Pattern of Respiratory Diseases, Morbidities and Outcome in Patients Admitted in Respiratory Ward of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

ABSTRACT Introduction: Respiratory diseases are leading cause of morbidity and mortality worldwide imposing significant global health burden. The admission rate of patients is the indication of the overall workload in the ward. The aim of this study was to find the prevalence of admission of patients in the pulmonology ward among patients visiting pulmonology department of a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital. Medical records of all patients visiting pulmonology department and admitted in pulmonology ward from May 2018 to April 2020 were retrospectively reviewed. Data entry and analysis was done in SPSS version 20.0. Descriptive statistics were performed. Results: A total of 30,480 patients visited the pulmonology department in the two-year study period. Out of them, 1296 (4.25%) patients were admitted in the pulmonology ward. Eleven respiratory diseases were identified as primary causes for admission. Acute exacerbation of chronic obstructive pulmonary disease (44.5%), pneumonia (26.3%), tuberculosis (11%), lung cancer (5%) and bronchiectasis (3.9%) ranked top five causes for admission. Conclusions: Respiratory diseases impose tremendous burden in health care setting. Acute exacerbation of chronic obstructive pulmonary disease, pneumonia and tuberculosis remain an important cause of respiratory admissions in our study.


INTRODUCTION
Respiratory diseases constitute an important global health burden. Acute respiratory infections, pneumonia, tuberculosis, obstructive and restrictive lung diseases, pleural diseases, and malignancies are common respiratory conditions for hospital admission.
Chronic obstructive pulmonary disease (COPD), lower respiratory tract infections, lung cancer and tuberculosis have been identified as top four respiratory diseases among ten leading causes of death worldwide. 1 The forum of international respiratory societies (FIRS) estimated that 65 million people have moderate to severe COPD resulting in 3 million deaths per year, making it third leading cause of death worldwide. 2 Currently, asthma affects an estimated 334 million people worldwide and is projected to increase to 400 million by the year 2025. 3 In 2015, 10

METHODS
This is a descriptive cross-sectional study conducted in the department of Pulmonology at Tribhuvan University Teaching Hospital (TUTH), a tertiary referral center in Kathmandu, Nepal. Ethical approval was obtained from Institutional Review Committee, TUTH (Reference no. 158/ (6-11) E2/076/077). All patients admitted in pulmonology ward from May 2018 to April 2020 were included in the study. Medical records of all patients admitted in pulmonology ward of TUTH over the period of two years were retrospectively reviewed and information on demographic data, pattern of respiratory diseases among admitted patients, comorbidities, duration of hospital stay, and treatment outcome were retrieved. Treatment outcome was further categorized into discharge, intensive care unit (ICU) admission, leave against medical advice (LAMA) and mortality.
Data were extracted from in-hospital patient records. Data entry and analysis was done in Statistical Package for the Social Sciences (SPSS) version 20.0. Descriptive analysis was done.

RESULTS
A total of 30,480 patients visited the pulmonology department in the two-year study period. Out of them, 1296 (4.25%) patients were admitted in the pulmonology ward. Eleven respiratory diseases were identified as primary causes for admission in respiratory ward. Acute exacerbation of chronic obstructive pulmonary disease (COPD) was the most common condition for admission followed by pneumonia and tuberculosis (TB) respectively (Table 1).  Figure 1).

Figure 1. Age distribution of patients.
Nearly 55% of patients had one of the 13 co-morbidities. Acute kidney injury (AKI) was the most common comorbidity seen in 100 (7.7%) patients. Other common co-morbidities were cardiac disease in 95 (7.3%), diabetes mellitus in 93 (7.2%), hypertension in 78 (6%), anemia in 61 (4.7%) and post TB sequelae in 40 (3.1%) patients ( Figure 2). The mean duration of hospital stay was found to be 8.8±6.18 days with range from 3 to 33 days. The highest duration of hospital stay was seen in patients with pneumothorax which was 11.12±7.51 days while lowest for acute severe asthma with duration of 5.62±2.50 days.
More than 90% of patients (n=1196) admitted in respiratory ward got discharged. Fifteen (1.2%) patients left against medical advice (LAMA), 60 (4.6%) patients JNMA I VOL 58 I ISSUE 232 I DECEMBER 2020 deteriorated and required subsequent admission in intensive care unit (ICU) while 25 (1.9%) patients had in-hospital mortality. Out of total ICU admissions, the highest admission rate was 58.3% (n=35) seen in patients with acute COPD exacerbation. The highest mortality rate was also seen in COPD patients which accounted to 36% (n=9) of total in-hospital mortality ( Figure 3).

DISCUSSION
We found that 1296 patients with respiratory diseases were admitted in respiratory ward over two years. In a study done by Pokharel  Another distinct contrasting feature in our study as compared to others is the lower prevalence of asthma as seen in 0.8% patients. The differences in occurrence of diseases could be implicated to diverse geographic and environmental variations among these regions.
The higher prevalence of COPD in our study could be related to the upsurge in national prevalence of COPD in recent years. In a study on prevalence of selected non-communicable diseases in Nepal conducted by the Nepal Health Research Council (NHRC), COPD had the highest prevalence (11.7%) among noncommunicable diseases reported in the participants. 10 Tobacco smoking, indoor and outdoor air pollution are major contributing factors for higher prevalence of COPD in Nepal. Biomass fuel is used widely used across Nepal for cooking purposes in more than 87% of households in rural areas as compared to 52% in urban areas. 11 In 2016, the Global burden of disease study estimated the prevalence of COPD in Nepal as 4,810 per 1,00,000 which was accountable for 5.72% of all deaths. 12,13 A myriad of co-morbidities were found to be associated with respiratory diseases. More than 55% of patients had one of the 13 co-morbidities among which acute kidney injury was the most common co-morbidity seen in 7.7% patients followed by cardiac disease in 7.3%. On contrary, Kumar A et al 6

CONCLUSIONS
Respiratory diseases impose an immense burden in health care setting. COPD, pneumonia, tuberculosis, lung cancer and bronchiectasis remained top five causes of respiratory admissions in our study. This is a hospital-based study from a tertiary referral center in Nepal potentially serving as preliminary findings upon which future studies can be based.