الفهرس 
AIR POLLUTIONOnly 14 pages are availabe for public view
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Abstract
Environmental effects upon human health are a major concern by researchers and scientists. One of those effects the increased environmental triggers that could promote some diseases such cancer or could trigger some unfavorable effects such as respiratory attacks in respiratory disease patients. One strategy of alleviating unfavorable effects of the environmental triggers is investigating biological biomarkers that could be used as a tool of prediction or estimation the unfavorable consequences of exposing to different environmental triggers.
This study investigated the previous strategy of searching for a possible biological biomarker that might have an association with the risk of hospitalization in asthmatic and chronic pulmonary obstructive disease. A predictive biomarker that might provide an estimation regarding the possibility of hospitalization is in need.
In Egypt, the prevalence of asthma in Egypt is about 7%, while the prevalence of chronic obstructive pulmonary disease is about 10% of population. There is a scarcity in scientific estimate for the economic cost of asthma and chronic Obstructive Pulmonary disease COPD disease burden in Egypt; however, the cost of medication and hospitalization for chronic obstructive pulmonary disease and asthmatic patients are clearly high. The estimate cost of managing mild asthma is about 2 billion Egyptian pound per year, this figure reflects a high economic burden as chronic Obstructive Pulmonary disease COPD share a lot of medication. This study evaluated if there is association between fibrinogen, c reactive protein and increased risk of hospitalization. As hospitalization for asthmatic and chronic Obstructive Pulmonary disease COPD patients exerts a lot of economical and phycological pressures on the patient and his family.
The study was observational case control study. The study recruited subjects at the outpatient clinic at the hospital during their regular visit for respiratory reasons and non-respiratory reasons to act as a control group. Asthmatic patients had been chosen according to The Guidelines of Global Initiative for Asthma and chronic Obstructive Pulmonary Disease patients had been selected and severity was categorized according to Global Initiative for Obstructive Lung Guideline, while the control group had been selected from the outpatients’ clinics counseling for non-respiratory reasons.
A Saint George Questionnaires of respiratory disease was used. The questionnaire included information about socio-economic status, age, exposure to risk factors such as tobacco smoke, inhaling for irritant or exposure to harmful occupational substance such as asbestos. Pulmonary function test was done for all subjects using spirometer. After that, a blood sample was done to assess of Fibrinogen, CRP.
Statistical analysis was performed using SPSS software V.20. Descriptive statistic used simple measures such as mean, median and standard deviation from sample population, while inferential statistics used independent sample t-test, and relationship test. Sample t-test used to compare means among group subjects. Relationship test used the correlation coefficient test to reveal the relation among variables and outcome. selected variables were c reactive protein and fibrinogen levels, while outcome was hospitalization. In addition, if the study had used a statistical significance model of ANOVA table, regression analysis, analysis of variance test (ANOVA) and ROC in order to investigate the significance of each variable, and to assess a possible cut off point for the suggested variables.
The study revealed that mean of fibrinogen among chronic Obstructive Pulmonary disease COPD group (583.24 mg/dL) was significantly higher than control (207 mg/dL), (P<0. 001). Mean of CRP (14.2 mg/L) was significantly higher than control (0.98 mg/L), (P<0.001). Mean of fibrinogen among asthmatic group (414.8 mg/dL) was significantly higher than control (207 mg/dL). Mean of CRP (10.2 mg/L) was significantly higher than control (0.98 mg/dL). Statistically significant inverse correlation was found between fibrinogen and ratio of Forced Expiratory Volume in the first second (FEV1) to full Forced Vital Capacity (FVC) this ratio is expressed as FEV% (r=-0.885). Also, an inverse correlation between CRP and FEV% (r=-.75). ROC analysis suggested cut score for fibrinogen at 445 mg/dL with 78.8% sensitivity and 27.3% specificity, 370 mg/dL with 71.4% sensitivity and 28% specificity of for chronic Obstructive Pulmonary disease COPD and asthmatic groups respectively, while CRP at 9.4 mg/L with 60% sensitivity and 22.7% specificity, 7.25 mg/L with 88% sensitivity and 29% specificity for chronic Obstructive Pulmonary disease COPD and asthmatic groups respectively. Regression analysis explained that 43% of causes for hospitalization might be for level variation of fibrinogen, CRP and decreased respiratory function.
In conclusion, the study revealed that increased levels of fibrinogen, c reactive protein and decreased pulmonary function might be associated to increased risk of hospitalization.
CONCLUSION
T
he study revealed interesting findings that might be useful. For example, c reactive protein levels and fibrinogen levels of chronic obstructive pulmonary diseases group and asthmatic group were significantly different from the control group. The correlation among fibrinogen and c reactive protein was moderate; however, a strong correlation was detected between the ration of forced expiratory volume and the forced vital capacity.
The ROC curve statistics suggested that if fibrinogen level is more than 445 mg/dl and c reactive protein is more than 9.4 mg/L there might be about 70%-75% chance for chronic obstructive pulmonary diseases patients of increased risk of hospitalized. Regarding asthmatic patients ROC curve statics suggested that if fibrinogen levels is more than 370 mg/dl and c reactive protein is more than 7.25 mg /L, there might be about 66%-75% chances of increased risk of hospitalization. This finding is supported by conducting linear equation statistics as the linear regression equation reveled that variation of fibrinogen and c reactive protein might be associated with increased risk of hospitalization by 43%.
In conclusion, the study revealed that the increased levels of c reactive protein and fibrinogen in asthmatic and chronic obstructive pulmonary diseases patients might be associated with increased risk of hospitalization and exacerbation risk. Therefore, those two inflammatory biomarkers might have a promising potential for a predictive biomarker.
Also the research brings the light the possibility of using advanced statistics to extract a possible evaluation for using inflammatory biomarkers as possible tool for investigating the risk of hospitalization for chronic obstructive pulmonary disease and asthmatic patients for possible respiratory attacks that might be triggered by possible environmental factors or environmental pollutants.