially reduce the burden of AE in Indonesia. Further longitudinal studies are necessary to elucidate the causal relationships involved and evaluate the effectiveness of targeted interventions.

Keywords

Acknowledgement

We would like to thank Lelyza Trisaid, who helped us in making the abstract infographics.

References

  1. Kuruvilla ME, Vanijcharoenkarn K, Shih JA, Lee FE. Epidemiology and risk factors for asthma. Respir Med 2019;149:16-22. https://doi.org/10.1016/j.rmed.2019.01.014
  2. Lawson JA, Janssen I, Bruner MW, Hossain A, Pickett W. Asthma incidence and risk factors in a national longitudinal sample of adolescent Canadians: a prospective cohort study. BMC Pulm Med 2014;14:51. https://doi.org/10.1186/1471-2466-14-51
  3. Castillo JR, Peters SP, Busse WW. Asthma exacerbations: pathogenesis, prevention, and treatment. J Allergy Clin Immunol Pract 2017;5(4):918-927. https://doi.org/10.1016/j.jaip.2017.05.001
  4. Kostakou E, Kaniaris E, Filiou E, Vasileiadis I, Katsaounou P, Tzortzaki E, et al. Acute severe asthma in adolescent and adult patients: current perspectives on assessment and management. J Clin Med 2019;8(9):1283. https://doi.org/10.3390/jcm8091283
  5. Cazzola M, Rogliani P, Ora J, Calzetta L, Matera MG. Asthma and comorbidities: recent advances. Pol Arch Intern Med 2022;132(4):16250. https://doi.org/10.20452/pamw.16250
  6. Rand CS, Wright RJ, Cabana MD, Foggs MB, Halterman JS, Olson L, et al. Mediators of asthma outcomes. J Allergy Clin Immunol 2012;129(3 Suppl):S136-S141. https://doi.org/10.1016/j.jaci.2011.12.987
  7. Zhang L, Zhang X, Zheng J, Wang L, Zhang HP, Wang L, et al. Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis. J Thorac Dis 2016;8(6):1257-1268. https://doi.org/10.21037/jtd.2016.04.68
  8. Triasih R, Setyowireni D, Nurani N, Setyati A. Prevalence, management, and risk factors of asthma among school-age children in Yogyakarta, Indonesia. J Asthma Allergy 2023;16:23-32. https://doi.org/10.2147/JAA.S392733
  9. Ministry of Health Republic Indonesia. The report of Indonesian National Health Survey 2018; 2019 [cited 2020 Sep 29] Available from: https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/Laporan%20Riskesdas%202018%20Nasional.pdf (Indonesian).
  10. Idaiani S, Indrawati L. Functional status in relation to depression among elderly individuals in Indonesia: a cross-sectional analysis of the Indonesian National Health Survey 2018 among elderly individuals. BMC Public Health 2021;21(1):2332. https://doi.org/10.1186/s12889-021-12260-z
  11. Beusenberg M, Orley J, World Health Organization. A user's guide to the self reporting questionnaire (SRQ); 1994 [cited 2015 Apr 23]. Available from: https://iris.who.int/handle/10665/61113
  12. Idaiani S, Suryaputri IY, Mubasyiroh R, Indrawati L, Darmayanti I. Validity of the self reporting questionnaire-20 for depression based on national health survey. Res Square [Preprint]. 2021 [cited 2022 Jan 12]. Available from: https://doi.org/10.21203/rs.3.rs-362342/v1
  13. Harbuwono DS, Pramono LA, Yunir E, Subekti I. Obesity and central obesity in Indonesia: evidence from a national health survey. Med J Indones 2018;27(2):114-120. https://doi.org/10.13181/mji.v27i2.1512
  14. Sohn KH, Song WJ, Park JS, Park HW, Kim TB, Park CS, et al. Risk factors for acute exacerbations in elderly asthma: what makes asthma in older adults distinctive? Allergy Asthma Immunol Res 2020;12(3):443-453. https://doi.org/10.4168/aair.2020.12.3.443
  15. de Roos EW, Lahousse L, Verhamme KM, Braunstahl GJ, In 't Veen JJ, Stricker BH, et al. Incidence and predictors of asthma exacerbations in middle-aged and older adults: the Rotterdam Study. ERJ Open Res 2021;7(3):00126-2021. https://doi.org/10.1183/23120541.00126-2021
  16. Al-Muhsen S, Horanieh N, Dulgom S, Aseri ZA, Vazquez-Tello A, Halwani R, et al. Poor asthma education and medication compliance are associated with increased emergency department visits by asthmatic children. Ann Thorac Med 2015;10(2):123-131. https://doi.org/10.4103/1817-1737.150735
  17. Evans A, Farewell D, Demmler J, Bandyopadhyay A, Powell CV, Paranjothy S. Association of asthma severity and educational attainment at age 6-7 years in a birth cohort: population-based record-linkage study. Thorax 2021;76(2):116-125. https://doi.org/10.1136/thoraxjnl-2020-215422
  18. Mazalovic K, Jacoud F, Dima AL, Van Ganse E, Nolin M, C D, et al. Asthma exacerbations and socio-economic status in French adults with persistent asthma: a prospective cohort study. J Asthma 2018;55(10):1043-1051. https://doi.org/10.1080/02770903.2017.1391280
  19. Busby J, Price D, Al-Lehebi R, Bosnic-Anticevich S, van Boven JF, Emmanuel B, et al. Impact of socioeconomic status on adult patients with asthma: a population-based cohort study from UK primary care. J Asthma Allergy 2021;14:1375-1388. https://doi.org/10.2147/JAA.S326213
  20. Jordan KA, Mackintosh KA, Davies GA, Griffiths CJ, Lewis PD, McNarry MA. Perceptions surrounding the possible interaction between physical activity, pollution and asthma in children and adolescents with and without asthma. BMC Public Health 2023;23(1):2416. https://doi.org/10.1186/s12889-023-17174-6
  21. Eijkemans M, Mommers M, Draaisma JM, Thijs C, Prins MH. Physical activity and asthma: a systematic review and metaanalysis. PLoS One 2012;7(12):e50775. https://doi.org/10.1371/journal.pone.0050775
  22. Panagiotou M, Koulouris NG, Rovina N. Physical activity: a missing link in asthma care. J Clin Med 2020;9(3):706. https://doi.org/10.3390/jcm9030706
  23. Dowdell EB, Posner MA, Hutchinson MK. Cigarette smoking and alcohol use among adolescents and young adults with asthma. Nurs Res Pract 2011;2011:503201. https://doi.org/10.1155/2011/503201
  24. Thomson NC, Chaudhuri R, Livingston E. Asthma and cigarette smoking. Eur Respir J 2004;24(5):822-833. https://doi.org/10.1183/09031936.04.00039004
  25. Foer D, Beeler PE, Cui J, Karlson EW, Bates DW, Cahill KN. Asthma exacerbations in patients with type 2 diabetes and asthma on glucagon-like peptide-1 receptor agonists. Am J Respir Crit Care Med 2021;203(7):831-840. https://doi.org/10.1164/rccm.202004-0993OC
  26. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol 2018;141(4):1169-1179. https://doi.org/10.1016/j.jaci.2018.02.004
  27. Castro M, Zimmermann NA, Crocker S, Bradley J, Leven C, Schechtman KB. Asthma intervention program prevents readmissions in high healthcare users. Am J Respir Crit Care Med 2003;168(9):1095-1099. https://doi.org/10.1164/rccm.200208-877OC