Epidemiological and Seasonal Patterns of Respiratory Diseases at a Community Health Facility in Garhwal Region, Pauri Garhwal, Uttarakhand: A Retrospective Study

Respiratory diseases are among the leading causes of morbidity and mortality globally as well as in India. According to the Global Burden of Disease (GBD) Study 2016, chronic respiratory diseases ranked among the top causes of disability-adjusted life years (DALYs) in India, contributing substantially to long-term morbidity and premature mortality. In the Indian healthcare system, diseases of the respiratory system constitute one of the largest disease burdens, accounting for approximately 15.3% of all prescriptions nationwide, reflecting high clinical demand in both outpatient and inpatient settings¹.

A major multicenter seasonal study from India, the Seasonal Variation of Respiratory Diseases (SWORD) study, conducted across 302 healthcare centers and involving over 25,000 patients, demonstrated that respiratory conditions such as asthma (~30%), chronic obstructive pulmonary disease (COPD, ~15.6%), respiratory tract infections (RTIs, ~11.3%), and tuberculosis (~8.7%) exhibit marked seasonal variation in outpatient attendance². The study highlighted that asthma cases peak during autumn and winter, COPD exacerbations are significantly higher in winter compared to summer, and RTIs show maximum prevalence during colder months, underscoring the strong influence of seasonal and climatic factors on respiratory morbidity³.

National mortality statistics further emphasize the seriousness of respiratory diseases in India. As per the National Statistical Office (NSO) report (2021–2022)⁴, respiratory infections accounted for nearly 78% of deaths due to communicable diseases, indicating their dominant contribution to infectious disease-related mortality. More recent health surveillance summaries and mortality trends extending into 2023 continue to show respiratory infections and chronic respiratory diseases as major contributors to hospital admissions and deaths, particularly among elderly populations and individuals with co-morbid conditions⁵.

The burden of chronic respiratory diseases has increased substantially over the last decade. Estimates based on GBD-2016 data suggested that nearly 45–50 million Indians were living with COPD⁶. Updated analyses and projections published between 2022 and 2023 indicate that this number has risen to approximately 55 million, making COPD the second leading cause of death in India, only after cardiovascular diseases. Asthma prevalence has also remained consistently high, affecting an estimated 30–35 million individuals, with significant underdiagnosis in rural and hilly regions⁷.

Multiple risk factors contribute to this growing respiratory disease burden in India. These include ambient air pollution, tobacco smoking, indoor air pollution from biomass fuel use, occupational dust exposure, and seasonal climatic variations⁸. Studies conducted between 2016 and 2023 have consistently demonstrated a strong association between elevated levels of PM2.5 and PM10 and increased hospital visits for asthma, COPD exacerbations, and acute respiratory infections⁹. Winter months are particularly associated with higher morbidity due to temperature inversion phenomena, which trap pollutants near ground level.

Recognizing the rising burden of respiratory diseases, the Government of India has implemented several national public health initiatives. The National Programme for Prevention and Control of Chronic Respiratory Diseases (NPCDCRD) focuses on early detection and standardized management of asthma and COPD, while the National Tuberculosis Elimination Programme (NTEP) addresses tuberculosis control and elimination. In addition, the National Clean Air Programme (NCAP) targets reduction of ambient air pollution, a key environmental risk factor, and Ayushman Bharat–PMJAY has expanded access to diagnostic and treatment services for respiratory illnesses, particularly among economically vulnerable populations¹⁰.

Despite these national efforts, region-specific evidence from rural and hilly areas such as the Garhwal Region of Pauri Garhwal, Uttarakhand remains limited. Unique geographic and climatic conditions, including cold winters, extensive biomass fuel use, and constrained access to healthcare services, may significantly influence the pattern, severity, and outcomes of respiratory diseases in this region compared to urban and plain areas¹¹.

Therefore, the present retrospective study was undertaken to evaluate the epidemiological profile, seasonal variation, associated risk factors, co-morbidities, treatment patterns, and clinical outcomes of respiratory diseases among patients attending a community health facility in the Garhwal Region, Pauri Garhwal, Uttarakhand. The findings are expected to support region-specific healthcare planning and strengthen preventive and therapeutic strategies for respiratory diseases in similar rural hilly settings.

Aim

To study the epidemiological and seasonal patterns of respiratory diseases and associated risk factors among patients at a community health facility in Garhwal Region, Pauri Garhwal, Uttarakhand.

Objectives:

1. To assess the age and gender distribution of patients attending the community health facility.
2. To evaluate the social history of patients, including smoking, biomass fuel exposure, and occupational dust/smoke exposure.
3. To determine the prevalence and distribution of various respiratory diseases among the patients.
4. To analyze the seasonal pattern of respiratory disease occurrence in the study area.
5. To assess the type of healthcare visit (OPD/IPD) and severity of respiratory disease cases.
6. To evaluate the association of co-morbidities with different types of respiratory diseases.
7. To study the drug/medication usage pattern in the management of respiratory diseases.
8. To assess the gender-wise distribution of major respiratory diseases.
9. To analyze the relationship between social risk factors and types of respiratory diseases.
10. To determine the outcome of respiratory disease cases, including treatment, hospitalization, referral, and mortality.

METHODOLOGY

1. Study Design:

This was a retrospective, observational, cross-sectional study designed to assess the epidemiological profile, seasonal variation, risk factors, co-morbidities, and treatment patterns of respiratory diseases among patients attending the Outpatient Department (OPD) at a community health facility in the Garhwal region, Pauri Garhwal, Uttarakhand.

2. Study Site:

The study was conducted at the following healthcare facilities in the Pokhra block of Pauri Garhwal district, Uttarakhand:

• Outpatient Department (OPD) of the Community Health Centre (CHC), Pokhra
• Outpatient Department (OPD) of the Rural Health Training Centre (RHTC), Pokhra
• Government hospitals in the Pokhra block

3. Study Duration:

The study was conducted over a period of 6 months (e.g., July 2026 to December 2026).
The retrospective data were collected from OPD patient records covering one year (e.g., January 2025 to December 2025).

4. Study Criteria:

Inclusion Criteria:

• Patients diagnosed with respiratory diseases such as asthma, COPD, respiratory tract infections, tuberculosis, bronchitis, and pneumonia.
• Patients of all age groups were included.
• Both males and females were included.
• Patients attending the Outpatient Department (OPD) were included.
• Patients with complete medical records available in OPD registers were included.
• Residents of Garhwal region, specifically Pokhra block, were included.

Exclusion Criteria:

• Patients with incomplete or missing OPD records were excluded.
• Patients diagnosed with non-respiratory diseases only were excluded.
• Duplicate patient records were excluded.
• Records with insufficient demographic or clinical information were excluded.

5. Source of Data:

• Patient records were collected from OPD registers of CHC, RHTC, and government hospitals.
• Hospital OPD medical records and case sheets were reviewed.
• Laboratory reports and diagnostic records (if available) were reviewed.
• Prescription records and treatment charts were reviewed.

6. Data Collection:

Data were collected through:

• Review of OPD patient records for demographic details (age, gender, occupation, residence, etc.).
• Collection of clinical information including diagnosis and type of respiratory disease.
• Assessment of social history such as smoking, biomass fuel exposure, and occupational exposure.
• Collection of seasonal data based on month and season of OPD visit.
• Collection of treatment details including prescribed medications.

7. Study Procedure:

1. OPD patient records from selected healthcare centers were reviewed.
2. Eligible patient records were identified based on inclusion and exclusion criteria.
3. Demographic, clinical, seasonal, and treatment data were recorded.
4. Information was collected using a structured Case Record Form (CRF).
5. Data were classified based on age, gender, type of respiratory disease, season, and risk factors.
6. Collected data were compiled and verified for completeness and accuracy.

8. Data Analysis:

Data were analyzed by preparing tables and graphs using Microsoft Excel.

Need of the Study

1. Respiratory diseases such as asthma, COPD, bronchitis, and respiratory infections are major causes of morbidity and mortality worldwide.
2. The burden of respiratory diseases is increasing in India, especially in rural and hilly regions due to environmental and lifestyle factors.
3. Seasonal variations significantly influence the occurrence and severity of respiratory diseases.
4. There is limited region-specific data available on the epidemiological and seasonal patterns of respiratory diseases in the Pauri Garhwal region.
5. Identification of demographic characteristics and risk factors helps in early diagnosis and better disease management.
6. Evaluation of treatment patterns helps in promoting rational drug use and improving patient outcomes.
7. The findings of this study will help in improving healthcare planning, preventive strategies, and management of respiratory diseases in the Garhwal region.

RESULTS

A total of 80 patients diagnosed with respiratory diseases were included in the study from OPD records of CHC Pokhra, RHTC Pokhra, and government hospitals of Pokhra block, Pauri Garhwal.

Objective 1: To assess the age and gender distribution of patients attending the community health facility

Among the 80 patients included in the study, the majority belonged to the 41–60 years age group (35%), followed by patients above 60 years (27.5%). Patients aged 19–40 years accounted for 25%, while pediatric patients constituted 12.5% of the study population.

Gender-wise distribution showed that 46 patients (57.5%) were males, whereas 34 patients (42.5%) were females.

1. Age-wise Distribution

2. Gender-wise Distribution

Objective 2: To evaluate the social history of patients, including smoking, biomass fuel exposure, and occupational dust/smoke exposure

Smoking was identified in 28 patients (35%), making it the most common social risk factor. Biomass fuel exposure was observed in 24 patients (30%), while occupational dust/smoke exposure was present in 12 patients (15%). No significant risk factor was identified in 20% of patients.

3. Social Risk Factors

Objective 3: To determine the prevalence and distribution of various respiratory diseases among the patients

Respiratory tract infections (RTIs) were the most common respiratory condition, affecting 22 patients (27.5%), followed by asthma in 20 patients (25%) and COPD in 18 patients (22.5%). Tuberculosis accounted for 10% of cases, while bronchitis and pneumonia constituted smaller proportions.

4. Prevalence of Respiratory Diseases

Objective 4: To analyze the seasonal pattern of respiratory disease occurrence in the study area

The highest number of respiratory disease cases was reported during the winter season (37.5%), followed by monsoon season (25%). Summer and autumn seasons each accounted for 18.75% of cases.

5. Seasonal Distribution

Objective 5: To assess the type of healthcare visit (OPD/IPD) and severity of respiratory disease cases

Out of the total patients, 65 patients (81.25%) were managed at the OPD level, while 15 patients (18.75%) required hospitalization or referral for advanced management.

6. Type of Healthcare Visit

Objective 6: To evaluate the association of co-morbidities with different types of respiratory diseases

Hypertension was the most common co-morbidity, observed in 18.75% of patients, followed by diabetes mellitus (15%). Co-morbidities were more frequently observed among COPD and elderly patients.

7. Co-morbidities

Objective 7: To study the drug/medication usage pattern in the management of respiratory diseases

Bronchodilators were the most commonly prescribed medications, used in 60 prescriptions, followed by antibiotics (38 prescriptions) and antihistamines (30 prescriptions). Combination inhalers containing ICS + LABA were prescribed in 32.5% of patients, while triple therapy was mainly used in severe COPD cases.

8. Drug Utilization Pattern

Objective 9: To analyze the relationship between social risk factors and types of respiratory diseases

Smoking was strongly associated with COPD and bronchitis cases, whereas biomass fuel exposure was commonly observed among female asthma and RTI patients. Occupational dust exposure was mainly associated with chronic respiratory symptoms.

Objective 10: To determine the outcome of respiratory disease cases, including treatment, hospitalization, referral, and mortality

The majority of patients (77.5%) improved with treatment and follow-up care. Hospitalization was required in 7.5% of patients, while 12.5% were referred to higher healthcare centers for specialized management. Mortality was observed in 2.5% of severe respiratory disease cases.

9. Outcome of Cases