bangalore and bronchial asthma : an environmental …

108 Medicine : Ethics and Practice

BANGALORE AND BRONCHIAL ASTHMA : AN ENVIRONMENTAL AND POPULATION SURVEY

Bangalore City with its salubrious climate has been acclaimed to be the fastest growing city in the World and has also earned the dubious distinction of being the birthplace of ‘bronchial asthma’. In order to confirm the cause/causes as well as establish the authenticity of the high prevalence of bronchial asthma in Bangalore, a detailed and systematic analysis of environmental factors and door to door statistical survey has been undertaken in the city.

Atmospheric pollen and fungal spores were collected from the flat roofs of buildings (8 to 20 mts. height) at six different places in the city. The technique for preparing, e x p o s i n g a n d c o u n t i n g pollen grains and spores was essentially the same as recommended by the pollen

survey committee of the American Academy of Allergy (Durham, et al., 1946). The slides were exposed and examined daily for two full consecutive years and a pollen calendar was established.

A total number of 74 types of air borne pollen and 113 species of spores were identified in all. The maximum quantity of air borne pollen have come from weeds followed by trees and grass pollens. The highest

A Report by Dr.V. Parameshvara, Secretary, Asthma Research Society Bangalore. Paper presented at the 40th Annual Conference of Association of Physicians of India,

Bangalore, 1985.

Bangalore & Bronchial Asthma 109

amount of grass pollen, was collected in September and October, while pollen of trees and weeds were found throughout the year. The pollen of parthenium was the highest (41%) followed by grass pollen (28%) and cassia species (11%). The weed pollen were more in the months of June and July. There were two seasons for the trees to bloom: (a) April to June and (b) October to December. The grasses grew throughout the year. The highest number of pollen from all the categories were collected in July and were lowest in January.

The dominant types of spores collected in different areas were predominantly cladosporium (49 to 85%), aspergillus - penicillin (2 to 8%), alternaria (2 to 7%) and curvilon and heminthosporium (1.45%). Cladosporium were found

abundantly from April to July, lowest in December, spores of aspergillus-penicillin were found throughout the year and were highest from March to May while that of alternarie was less in December to January and high in May and June. The fungal spores consistently increased from January to July.

The data of temperature, rainfall, wind speed and relative humidity have also been collected in the respective years. Sudden rise in the speed of wind from April to June had helped in distributing the pollen. Similarly higher the percentage of humidity, more was the pollen collected. The


spore content was low during August to December when the rain fall was mostly heavy.

A Survey to determine the prevalence of bronchial asthma was undertaken simultaneously in respective areas by door to door approach. Accordingly, 1,47,805 persons belonging to 27, 223 houses (average number 5.4) were surveyed during the same calendar years and a total number of 1940 asthmatics were identified (men : women = 1044 : 896)—a prevalence rate of 1.31%. Of these 730 (37.63%) reported they would get relief from the disease when they went out of Bangalore. Housewives (37.01%) and office boys (40.31%) were more susceptible than industrial workers (7.11%) and retired persons. The greater percentage (40%) of attacks occurred during winter followed by the rainy season (20%). 30.27% gave a family history of asthma or allergic disorders. Greatest number of attacks occurred at night (31.15%) and 21.5% had continuous wheeze.

A unique combination of temperature, humidity and wide variations in temperature seems to contribute to the higher prevalence of bronchial asthma in Bangalore.

Results and DiscussionAfter the discovery of aeroallergens and their association with some

respiratory disorders in the late 1800’s little technological advancement in colle ction techniques was made until 1940’s, when Dur ham and others conducted detailed studies of pollen grain densities, fall out rates, air sample volume tric analysis. Sophisticated continuous volumetric samplers were developed in the 1950’s and 1960’s. Two basic phenomena of the sampling of large number of organic micro particles, which are related to the effective clinical utilization of these data by the allergist were recognized.

First, the greater the number of microparticles counted, the greater


probability that more types of pollen and spores will be identified. The more types recognized in each sample, the more likely that representatives of most of the aeroallergens present during any collection period had been captured by the air sampler. Second, the greater the range of particle sizes collected, the higher the probability that the machine was collecting materials capable of penetrating the level of the respiratory tract from where an allergenic response can be clinically recognized. In attempting to collect the greatest number of clinically significant particles, the allergist is tempted to sample for extended periods of time.

After a comparative study of the sampling characteristics of the Durham, Rotorod, Rotoslide and Anderson samplers for atmospheric pollen and spores or Batcheldor of Pollen Research Associates Inc., California recommends the use of the Rotorod aeroallergen collector with retractable collecting rod head and rain cover. Its advantages include its small size (8" x 8" x 10"), relatively low cost ($ 230.00) and availability on short notice. Most important is its collection efficiency and practicality for the palynologist and allergist.

The next point is regarding the height at which sampling should be done. Recently, daily observations on aerial pollen at Nagpur for one year at the heights of 1 metre, 15 metres and 40 metres, showed that their number decreased with the increase in height. The following table from the pollen calender of Nagpur gives support to this statement (Deshpande and Chitaley, 1976).

Pollen Class

(1) Grasses 24.7 34.5 40.8

(2) Weeds 32.5 26.0 19.5

1m h

eigh

t %

of p

olle

n

15 m

hei

ght

% o

f pol

len

40

m h

eigh

t %

of p

olle

n


(3) Trees 30.0 31.0 27.0

In the present study traps were placed from 8 m height buildings to 20 m height buildings in diffe rent places. The maximum amount as well as diverse types of pollen and fungal spores were colle cted, however, from the roof of Indian Institute of Science Library building which is about 20m height.

The pollen calender for 1976-1978 from 10 different places shows that pollen grains were present all the year round in the Bangalore “atmosphere. All the identified pollen types could be attributed to the local plants. The number and percentage of the dominant pollen types have been tabulated. (Table 2)

Table 2

Number & Percentage of Dominant Pollen of Bangalore City

From 14-7-1976 to 13-7-1977

No. Plant G.S.C. I.I.Sc. Cantonment Rajajinagar Indiranagar Basavangudi Species Number % Number % Number % Number % Number % Number %

1. Cassia species 1,395 (19.91) 1,426 (15.05) 448 (16 38) 1,584 (22.50) 424 (7.15) 116 (6.87)

2. Parthenium

Month Grasses Weeds Trees Unidentified Total A n n u a l percentage July 38 328 163 15 544 9.7 August 82 185 136 11 414 7.4 September 212 201 226 2 641 11.4 October 128 223 182 7 540 9.7 November 81 219 174 6 480 8.5 December 65 215 185 6 471 8.4 January 73 157 149 5 384 6.8 February 46 218 177 6 447 8.0 March 53 185 202 5 445 8.0 April 25 193 159 3 380 6.7 May 29 235 185 7 456 8.2 June 24 205 162 7 398 7.2 Total : 856 2,564 2,100 80 5,600 100

Table showing the average seasonal and monthly pollen count per cover slip area ( 1976-77)

Table 3


Table 4 Table Showing the Average Seasonal and Monthly Pollen Count Per Cover Slip Area (1977-

Months Grass Weeds Trees Uuidentified Total

1. August 62 237 125 36 463

2. September 92 134 86 23 335

3. Ootober 91 161 118 6 376

4. November 85 140 153 3 381

5. December 59 158 114 2 333

6. January 55 107 72 5 240

7. February 93 102 91 6 292

8. March 99 321 86 1 507

9. April 46 259 119 15 439

10. May 104 236 148 19 507

11. June 111 639 156 15 1,921

12. July 93 848 88 8 1,037

TOTAL 990 3,342 1,356 140 5,828

Grasses Trees Weeds

Jayanagar 795 934 1,504 23.685% 27.98% 44.83%

Indian Institute of Science 1,274 2,242 2,274 21.56% 37.95% 38.49%

Good Shepherd Convent 867 1,417 1,937 19.85% 32.45% 44.36%

Vijayanagar 1,032 1,106 8,803 9.33% 10.00% 79.62%

Chamarajpet 914 1,121 1,951 22.71% 27.86% 48.49%

Table 5 Table showing the number and percentage of Grasses, Trees and Weeds (1977-78)


Table 6 A Comparative Chart showing the Percentage of Grasses, Trees and Weeds Pollen from Calcutta, Nagpur and Bangalore

Calcutta Nagpur Bangalore

1976-77 1977-78

Grasses 30.0% 33.3% 17.51% 17.00% Trees 34.5% 29.3% 37.50% 23.76% Weeds 26.5% 26.0% 44.80% 57.38%

Allergenically significant.

No. Fungus Species G.S.C. I.I.Sc. Cantonment Rajajinagar Indiranagar Basavangudi

TABLE 8 (1976-77)

Table showing the number and percentage of dominant fungal spores from all the 6 Units (1976-77)

Months Alternaria Helminthosporium Cladosporium Aspergillus Penicillium Curvularia Smut spores

July 115 32 200 148 24 10

August 54 20 263 56 12 6

September 54 47 176 91 18 38

October 61 35 117 86 22 6

November 42 19 72 16 15 1

December 37 24 78 22 17 2

January 20 24 90 19 51 2

February 35 37 206 87 20 5

March 47 36 244 168 26 28

April 96 43 290 194 38 26

May 94 44 307 171 35 13

June 102 44 259 177 39 4

TOTAL 757 405 2,402 1,235 317 141

SPORES

TABLE 7 (1976-77)

Table showing the Average monthly spore count per cover slip area :


Coming to the effect of wind speed on the air-spora, the pollen and spore counts were less when the wind speed was high and vice versa.

Survey of Asthma CasesFrom July 1976 to July 1977, a total number of 54,238 persons had

been surveyed for asthma cases. The areas where the survey work carried out and the number of persons surveyed in those areas have been given below.

Area Number of Number of houses covered persons covered

1. Basavangudi 1,903 12423

2. Majestic and surrounding areas 2,452 13089

3. Gandhinagar 667 3,594

4. Rajajinagar 2,093 12,202

About 600 Asthmatics have been indentified. The percentage of Asthmatics being 1.1%. This tallies with the statistical data reported for New Delhi (0.98%), Patna rural (2.70%) and Patna urban 1.6%. Thus the incidence of asthma is not high as it was thought earlier. But the interesting finding is that about 37% of Asthmatics get complete relief if they leave Bangalore.

Survey Data of Asthma Cases in Bangalore During 1976–77

1. Number of persons covered 54,2382. Number of houses covered 9,8063. Number of Asthma cases 6074. Percentage of Asthmatics in the

above population 1.12%5. Number of patients who get relief

outside Bangalore 2256. Percentage of Asthmatics who get

relief outside Bangalore 37%


From August 1977 to August 1978 a total number of 7,417 houses were surveyed for asthma cases, the number of cases surveyed being 93,567 and the total number of asthmatics being 1.42% The areas surveyed, and the number of persons covered in each area given below.

Area No. of persons covered1. Vijayanagar* 14,2282. Richmond & Austin Town 8,888

3. Cox Town 11,5204. Thyagarajnagar 11,9685. Chamarajpet* 3,4676. Jayanagar* 21,0027. Vasanthanagar 2,7998. Wilsongarden 10,8319. Yeshwanthapur 9,254 Grand Total 93,567

The

* in

dica

tes

the

plac

es

whe

re a

ir sp

ora

has

been

an

alys

ed.

Consolidated Results of the Asthmatics Survey Conducted During 1976-77 and 1977-78

1976-77 1977-78 Total

Total number of houses covered 9,806 17,417 27,223

Total number of persons covered 54,238 93,567 1,47,805

Number of persons in each house 5.5 5.4 5.42

Total number of Asthmatics found 607 1,333 1,940

Percentage of Asthmatics 1.12 1.42 1.31

Number of patients who get relief when they go out of Bangalore 225 505 730

Percentage of Asthmatics who get relief when they go out of Bangalore 37.06 37.88 37.63


Cymbopogon flexosus Cyanodon dactylon

Parthemum hysterophorus Cassia marginata

Cassia occidentalis Amaranthus spinosus


Pithecelobium dulce Tecoma stans

Peltophorum pterocarpum Albizzia species

Cyperus KyllingaCyperaceae


Datura metel Acacia species

Croton bonplandianum Lagascea mollis

Solanum species Kigelia pinnata


Bauhinia species Tabebuia species

Tridax Procumbens Millingtonia hortensis

Allamanda Cathartica Alternaria


Pyricularia Curvularia

Aspergillus penicillium Bispora

Alternaria CladosporiumFusarium


Bibliography

Agarwal, M.K., Shivpuri, D.N. and Mukerji, K.G. 1969. Studies on the allergenic fungal spores of the Delhi, India, metropolitan area. J. Allergy 44 : 193-203.

Agarwal, M.K. and Shivpuri, D.N. 1974, Fungal spores – their role in respiratory allergy. Advances in pollen–spore Research 1 : 78-128.

Alemony Vall, R. 1955, Sintesis Medica, Wasserman, Barcelona pp. 439.

Barat, R. (1969), A study on microbial population in air. D. Phil. Thesis, Universuty of Calcutta.

Barat, R. and Das, A.C. (1963), Ann. Biochem. Exp. Med. 23 : 461.

Bernton, A. S. and Thom, C. (1937) J. Allergs 8 : 363.

Blackley, C. H. 1973, Hay fever : Its causes, treatment and effective prevention: Experimental researches. London.

Cadham, F. T. 1924, Asthma due to grain rusts. J. A. M. A. 83: 27.

Chakravarty, R. 1974, Fungi in air and human allergy. J. Science Club 28: 83-106.

Chanda, S and Sarkar, P. K. 1972 , Pollen grains as a causative agent for respiratory allergy with reference to aeropalynology of Greater Calcutta. Trans. Rose Res. Inst· 35: 61-67.

Chaubal, P. D. and Deodikar, G. B. 1964, Airborne spores around Poona. J. Poona Univ. 26: 123-136.

Chitaley, S. D. and Bajaj (1973, 1974, 1975) C.f. in, Abstracts of the IV International Palynological Conference, Lucknow-1977.

Cobe, H. M. 1932, J. Allergy 3: 339.

Cunningbam, D. D. 1873, Microscopic examination of air. Government Printers, Calcutta 58 pp.

Deshpande, S. U. and Chitaley, S. D. 1976, Pollen calendar of Nagpur,


India. Rev. Palaeobot. Palynol. 21: 253--262.

Dobell, C. 1932, Antony Van Leuwenhoek and his little animals Bale and Danielsson London.

Dransfield, M. 1966, Trans. Br. Mycol. Soc. 49 : 121.

Durham, O. C. (1937), J. Allergy 8 : 480.

Durham, O. C. 1938, J. Allergy 9 : 40.

Durham, O. C. 1946 , The volumetric incidence of atmospheric allergens. J. Allergy 17 : 178–180.

Durham, O. C., Black and Walzer, M. 1946, Preliminary report of the National pollen Survey Committee of the American Academy of Allergy on proposed standardization of pollen counting techniques. J and Allergy 17, 178-180.

Feinberg, S. M. (1939), Arch. Dermat. Syph., 40 : 200.

Ganesan, R and Raghavan, R. 1960, Studies in aeropalynology at Annamalainagar (S. India). Proc. 47th Indian Sci. Congr. Assoc. pp. 350.

Gregory, P. H. 1952, Possible role of basidiospores as air borne allergens. Nature 170 : 414

Hansen, K. 1928, On Mold Asthma. Verhandle Deutsch Gesellch. Inn. Med. 40: 204.

Harris, L. A. 1939, J. Allergy 10: 433.

Hirst, J. J. et al 1955 c. f. in Gregory, P. H., The microbiology of the atmosphere, New York, Inter Science Publishers Inc.

Hopkins, J. G., Benham, R. W. and Kesten, B. M. (1930), J. A. M. A. 94 : 6.

Hyde, H. A. 1969, Aeropa1yno1ogy in Britain-an outline. New Phytol. 68: 579-590.

Indian Council of Medical Research, New Delhi, 1961, Morbidity Survey of Contributary health scheme beneficiaries.

Jaggi, O. P. 1975, Asthma and other allergies. Orient Longman, Delhi.


Kalra, S. L. and Dumbrey, D. G. 1957, Aerobiology of army medical campus, Poona Part I: Pollen, Spores ana Mites. Armed Forces Med. J. (Ind.) 13: 3–16.

Kantor, C. L. 1966, Asthma and other allergies by O. P. Jaggi, Orient Longman (1975).

Karnik, C. K. 1962, A contribution to the rain water forms and air spora of Jalgaon District. Sci. and Gult. 28 : 475–476.

Kasliwal, R. M. Sethi, J. P. and Sogani, I. C. 1959, Studies in atmospheric Poilen : A daily census of pollens of Jaipur 1957–1958. Ind. Jour. Med. Res. 47 : 515–521.

Kern, R. A. (1962), Arch: Environ. Health, 4: 28.

Lakhanpal, R.N. and Nari, P.K.K. 1958, Survey of the atomospheric pollen at Lucknow J. Sci. Ind. Res. 17 : 80–87.

Lakhanpal, R.N. and Nair, P.K.K. 1960, Survey of the atmospheric pollen at Almora. J. Sci. Ind. Res. 19 : 51–53.

Liebeskind, A. (1965), Ann. Allergy 23 : 158.

Nair, P.K.K. 1963, An analysis of atmospheric pollen, fungal spores and other vegetable matter at Vellore, Madras State. Ind. Jour. Med. Res. 51 : 447.

Nilsby, I. 1949, Allergy to molds in Sweden–a botanical and clinical study. Acta Allergol. 2 : 57.

Pady, S.M., Kramer, C.L. and Wiley, B.J. 1962, Mycologia 54 : 168.

Pasteur, L. (1861), Ann. Sci. NAT (Zool) 16 : 5.

Rajan, B.S.V., Nigam, S.A. and Shukla, 1952. A study of the atmospheric fungal flora at Kanpur. Proc. Ind. Acad. Sci. B. 35 : 33-37.

Ramalingam, A. 1966. Indian Phytopath. 19 : 76-81.

Ramalingam, A. (1971), Proc. Indian Acad. Sci. 74 : 227.

Reddy, S.C. 1970 IN : Sreeramulu, T. 1970. Airspora of the crop fields and its applications. J. Palynol 6 : 31-38.

Reddy, S. C. 1974, A study of potentially allergic pollen producing plants of Vishakapatnam. J. Palynol. 10 : 155-157.


M. 1956. Br. Mycol. Soc., 39 : 431.

Robin, C. (1871), Traite du microscope, Paris.

Roth, A. (1966), Ann. Allergy. 24: 73.

Saha, J.C. and Kalyanasundaram, S. 1962. Studies on pollen allergy in Pondicherry Part I. Survey of potentially allergenic plants. Ind. J. Med. Res. 50 : 881-888.

Sandhu, D. K. Shivapuri, D.N. and Sandhu, R.S. 1964. Studies on the airborne fungal spores in Delhi–their role in respiratory allergy. Ann. Allergy 22: 374.

Schenck, N.C. (1968), Phytopathol. 58 : 91.

Shivpuri, D.N. Viswanathan, R. and Dua, K.L. 1960. Studies in pollen allergy in Delhi area Part I: Pollination calendar. Ind. Jour. Res. 48: 15–20.

Shivpuri, D.N. Dua, K.L. and Subramanian, T.A.V. 1963. Studies in pollen allergy in Delhi area Part III. Ind. Jour. Med. Res. 51 : Med. 64-67.

Shivpuri, D.N. and Singh, M.P. 1965. On etiologic diagnosis of offending allergens in 200 patients of bronchial asthma and allergic colds. J. Palynol. 1: 90–96.

Sreerarnulu, T. (1959), Trans. Br. Mycol. Soc. 42 ; 177.

Sreerarnulu, T. and Ramalingam, A. 1966. A two year study of the air-spora of a paddy field near Visakapatnam. Indian J. Agri Sci. 36: 111–132.

Sreeramulu, T. and Seshavataram, V. (1962). Indian Phytopathol. 15: 61.

Tilak, S.T. and Kulkarni, R.L. 1970. A new air sampler Experentia 26: 441–443.

Tilak, S.T. and Shrinivasulu, B.V. 1967. Air-spora of Aurangabad. Indian J. Microbiol. 7: 167–169.

Tilak, S.T. and Shrinivasulu, B.V. 1971. Air-spora of Aurangabad -


Ascospores. Ind. Phytopath. 24 : 740-743.

Tyndall, J. (1881). Essays on the floating matter on the air in relation to putrefaction and infection. Longmans, London.

Van Leeuwen, W.S. 1924. Bronchial asthma in relation to climate. Proc. Roy. Soc. Med. 17: 19.

Vaughan, W.T. and Black, J.H. 1954. Practice of allergy. Henry Kimton London.

Viswanathan, R. 1946. Definition, incidence, aetiology and natural history of asthma. Ind. J. Chest. Dis. 6 : 109–124.

Viswanathan, R. Mody, R.K. Prasad, S.S. and Sinha, S.P. 1965. Bronchial asthma and chronic bronchitis. J. Ind. Med. Assoc. 45: 480.

Wig, K.L. and Gularia, J.S. 1961. Respiratory allergy–A symposium p. 9 Asia Publishing House, New Delhi.

Asthma Research Society 1. Prof. B.R. Seshachar President

Centre for Theoretical Studies Indian Institute of Science, Bangalore -560 012.

2. Dr.V. Parameshwara Secretary Consulting Physician and Cardiologist No. 45 Race Course Road Bangalore - 560 002.

3. Prof. T. Ramakrishnan Chairman Microbiology & Cell Biology Laboratory Indian Institute of Science, Bangalore - 560 012.

4. Prof. H. Sharat Chandra Member Microbiology & Cell Biology Laboratory Indian Institute of Science, Bangalore - 560 012.

5. Dr. M. Sirsi Member Microbiology and Cell Biology Laboratory Indian Institute of Science, Bangalore - 560 012.

6. Dr. B.V. Ramaswami Member


No. 20 Market Road Bangalore - 560 004.

7. Dr. T.B. Subba Rao Member Health Centre Indian Institute of Science, Bangalore - 560 012.

8. Dr. B.S. Subba Rao Member Health Centre Indian Institute of Science, Bangalore - 560 012.

9. Dr. (Mrs.) Nalini Dhawan Member Bungalow No. 5 Indian Institute of Science, Bangalore - 560 012.

10. Dr. Ramesh Maheshwari Member Department of Biochemistry Indian Institute of Science, Bangalore - 560 012.

Project Staff

bangalore and bronchial asthma : an environmental …

Documents