Predictors of asthma severity during the pilgrimage to Mecca (Hajj)

The annual pilgrimage to Mecca (Hajj) is one of the largest gatherings in the world and thus its participants are exposed to various communicable and noncommunicable diseases. This provides an opportunity to study travel epidemiology.

The aim of the study was to estimate the predictors of asthma severity during the Hajj.

The study cohort was recruited from patients who presented to the emergency department (ED) of the King Abdul Aziz Hospital, Mecca, Saudi Arabia, between December 3 and 18, 2008 (5-20 Dhul-Hijjah 1429 H). We included newly diagnosed and previously documented cases presenting with asthma symptoms. Sociodemographic and clinical data were collected and the risk factors were assessed. The severity of asthma exacerbation was measured according to the National Heart, Lung, and Blood Institute guidelines. Data were analyzed using the SPSS software.

The study involved 58 subjects, including 38 women (65.5%). There were 27 subjects (46.6%) with mild asthma attack, 18 (31%) with moderate asthma attack, and no cases with life-threatening asthma. Insignificantly increased risk of severe asthma attack was observed in the following groups: women, people aged 46-60 years, pilgrims (hajis) who did not belong to a hajj group, non-hajis, illiterates, and nonsmokers - the odds ratio (OR) (95% confidence interval [CI]) was 3.7 (0.7-18.5), 1.7 (0.5-6.3), 2.4 (0.7-8.5), 5.1 (0.6-44.1), 2.3 (0.7-9.1), and 2.0 (0.4-10.4), respectively. Forty-six subjects (79.3%) had a history of allergy to components of smoke, detergents, dust, animal dander, and perfumes, while only 5 patients (8.6%) had drug allergy. High risk of severe asthma was observed in subjects with a history of drug allergy, as well as in obese subjects and those who often presented to the ED - OR (95% CI) was 6.5 (0.9-43.9), 18.0 (4.0-80.7), and 3.1 (0.8-11.5), respectively.

Higher risk of severe asthma attack was observed in women, people aged 46-60 years, hajis who did not belong to a hajj group, non-hajis, illiterates, nonsmokers, obese patients, and those who often presented to the ED within the previous 12 months due to asthma exacerbation.