Signs of reversing trends in prevalence of asthma

Robust in-vehicle respiratory rate detection using multimodal signal fusion

Continuous health monitoring in private spaces such as the car is not yet fully exploited to detect diseases in an early stage. Therefore, we develop a redundant health monitoring sensor system and signal fusion approaches to determine the respiratory rate during driving. To recognise the breathing movements, we use a piezoelectric sensor, two accelerometers attached to the seat and the seat belt, and a camera behind the windscreen. We record data from 15 subjects during three driving scenarios (15 min each) city, highway, and countryside. An additional chest belt provides the ground truth. We compare the four convolutional neural network (CNN)-based fusion approaches: early, sensor-based late, signal-based late, and hybrid fusion. We evaluate the performance of fusing for all four signals to determine the portion of driving time and the signal combination. The hybrid algorithm fusing all four signals is most effective in detecting respiratory rates in the city ([Formula: see text]), highway ([Formula: see text]), and countryside ([Formula: see text]). In summary, 60% of the total driving time can be used to measure the respiratory rate. The number of signals used in the multi-signal fusion improves reliability and enables continuous health monitoring in a driving vehicle.

Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong ISAAC Study from 1995 to 2015

BACKGROUND

The prevalence of allergic diseases has been increasing in developing areas but has reached a plateau in many developed areas. Regular surveys are imperative to assess the disease burden for the prioritization of resource allocation.

OBJECTIVES

We examined the change in the prevalence of wheezing, allergic rhinitis (AR), and eczema in school-aged children with possible associative factors and possible health effects of school air quality.

METHODS

This was the third repeated cross-sectional study conducted in 2015-2016 using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Our first and second surveys were conducted in 1994-1995 and 2000-2001, respectively. Regarding the third survey, we recruited 3698 children aged 6-7 from 33 local schools in 18 districts. Air quality, temperature, and humidity were also measured. The changes in prevalence, multiple regression, and GLIMMIX procedure were analyzed.

RESULTS

From our first survey to our third survey, the increased prevalences for lifetime wheeze, current wheeze, lifetime rhinitis, current rhinitis, current rhinoconjunctivitis, lifetime chronic rash, and current chronic rash were 4.2%, 2.1%, 12.5%, 12.6%, 14.2%, 3.9%, and 4.1%, respectively. Increased prevalence of parental atopy had the strongest association with an increased prevalence of each of these seven health outcomes. There was no significant association between school air pollutant levels and the prevalence of health outcomes.

CONCLUSIONS

There was an increase in the prevalence of wheezing, allergic rhinitis, and eczema across the surveys. The most important associated risk factor identified was the increased prevalence of a parental history of atopy.

Prescribing patterns and cost-utility analysis of management of childhood asthma in Saudi Arabia: a retrospective cross-sectional study

Objective

This study is based on a retrospective cross-sectional study to assess the prescribing patterns and cost-utility analysis of management of childhood asthma in Saudi Arabia.

Methods

Prescription data were collected for 1 year from electronic records of pharmacy. The unit dose price was retrieved from pharmacy database and compared with daily price based on WHO Defined Daily Dose (DDD) and Saudi Initiative for Asthma (SINA). The cost of each drug is calculated from average prices of each unit dose of each prescription.

Key findings

In male children (57.98%), asthma was more common in comparison to female children (41.02%) at the studied hospital. Salbutamol (44.55%) was the most commonly prescribed medication followed by budesonide (30.97%) and montelukast (12.82%), whereas prednisolone (0.15%) was the least prescribed medication for the management of childhood asthma. It was found that fixed-dose combination of budesonide and formetrol prescribed for the longest duration of therapy (30 days) and imposed highest cost as well [197.10 SR (52.53 USD)] among all the prescribed medicine.

Conclusion

In this study, inhalation route is the most preferred one for management of asthma; this may be due to their fast therapeutic action. Salbutamol was the most popular drug for quick reliever therapy, while budesonide was the most favoured drug for childhood asthma management. Medication prescribed for the management of childhood asthma at the mentioned study centre adhere to SINA guideline.

Association of diabetes-related autoantibodies with the incidence of asthma, eczema and allergic rhinitis in the TRIGR randomised clinical trial

AIMS/HYPOTHESIS

This paper presents the relationship between islet autoantibodies, precursors of type 1 diabetes, and the development of persistent asthma, allergic rhinitis and atopic eczema.

METHODS

A total of 2159 newborns who had a first-degree relative with type 1 diabetes and selected HLA genotypes were followed until the youngest participant reached 10 years of age. Islet cell antibodies (ICA) were detected using indirect immunofluorescence. Autoantibodies to insulin (IAA), GAD (GADA), the tyrosine phosphatase-related insulinoma-associated 2 molecule (IA-2A) and zinc transporter 8 (ZnT8A) were quantified with the use of specific radiobinding assays. As an ancillary study, the incidence of asthma, allergic rhinitis and eczema was assessed in 1106 of these children using the International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire when the children were 9-11 years old. HRs with 95% CIs were calculated to depict the incidence of these diseases following seroconversion to autoantibody positivity.

RESULTS

The cumulative incidence of atopic eczema, allergic rhinitis and persistent asthma were 22%, 9% and 7.5%, respectively, by 9-11 years of age. The occurrence of diabetes-related autoantibodies showed a protective association with subsequently reported incidence of asthma and eczema. The incidence of rhinitis was not significantly related to the occurrence of IAA or GADA (statistical power was limited), but demonstrated the same inverse relationship as did the other diseases with ICA or when multiple autoantibodies first appeared together.

CONCLUSIONS/INTERPRETATION

The findings add evidence to the relationships between these atopic diseases and diabetes-related autoimmunity and also suggest that, for eczema, the interaction depends upon which autoantibody appeared first.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00179777 Graphical abstract.

Aeroallergens in Canada: Distribution, Public Health Impacts, and Opportunities for Prevention

Aeroallergens occur naturally in the environment and are widely dispersed across Canada, yet their public health implications are not well-understood. This review intends to provide a scientific and public health-oriented perspective on aeroallergens in Canada: their distribution, health impacts, and new developments including the effects of climate change and the potential role of aeroallergens in the development of allergies and asthma. The review also describes anthropogenic effects on plant distribution and diversity, and how aeroallergens interact with other environmental elements, such as air pollution and weather events. Increased understanding of the relationships between aeroallergens and health will enhance our ability to provide accurate information, improve preventive measures and provide timely treatments for affected populations.

Prevalence, associated factors, and control level of asthma symptoms among adolescents in Northern Jordan

Objective To investigate the prevalence, associated factors, and control level of asthma in Jordanian high school students. Methods A descriptive, comparative, cross sectional design was used and a cluster sample of 2691 students (mean age = 14.5 years, 51.0% girls), drawn from eight randomly selected public high schools in Northern Jordan, participated in the study. Each student had the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire completed in the classroom between February and May, 2015. Results The prevalence of recent wheezing in the last 12 months was 11.7% whereas the prevalence of diagnosed asthma was 6.2%. About 49% of students experienced cough all the time, and 33.5% experienced waking up at night due to wheezing some of the time. About 30.9% of students reported moderate to big exercise-induced asthma. The mean total Asthma Control Test (ACT) score was 5.85 (SD = 3.56) with all of students reporting uncontrolled asthma during the last month. Higher rates of asthma symptoms were reported by females, 10th graders, and students with negative family history. Importantly, students with diagnosed asthma or recent wheezing reported higher rates of ever smoking tobacco vs. non-asthmatics (p < 0.000); dual (18.6% vs. 9.8%), cigarettes only (11.2% vs. 7.3%), and waterpipe only (18.0% vs. 14.7%). Conclusion Overall, students with asthma or wheezing had increased rates of tobacco smoking. Policies need to be set and enforced to provide a better environment for these youth, especially making all schools smoke-free zones. A multifaceted, comprehensive awareness and management program is required in schools to control and manage asthma symptoms.

Susceptibility to allergy in adoptive children: a cross-sectional study at "Bambino Gesù Children's Hospital"

Background

Prevalence of allergy has steeply increased during the past few decades, particularly in high-income countries. The development of atopy could present different characteristics in internationally adopted children with regard to incidence, specific patterns of allergies and timing of occurrence. We aimed to investigate the occurrence of allergic diseases among adopted children in Italy.

Methods

We collected demographic information, preadoption immunization data, infectious diseases screening results, immunological status, and performed hematological and biochemical tests according to a standardized protocol in 108 adopted children.

Results

At initial visit (mean age was 5.7 ± 3.2 years), 48 children displayed elevated total serum IgE levels with a prevalence of 56.5% (95%CI: 0.45; 0.67). The prevalences of children screened positive for one or more food allergens and inhalants were 30.1% (95%CI: 19.9%; 42.0%) and 34.3% (95%CI: 23.3%; 46.6%) respectively, only 9 children exhibited abnormal absolute eosinophil counts, 23 (21.3%) had a parasitic infection and 60 (55.6%) had received at least one dose of vaccine.

Conclusions

Children without medical records or with a past medical history suggestive of atopy should perform a thorough allergy evaluation at the time of adoption. Our study offers also a glimpse at the vaccination status and immune-allergic profiles of recent migrant children in Italy.

Prevalence of and Risk Factors for Childhood Asthma, Rhinitis, and Eczema in Hong Kong: Proposal for a Cross-Sectional Survey

BACKGROUND

Previous studies have shown that particulate matter is a major problem in indoor air quality in Hong Kong schools, but little has been done to assess its relationship with health indicators in the children attending those schools. Our study aims to address this research gap by collecting aerosol data in schools to examine the link between different air pollutants with childhood respiratory health. It is important to explore whether or not the prevalence of asthma, allergic rhinoconjunctivitis, and eczema are increasing in local children.

OBJECTIVE

Our aim is to (1) examine the prevalence of asthma, allergic rhinitis, and eczema in school children aged 6-7 years in Hong Kong between 2001 and 2017, and (2) measure air quality at primary schools and explore its relationship with health outcomes measured by the International Study of Asthma and Allergies in Childhood (ISAAC) survey.

METHODS

This is a cross-sectional study consisting of an ISAAC questionnaire and aerosol data collection. We have recruited over 2000 parents of primary school students aged 6-7 years old for the questionnaire, and so far 19 schools have completed aerosol data collection.

RESULTS

The study is expected to be completed this year.

CONCLUSIONS

We predict that our study will show a significant change in the prevalence of asthma, allergic rhinitis, and eczema in school children aged 6-7 years old in recent years. In addition, we expect to show a significant association between air quality at school and health outcomes measured by the ISAAC survey.

Significant disparities in allergy prevalence and microbiota between the young people in Finnish and Russian Karelia

BACKGROUND

Atopic allergy has been more common among schoolchildren in Finland, as compared to Russian Karelia. These adjacent regions show one of the most contrasting socio-economical differences in the world.

OBJECTIVE

We explored changes in allergy from school age to young adulthood from 2003 to 2010/2012 in these two areas. The skin and nasal microbiota were also compared.

METHODS

Randomly selected children from Finnish (n = 98) and Russian Karelia (n = 82) were examined in 2003, when the children were 7-11 years of age, and again in 2010 (Finnish Karelia) and 2012 (Russian Karelia). We analysed self-reported allergy symptoms and sensitization to common allergens by serum sIgE values. The skin (volar forearm) and nasal mucosa microbiota, collected in 2012 (aged 15-20 years), identified from DNA samples, were compared with multivariate methods.

RESULTS

Asthma, hay fever, atopic eczema, self-reported rhinitis, as well as atopic sensitization, were threefold to 10-fold more common in Finland, as compared to Russian Karelia. Hay fever and peanut sensitization were almost non-existent in Russia. These patterns remained throughout the 10-year follow-up. Skin microbiota, as well as bacterial and fungal communities in nasal mucosa, was contrastingly different between the populations, best characterized by the diversity and abundance of genus Acinetobacter; more abundant and diverse in Russia. Overall, diversity was significantly higher among Russian subjects (P_skin < 0.0001, P_{nasal-bacteria} < 0.0001 and P_nasal-fungi < 0.01). Allergic diseases were not associated with microbial diversity in Finnish subjects.

CONCLUSIONS AND CLINICAL RELEVANCE

Differences in allergic phenotype, developed in early life, remain between populations. A parallel difference in the composition of skin and nasal microbiota suggests a potential underlying mechanism. Our results also suggest that high abundance and diversity of Acinetobacter might contribute to the low allergy prevalence in Russia. Implications of early-life exposure to Acinetobacter should be further investigated.

The impact of allergic rhinitis on the management of asthma in a working population

Background

Currently, little data is available about the management of asthma in the working population. The aim of this study was to describe asthma control and severity among workers according to current or previous allergic rhinitis comorbidity.

Methods

A network of occupational physicians participated in this pilot study on a voluntary basis. They included a random sample of salaried workers during their systematic occupational medical check-up. All subjects completed a self-administered questionnaire based on the European Community Respiratory Health Survey screening questionnaire, and if they reported any respiratory symptoms including allergic rhinitis, the physician filled in a medical questionnaire. Current asthma control and severity were evaluated according to 2006 Global Initiative for Asthma guidelines.

Results

A total of 110 occupational physicians from two French regions participated. Out of the 6906 employees screened, 3102 identified respiratory symptoms and completed the medical questionnaire and performed spirometry. Overall, 374 were identified as current asthmatics, including 271 (72.5 %) with allergic rhinitis. Among current asthmatics with current allergic rhinitis (n = 95), 68.8 % had partially controlled asthma or uncontrolled asthma, including 51.6 % who received insufficient anti-asthmatic treatment. Partly or no control asthma was not associated with current rhinitis (OR = 1.4; 95 % CI: 0.8-2.7). Current asthmatics with current or previous allergic rhinitis had a significantly lower risk of emergency department visits than current asthmatics without allergic rhinitis (respectively 11.6, 17.1 and 29.1 %; P = 0.002).

Conclusions

Most current asthmatics both with and without allergic rhinitis had uncontrolled asthma, with inappropriate treatment. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace.

Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization

The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population.

Increased concentrations of greenhouse gases, and especially carbon dioxide (CO₂), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges.

This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand.

Trends in wheeze in Dutch school children and the role of medication use

BACKGROUND

While the prevalence of childhood wheeze continues to increase in many countries, decreasing trends have also been reported. This may be explained by increased use of asthma medication, which effectively suppresses wheeze symptoms. In this study we investigated trends in wheeze in Dutch school children between 1989 and 2005, and their association with medication use.

METHODS

In five repeated cross-sectional surveys between 1989 and 2005, parents of all 5- to 6-year-old and 8- to 11-year-old children eligible for a routine physical examination were asked to complete a questionnaire on their child's respiratory health. We identified all children for whom a questionnaire was completed in two successive surveys. Children were grouped according to birth year and classified into one out of four wheeze categories: "no wheeze," "discontinued wheeze," "continued wheeze," or "new-onset wheeze."

RESULTS

In total, 3,339 children, born in 1983 (N = 670), 1988 (N = 607), 1992 (N = 980), and 1995 (N = 1,082), participated twice. Over the study period, the proportion of children with "no wheeze" increased from 73.8% to 86.1% (Ptrend  < 0.001), while the proportion of children with "discontinued" and "continued" wheeze decreased from 13.2% to 6.3% (Ptrend  < 0.001) and from 8.8% to 3.1% (Ptrend  < 0.001), respectively. Medication use was consistently associated only with the presence of wheeze symptoms and this association did not change over time (Pbirth year × medication use  > 0.05 for all wheeze categories).

CONCLUSION

An increasing trend of Dutch school children with "no wheeze," and decreasing trends of children with "discontinued" and "continued" wheeze between 1989 and 2005 could not be explained by (increased) medication use. This suggests that wheeze prevalence is not masked by medication use, but is truly declining.

Time trends in the incidence, prevalence and age at diagnosis of asthma in children

BACKGROUND

Current knowledge on the prevalence of asthma is mainly based on cross-sectional questionnaire data. Current population-based data on the incidence of asthma in children are scarce.

OBJECTIVE

To study the incidence, prevalence, and age at diagnosis of asthma in children in the Netherlands over the study period 2000-2012.

METHODS

A population-based cohort study was conducted in the Integrated Primary Care Information database. The cohort consisted of 176,516 children (379,536 personyears (PY) of follow-up), aged 5-18 years between 2000 and 2012. All medical records of children with physician diagnosed asthma were validated. Incidence rates, annual percent change (APC), and prevalence for asthma were calculated. Influence of age and gender on incidence rates and change in age at diagnosis were studied.

RESULTS

We identified an asthma cohort of 14,303 children with 35,118 PY. The overall incidence rate was 6.7/1000 PY (95% CI, 6.45-6.97). Until 2008, the incidence rate was significantly increasing (APC 5.79 (95% CI 1.43-10.34); from 2008 onwards, a non-significant decrease was observed (APC -12.16 (95% CI -23.07 to 0.28). Incidence for girls was lower than for boys, this difference decreased with increasing age. (p < 0.001) Overall, the age at diagnosis increased over calendar time and was lower for boys. (linear trend p < 0.001).

CONCLUSION

Our population-based cohort study observed an incidence rate of 6.7 per 1000 PY of physician-diagnosed asthma in children in the Netherlands over 2000-2012. The asthma incidence rate was increasing until 2008. Further studies are needed to confirm the decrease in asthma incidence rate from 2008 onwards.

The impact of co-existing seasonal allergic rhinitis caused by Japanese Cedar Pollinosis (SAR-JCP) upon asthma control status

BACKGROUND

Seasonal Allergic Rhinitis Caused by Japanese Cedar Pollinosis (SAR-JCP) is a most common allergic rhinitis, affecting about 40% in Japan, but the influence from SAR-JCP upon asthma is controversial. The purpose of this study is to investigate the effect of coexistence of SAR-JCP upon control status of asthma using SACRA (Self-Assessment of Allergic Rhinitis and Asthma Questionnaire).

METHODS

The design was prospective, single-center, observational study. Asthmatic patients were classified into 3 groups, patients without rhinitis, those with perennial rhinitis or those with SAR-JCP from the results of SACRA. The control status of asthma were evaluated by Visual Analog Scale (VAS) in SACRA and Asthma Control Test (ACT) score. They were evaluated twice, from September to January (nonpollen-season) and February to April (pollen-season) and compared.

RESULTS

451 patients were enrolled and 325 cases (72%) were diagnosed as having comorbidity of rhinitis, among which 173 with only perennial rhinitis, while 152 with SAR-JCP. There was no significant difference in asthma control level measured by VAS and ACT score among 3 groups during nonpollen-season. The asthma control level measured by VAS (1.91-2.95) and ACT score (22.7-21.6) got worse during pollen-season among patients with SAR-JCP, even though 84% received treatment for rhinitis. Although it differed according to criteria, asthma control during pollen-season was impaired in 18-38% asthmatic patients with SAR-JCP.

CONCLUSION

It is possible to minimize the influence of AR on asthma control by obtaining an accurate diagnosis and providing sufficient treatment for rhinitis.

Prevalence of asthma and respiratory symptoms in 15-17 year-old Greek-Cypriots by proximity of their community of residence to power plants: Cyprus 2006-07

OBJECTIVES

Numerous studies have reported adverse effects of traffic pollution on respiratory health. Exposure to power plants emissions has not been as comprehensively studied. The prevalence of asthma and respiratory symptoms was investigated among 15-17 year-olds in communities in the vicinity of power plants in Cyprus in relation to the rest of the island.

STUDY DESIGN

Cross-sectional study

METHODS

Based on responses of 5817 participants to the ISAAC questionnaire, study outcomes were: active asthma (i.e. report of asthma and current symptoms), inactive asthma and respiratory symptoms without a diagnosis. Associations in terms of the distance of the participants' community to any of the three power plants were investigated in logistic models before and after adjusting for known confounders.

RESULTS

At 7.4% (95% CI: 4.5, 11.3), the prevalence of active asthma in communities at 5 km of power plants appeared elevated but reduced to national levels of 5% at longer distances. Adjusted odds ratio for active asthma was 1.83 (95% CI: 1.04, 3.24) in the 5 km zone compared to 30 km away. No clear pattern was observed for inactive asthma while the odds ratio of respiratory symptoms in the absence of diagnosis was 0.76 (95% CI: 0.58, 1.01) in the affected communities.

CONCLUSIONS

Higher prevalence of active asthma was observed in the vicinity of power plants, with no evidence of a distance-response relationship. With less than 5% of this age-group residing in close proximity to power plants, this corresponds to a small fraction of active asthma attributable to power plant emissions.

Time trends of incidence of age-associated diseases in the US elderly population: Medicare-based analysis

OBJECTIVES

time trends of age-adjusted incidence rates of 19 ageing-related diseases were evaluated for 1992-2005 period with the National Long Term Care Survey and the Surveillance, Epidemiology and End RESULTS Registry data both linked to Medicare data (NLTCS-Medicare and SEER-Medicare, respectively).

METHODS

the rates were calculated using individual medical histories (34,077 individuals from NLTCS-Medicare and 199,418 from SEER-Medicare) reconstructed using information on diagnoses coded in Medicare data, dates of medical services/procedures and Medicare enrolment/disenrolment.

RESULTS

increases of incidence rates were dramatic for renal disease [the average annual percent change (APC) is 8.56%, 95% CI = 7.62, 9.50%], goiter (APC = 6.67%, 95% CI = 5, 90, 7, 44%), melanoma (APC = 6.15%, 95% CI = 4.31, 8.02%) and Alzheimer's disease (APC = 3.96%, 95% CI = 2.67, 5.26%), and less prominent for diabetes and lung cancer. Decreases of incidence rates were remarkable for angina pectoris (APC = -6.17%, 95% CI = -6.96, -5.38%); chronic obstructive pulmonary disease (APC = -5.14%, 95% CI = -6.78,-3.47%), and ulcer (APC = -5.82%, 95% CI = -6.77,-4.86%) and less dramatic for carcinomas of colon and prostate, stroke, hip fracture and asthma. Incidence rates of female breast carcinoma, myocardial infarction, Parkinson's disease and rheumatoid arthritis were almost stable. For most diseases, an excellent agreement was observed for incidence rates between NLTCS-Medicare and SEER-Medicare. A sensitivity analysis proved the stability of the evaluated time trends.

CONCLUSION

time trends of the incidence of diseases common in the US elderly population were evaluated. The results show dramatic increase in incidence rates of melanoma, goiter, chronic renal and Alzheimer's disease in 1992-2005. Besides specifying widely recognised time trends on age-associated diseases, new information was obtained for trends of asthma, ulcer and goiter among the older adults in the USA.

[Characteristics of admissions to pediatric emergency departments for exacerbations of asthma. Assessment and prospects for improving prehospital care]

INTRODUCTION

The frequency of emergency department visits for asthma is a major public health problem in pediatrics. The aim of this study is to establish the characteristics of children visiting pediatric emergency departments for acute asthma and to assess their therapeutic management prior to admission.

METHODS

A prospective clinical study performed during 3 months at the pediatric emergency department of the university teaching hospital of Clermont-Ferrand, of children aged 1 to 16 years admitted to the department with a clinical diagnosis of asthma exacerbation.

RESULTS

One hundred and forty-three patients were included in the study. Asthma crises were moderate to severe in 69.2% of cases (n=99). Initial therapeutic management prior to the admission to the emergency department was appropriate in 17.5% of cases (n=25). Most of the known asthmatic patients had not been followed up by a pediatric pulmonologist (n=56). A crisis protocol had been set up in 16.5% of cases (n=20). Exacerbations were more severe among younger patients (P=0.002) and economically disadvantaged children (P=0.025).

CONCLUSIONS

This study uncovers poor knowledge of the disease among asthmatic children and their families, and an insufficient awareness among health practitioners of current recommendations for the treatment of asthmatic children. Admissions to the emergency department for asthma could be partly avoided by improving diagnosis and therapeutic education.

Food components and the immune system: from tonic agents to allergens

The intestinal mucosa is the major site of contact with antigens, and it houses the largest lymphoid tissue in the body. In physiological conditions, microbiota and dietary antigens are the natural sources of stimulation for the gut-associated lymphoid tissues (GALT) and for the immune system as a whole. Germ-free models have provided some insights on the immunological role of gut antigens. However, most of the GALT is not located in the large intestine, where gut microbiota is prominent. It is concentrated in the small intestine where protein absorption takes place. In this review, we will address the involvement of food components in the development and the function of the immune system. Studies in mice have already shown that dietary proteins are critical elements for the developmental shift of the immature neonatal immune profile into a fully developed immune system. The immunological effects of other food components (such as vitamins and lipids) will also be addressed. Most of the cells in the GALT are activated and local pro-inflammatory mediators are abundant. Regulatory elements are known to provide a delicate yet robust balance that maintains gut homeostasis. Usually antigenic contact in the gut induces two major immune responses, oral tolerance and production of secretory IgA. However, under pathological conditions mucosal homeostasis is disturbed resulting in inflammatory reactions such as food hypersensitivity. Food allergy development depends on many factors such as genetic predisposition, biochemical features of allergens, and a growing array of environmental elements. Neuroimmune interactions are also implicated in food allergy and they are examples of the high complexity of the phenomenon. Recent findings on the gut circuits triggered by food components will be reviewed to show that, far beyond their role as nutrients, they are critical players in the operation of the immune system in health and disease.

Increased prevalence of self-reported asthma among Korean adults: an analysis of KNHANES I and IV data

BACKGROUND

Asthma is one of the most common chronic conditions. Knowing the longitudinal trends of prevalence is important in developing health service planning and in assessing the impact of the disease. However, there have been no studies that examined current asthma prevalence trends in Korea through the analysis of nationwide surveys.

METHODS

Data were acquired from patients aged 20-59 years who participated in the First Korean National Health and Nutritional Examination Surveys (KNHANES), which was conducted in 1998, and in the second year of the Fourth KNHANES, which was conducted in 2008. To estimate the prevalence of asthma with age and gender standardization, we used data from the Population and Housing Census, which was conducted by Statistics Korea in 2005.

RESULTS

The prevalence of physician-diagnosed asthma increased from 1998 to 2008 (1998: 0.7 %, 2008: 2.0 %). The prevalence of asthma medication usage also increased from 1998 to 2008 (1998: 0.3 %, 2008: 0.7 %); however, the prevalence of wheezing decreased between 1998 and 2008 (1998: 13.7 %, 2008: 6.3 %). A similar trend was observed after estimating the prevalence of asthma with age and gender standardization. Allergic rhinitis might be the reason for the increased prevalence of physician-diagnosed asthma, while the observed decrease in wheezing may be related to the decrease in smoking or the increase in the use of asthma medication.

CONCLUSIONS

The present study showed that the prevalence of both self-reported physician-diagnosed asthma and asthma medication usage increased from 1998 to 2008 in Korea, despite a possible changing pattern of diagnosing asthma.

Increase in prevalence of physician-diagnosed asthma in Helsinki during the Finnish Asthma Programme: improved recognition of asthma in primary care? A cross-sectional cohort study

BACKGROUND

The continuing rise in asthma prevalence has been questioned, with recent reports suggesting a plateau.

AIMS

To assess a 10-year trend in the age-adjusted prevalence of physician-diagnosed asthma, respiratory and allergic symptoms, and use of asthma medication in the adult population of Helsinki during the Finnish Asthma Programme from 1994 to 2004.

METHODS

Two cross-sectional postal surveys were conducted among random Finnish National Population Registry samples 10 years apart using the same protocol. A total of 6,062 subjects (75.9%) and 2,449 subjects (61.9%) participated in 1996 and 2006, respectively.

RESULTS

The prevalence of physician-diagnosed asthma increased from 6.5% in 1996 to 10.0% in 2006 (p<0.001). This was evident in both genders aged <60 years, but particularly in women aged <40 years, paralleling an increased use of asthma medication. Concurrently, the prevalence of allergic rhinoconjunctivitis increased from 37.2% to 44.4% (p<0.001). The prevalence of physician-diagnosed chronic obstructive pulmonary disease remained unchanged (3.7%), while current smoking abated. Subjects with a smoking history had more respiratory symptoms (p<0.001). Among subjects without physician-diagnosed asthma, those reporting allergic rhinoconjunctivitis had a higher prevalence of lower respiratory tract symptoms.

CONCLUSIONS

The prevalence of allergic rhinoconjunctivitis and physician-diagnosed asthma has increased in Helsinki during 10 years in adults, especially in women aged <40 years. Concomitantly, the use of asthma medication increased and subjects with physiciandiagnosed asthma were less symptomatic. The increase in the prevalence of physician-diagnosed asthma may partly be due to improved diagnostic recognition of asthma in primary care during the Finnish Asthma Programme, but the concurrent rise in allergic rhinoconjunctivitis may reflect a true rise in prevalence.

Increasing prevalence of asthma, allergic rhinoconjunctivitis and eczema among schoolchildren: three surveys during the period 1985-2008

AIM

The prevalence of asthma, allergic rhinoconjunctivitis (AR) and eczema among children has increased worldwide in the last four decades, but recent studies disagree as to whether the prevalence is continuing to rise or is levelling off or declining. The aim of this study was to assess time trends in a subarctic population.

METHODS

A cross-sectional, questionnaire-based survey was carried out in 2008 among children aged 7-14 years in randomly selected schools in Nordland County, Norway (n = 4150). The results are compared with results from identical studies in 1985 (n = 4870) and 1995 (n = 4456).

RESULTS

The main findings were an increasing prevalence of asthma ever (7.3% in 1985 to 17.6% in 2008, p for trend < 0.001) and AR ever (15.9% in 1985 to 24.5% in 2008, p for trend < 0.001), while the prevalence of eczema ever, after an increase between 1985 and 1995, remained unchanged in the last time period. The prevalence of current disease doubled and trebled between 1995 and 2008 for all three diseases.

CONCLUSION

A repeated cross-sectional survey between 1985 and 2008 documented an increasing prevalence of asthma ever and AR ever among schoolchildren (7-14 years), together with a considerably increase in current asthma, AR and eczema between 1995 and 2008.

A spatial analysis of asthma prevalence in Ontario

OBJECTIVE

The objective of this paper is to examine spatial patterns of asthma prevalence in the province of Ontario by age and sex between 2002 and 2006.

METHODS

We conducted a population-based, ecological-level study using the Ontario Asthma Surveillance Information System Database (OASIS), a validated registry of all Ontario residents with asthma. Data were mapped and analyzed at the sub-Local Health Integration Network (subLHIN) level (n=141). Comparative morbidity figures (CMFs) were calculated and analyzed for local clusters of high and low values ("hot spots" and "cold spots").

RESULTS

There were 1,601,353 individuals identified as having asthma over the study period, representing an overall prevalence rate of 12.93%. Results demonstrate distinct spatial patterns of asthma prevalence across the province which are age- and sex-specific. There was little overlap between asthma hot spots by age group, suggesting that different spatial processes are at play. Patterns of cold spots are consistently seen in the urban and suburban subLHINs in and around Toronto and Hamilton as well as in several of the highly rural northern subLHINs.

CONCLUSIONS

Findings illustrate the need for more geographically focused public health and health care planning and resource allocation, and highlight the need for research aimed at understanding the factors that may explain the spatial patterns identified here.

Is the asthma epidemic still ascending?

Asthma is a phenotypically heterogeneous disorder of multifactorial origins that affects 300 million people suffering from asthma and more than 250,000 asthma-related deaths each year. Although treatment for asthma has improved, its prevalence continues to increase, particularly in low and middle income countries, or in some ethnic groups in which prevalence was previously low. Observed spatio-temporal variations in the increased prevalence of asthma depend on exposure to environmental factors. Recently, several arguments are also in favor of the involvement of host susceptibility and stress in the observed increase of asthma prevalence. Further investigations are warranted to better understand mechanisms underlying asthma increase or stagnation.

Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study

Background

While it is suggested that the prevalence of asthma in developed countries may have stabilized, this is not clear in currently developing countries. Current available information for both adults and children simultaneously on the burden and impact of allergic conditions in Colombia and in many Latin American countries is limited. The objectives of this study were to estimate the prevalence for asthma, allergic rhinitis (AR), atopic eczema (AE), and atopy in six colombian cities; to quantify costs to the patient and her/his family; and to determine levels of Immunoglobulin E (IgE) in asthmatic and healthy subjects.

Methods

We conducted a cross-sectional, population-based study in six cities during the academic year 2009–2010. We used a school-based design for subjects between 5–17 years old. We carried out a community-based strategy for subjects between 1–4 years old and adults between 18–59 years old. Serum samples for total and antigen-specific (IgE) levels were collected using a population-based, nested, case–control design.

Results

We obtained information on 5978 subjects. The largest sample of subjects was collected in Bogotá (2392). The current prevalence of asthma symptoms was 12% (95% CI, 10.5-13.7), with 43% (95% CI, 36.3-49.2) reporting having required an emergency department visit or hospitalization in the past 12 months. Physician diagnosed asthma was 7% (95% CI, 6.1-8.0). The current prevalence of AR symptoms was 32% (95% CI, 29.5-33.9), and of AE symptoms was 14% (95% CI, 12.5-15.3). We collected blood samples from 855 subjects; 60.2% of asthmatics and 40.6% of controls could be classified as atopic.

Conclusions

In Colombia, symptom prevalence for asthma, AR and AE, as well as levels of atopy, are substantial. Specifically for asthma, symptom severity and absence from work or study due to symptoms are important. These primary care sensitive conditions remain an unmet public health burden in developing countries such as Colombia.

Rhinoconjunctivitis prevalence and associated factors in school children aged 6-7 and 13-14 years old in Bogota, Colombia

OBJECTIVE

Allergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of rhinoconjunctivitis and determine clinical, social and environmental associated factors, among school children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia.

METHODS

We used ISAAC (International Study of Asthma and Allergies in Childhood) phase III study methodology and questionnaire for design and data collection, and we did a secondary analysis of these data. The sample consisted of 3830 registers from adolescents between 13 and 14 years old and 3256 registers from children between 6 and 7 years.

RESULTS

The prevalence of rhinoconjunctivitis symptoms in the last year was 17.2% (95% CI, 15.9-18.5) in children vs. 24.9% (95% CI, 23.6-26.3) in adolescents. In both groups there was a female predominance in children (17.8% vs. 16.5%), and in the teenagers group (28.0% vs. 21.4%), though the differences were not statistically significant. The factors associated with rhinoconjunctivitis in the group of 6-7 years where: asthma [OR 3.9; (95% CI, 2.8-5.4)], atopic dermatitis [OR 2.3; (95% CI, 1.7-3.1)], use of acetaminophen in the last year [OR 2.6; (95% CI, 1.4-4.9)], use of antibiotics in the first year of live [OR 1.7; (95% CI, 1.3-2.3)], higher maternal education [OR 1.5; (95% CI, 1.0-2.3)] and cesarean delivery [OR 1.6; (95% CI, 1.2-2.1)]. Among the 13-14 year age-group, factors associated with rhinoconjunctivitis included: asthma [OR 2.6; (95% CI, 2.0-3.4)], atopic dermatitis [OR 1.8; (95% CI, 1.4-2.3)], use of acetaminophen in the last year [OR 1.8; (95% CI, 1.4-2.4)], consumption of fast-food three times or more per week [OR 1.5; (95% CI, 1.2-2.0), ever smoked [OR 1.4; (95% CI, 1.2-1.7)] and meat consumption was protective factor [OR 0.7; (95% CI, 0.5-0.9)].

CONCLUSION

In both studied groups, the estimated prevalence of rhinoconjunctivitis symptoms was relatively high. Future in-depth research is needed to assess the complex interactions between allergic rhinoconjunctivitis symptoms and social and environmental factors.

Fifty years of pediatric asthma in developed countries: how reliable are the basic data sources?

Given the difficulties in diagnosing, or even defining, asthma in children, claims of a pediatric asthma epidemic in Canada and other developed countries are accepted with surprisingly little critical examination. We reviewed a broad range of data sources to understand how the epidemic evolved during the last 50 years and also to assess the reliability of the conclusions drawn from that data. We obtained Canadian National and Provincial data from Statistics Canada National Population Health Survey, and the British Columbia Ministry of Health respiratory database. International data were obtained by extensive review of pediatric asthma epidemiological surveys published during the last 50 years. In many developed countries, there have been three separate epidemics involving different aspects of pediatric asthma during the last 50 years: a double peaked mortality epidemic (1960s and 1980s), a hospital admission epidemic (peaked around 1990) and a steadily growing epidemic of children who report asthmatic symptoms on questionnaires. Canadian pediatric rates for asthma mortality (1-2/million/year) and hospital admission (1-2/thousand/year) are low and have fallen for the last 20 years. Rates based on questionnaire studies are high (10-15/hundred) and rose steadily over the same period. Objective reductions in asthma deaths and hospital admission likely reflect improved education and treatment programmes. Current claims of an epidemic based largely on subjective self-reported symptoms require more careful analysis. The possibility that symptom misperception, disease fashions, and poor recall, may be part of the explanation for the current high levels of self-reported symptoms deserves more attention.

The burden of allergic rhinitis and asthma

Asthma and allergic rhinitis are common health problems that cause major illness and disability worldwide. The prevalence of allergic rhinitis is estimated to range from 10% to 20% in the USA and Europe. Multiple factors contribute to the wide range of reported prevalence rates. These include type of prevalence rate reported (current or cumulative), study selection criteria, age of participants, differences in survey methods, varied geographic locations and socioeconomic status, any of which are significant enough to confound direct comparison between studies. There is no standard set of diagnostic criteria for allergic rhinitis. In most studies, the criteria for diagnosis are based on the subject's reporting, solely by questionnaire and rarely confirmed by skin testing. In addition, most studies focus on hay fever, leaving perennial allergic rhinitis underestimated. Sinus imaging is generally not performed and, therefore, rhinosinusitis not differentiated. Some investigators report 'current' prevalence while others report 'cumulative' or 'lifetime' prevalence. Epidemiologic studies have consistently shown that asthma and rhinitis often coexist in the same patients. The prevalence of asthma is <2% in subjects without rhinitis while it varies from 10% to 40% in patients with rhinitis. Furthermore, the majority of patients with asthma experience rhinitis, which is a factor in the risk for asthma. Despite recognition that allergic rhinitis and asthma are global health problems, there are insufficient epidemiologic data and more data are needed with regard to their etiologic risk factors and natural history. This aim of this review is to enable the reader to discuss prevalence, risk factors and prognosis of allergic rhinitis and asthma.

Time trend in the prevalence of adult asthma in Japan: findings from population-based surveys in Fujieda City in 1985, 1999, and 2006

BACKGROUND

The burden of asthma is recognized as an important public health problem worldwide. In most countries, the prevalence of asthma has been reported to increase in the last few decades. However, more recent epidemiological studies have shown that the prevalence of asthma has been flat or even decreasing after the 1990 s in some developed countries. The recent time trend in the prevalence of adult asthma in Japan is unknown.

METHODS

Population-based surveys were conducted three times in the same region, in 1985, 1999, and 2006, at Fujieda City, Shizuoka, Japan, and the results were reported previously. We compared the results of these surveys to reveal the time trend in the prevalence of adult asthma. Although the questionnaires used in these surveys were not exactly the same, the time trend was assessed by comparing the responses to relevant questions between questionnaires.

RESULTS

The prevalences of wheeze following a common cold and dyspneal feeling at night increased significantly from 1985 to 1999 (4.2% to 7.6%, and 3.2% to 5.3%, respectively). The prevalences of lifetime asthma and current asthma also significantly increased from 1999 to 2006 (5.1% to 6.7%, and 1.5% to 3.4%, respectively).

CONCLUSIONS

The prevalences of asthma among adults in Fujieda City consistently increased from 1985 to 2006. There was no evidence that the prevalences were in plateau or decreasing. These findings suggest that more efforts are required to stop the increase in the burden of this disease in Japan.

Dietary supplementation with omega-3-PUFA-rich fish oil reduces signs of food allergy in ovalbumin-sensitized mice

We investigated the effect of dietary supplementation with n-3 PUFA (fish oil source) in an experimental model of food allergy. Mice were sensitized (allergic group) or not (nonallergic group) with OVA and were fed with OVA diet to induce allergy signals. Mice were fed with regular diet in which 7% of lipid content was provided by soybean (5% of n-3 PUFA) or fish (25% of n-3 PUFA) oil. Allergic group mice had increased serum levels of antiovalbumin IgE and IgG1 and changes in small intestine, characterized by an increased edema, number of rolling leukocytes in microcirculation, eosinophil infiltration, mucus production, and Paneth cell degranulation, in comparison to non-allergic group. All these inflammatory parameters were reduced in mice fed high-n-3-PUFA diet. Our data together suggest that diet supplementation with n-3 PUFA from fish oil may consist of a valid adjuvant in food allergy treatment.

Atopy and current intestinal parasite infection: a systematic review and meta-analysis

BACKGROUND

The rate of increase in prevalence of allergic disease in some countries implies environmental exposures may be important etiological factors. Our aim was to undertake a systematic review and meta-analysis of epidemiological studies to quantify the association between current intestinal parasite infection and the presence of atopy and to determine whether this relation is species specific.

METHODS

We searched MEDLINE, EMBASE, LILIACS and CAB Abstracts (to March 2009); reviews; and reference lists from publications. No language restrictions were applied. We included studies that measured current parasite infection using direct fecal microscopy and defined atopy as allergen skin sensitization or presence of specific IgE. We estimated pooled odds ratios (OR) and 95% confidence intervals (95% CI) using data extracted from published papers using random-effects model.

RESULTS

Twenty-one studies met our inclusion criteria. Current parasite infection was associated with a reduced risk of allergen skin sensitization OR 0.69 (95% CI 0.60-0.79; P < 0.01). When we restricted our analyses to current geohelminth infection, the size of effect remained similar OR 0.68 (95% CI 0.60-0.76; P < 0.01). In species-specific analysis, a consistent protective effect was found for infection with Ascaris lumbricoides, Tricuris trichuria, hookworm and Schistosomiasis. There were insufficient data to pool results for atopy defined by the presence of specific IgE.

CONCLUSION

Intestinal parasite infection appears to protect against allergic sensitization. Work should continue to identify the mechanisms of this effect and means of harnessing these to reduce the global burden of allergic disease.

[Relationships between indoor allergens, sensitization, and allergic asthma and rhinitis symptoms]

INTRODUCTION

There is a strong and consistent association between immediate hypersensitivity, asthma and exposure to allergens. However, the role that the inhaled allergen plays and the timing of events related to sensitization are still controversial.

BACKGROUND

Information obtained by studies of the follow-up of cohorts underlines the fact that there is no continuum between specific IgE responses and the development of childhood asthma. Allergic rhinitis and asthma result from a complex and multifactorial interaction between genetic factors, exposure to allergens, and many biological or chemical co-factors. However, when the child is exposed to an allergen, sensitization to the allergen is a risk factor for childhood asthma and severity of the disease.

CONCLUSIONS AND VIEWPOINTS

Despite numerous epidemiological studies, the association and links between atopy, allergens, environment, sensitization and allergic rhinitis and/or asthma remain difficult to evaluate and poorly understood. Complementary studies are also necessary for the standardization of therapeutic strategies.

Trends in asthma prevalence and incidence in Ontario, Canada, 1996-2005: a population study

In the 1980s and early 1990s, asthma prevalence increased significantly in most Westernized countries. In more recent years, asthma trends have been less clear, with some studies suggesting that they are still rising and others suggesting that they have stabilized or decreased. A population-based cohort study was conducted to estimate asthma prevalence and incidence trends in one large Canadian province, Ontario. All individuals with asthma living in Ontario, a province of Canada with a multicultural population of approximately 12 million, were identified in universal, population health administrative databases by using a validated health administrative case definition of asthma. Annual asthma prevalence, incidence, and all-cause mortality rates were estimated from 1996 to 2005. During this time, the prevalence of asthma increased by 70.5%. The age- and sex-standardized asthma prevalence increased from 8.5% in 1996 to 13.3% in 2005, a relative increase of 55.1% (P < 0.0001). Asthma incidence rates increased in children by 30.0% and were relatively stable in adults. Overall all-cause mortality decreased. Asthma prevalence in Ontario, Canada, has increased significantly. This is attributable, in part, to an increase in the incidence of asthma in children. Effective clinical and public health strategies are needed to prevent and manage asthma in the population.

Projections of the effects of climate change on allergic asthma: the contribution of aerobiology

Climate change is unequivocal and represents a possible threat for patients affected by allergic conditions. It has already had an impact on living organisms, including plants and fungi with current scenarios projecting further effects by the end of the century. Over the last three decades, studies have shown changes in production, dispersion and allergen content of pollen and spores, which may be region- and species-specific. In addition, these changes may have been influenced by urban air pollutants interacting directly with pollen. Data suggest an increasing effect of aeroallergens on allergic patients over this period, which may also imply a greater likelihood of the development of an allergic respiratory disease in sensitized subjects and exacerbation of symptomatic patients. There are a number of limitations that make predictions uncertain, and further and specifically designed studies are needed to clarify current effects and future scenarios. We recommend: More stress on pollen/spore exposure in the diagnosis and treatment guidelines of respiratory and allergic diseases; collection of aerobiological data in a structured way at the European level; creation, promotion and support of multidisciplinary research teams in this area; lobbying the European Union and other funders to finance this research.

Prevalence of asthma and allergic diseases in primary school children in Edirne, Turkey, two surveys 10 years apart

To assess change in prevalence and risk factors of asthma and allergic diseases among primary school children in rural and urban parts of Edirne, Turkey, a series of cross-sectional studies were conducted in 1994 and 2004. A questionnaire was administered to the parents of primary school children aged 7-12, in urban and rural parts of Edirne, Turkey (5412 in 1994 and 5735 in 2004). Response rates in 1994 and 2004 were 84% and 82.5%, respectively. There were significant differences between the age distribution, urban habitation (1994: 70.1%, 2004: 75.8%, p < 0.001), passive smoking (1994: 74.7%, 2004: 60.0%, p < 0.001), and family atopy (1994: 12.7%, 2004: 18.2%, p < 0.001) between the two surveys. Current prevalence of asthma and wheeze increased in the 2004 when compared to 1994 in both rural and urban regions (current asthma for rural and urban regions, 5.2% and 5.8% in 1994; 8.6% and 12.1% in 2004, respectively). Female-to-male ratio of current asthma increased from 0.7 in 1994 to 0.9 in 2004. Comparison of the risk factors in the two surveys suggested urban habitation and factors other than family atopy, passive smoking and no breast feeding as possible contributors for the increasing asthma and wheeze. Prevalence of asthma and allergic diseases increased among school children in Edirne, Turkey from 1994 to 2004. Life style changes and urbanization could be related to this increasing trend.

Prevalence of asthma by industry and occupation in the U.S. working population

BACKGROUND

Workers are potentially exposed to asthmagens daily. Our study was conducted to estimate the prevalence of asthma among working adults in the U.S. by industry and occupation.

METHODS

Using data from the National Health and Nutrition Examination Survey (2001-2004), multiple logistic regression was used to investigate associations between industry and occupation and current asthma as defined by positive responses to "Has a doctor or other health professional ever told you that you have asthma?" and "Do you still have asthma?"

RESULTS

Workers in mining (17.0%), health-related industries (12.5%), teaching (13.1%), or in health-related occupations (12.6%) had the highest prevalence of asthma. As compared to construction industry workers, workers in mining (aOR = 5.2, 95% CI: 1.1-24.2) or health-related (aOR = 2.3, 95% CI: 1.1-4.8) industries had significantly higher odds of asthma.

CONCLUSION

Our study adds to the increasing evidence that miners, healthcare workers and teachers remain high-risk working populations and appropriate evaluation and control measures are needed to protect these workers.

Reduction of asthma burden is possible through National Asthma Plans

Despite increase in understanding of asthma patomechanisms the practical actions to lessen asthma burden in the communities are far behind of scientific knowledge. There are still reports of uderdiagnosis and poor treatment leading to repeated severe exacerbations, often demanding emergency care and hospitalisation, which cause most of the economic burden both for families and society. From the public health perspective, the key issue is to implement the best standards of care in every-day practice. The problems are different in high income compared to low- and middle-income countries, and the solutions have to be tailored to each country needs and resources. We present here examples from Finland, Poland and Brazil, to show that asthma burden can be reduced using varied strategies in quite different societal, economical and health care environments. The experience from those interventions confirms that regardless of the health care system and its coverage, a major change for the better can be achieved by local efforts, systematic planning and networking to implement the best asthma practice.

[Asthma in France: a review of descriptive epidemiological data]

This article presents a review of the most recent data on descriptive epidemiology of asthma in France. The latest national surveys show a cumulative prevalence of asthma of more than 10% in children aged 10 years or more and a prevalence of current asthma from 6 to 7% in adults. In 2006, 1038 deaths from asthma were registered (64 deaths among people aged less than 45 years). After the peak observed in the 1980s, mortality from asthma has decreased. The decrease is also observed among children and young adults. According to data from the French discharge database (PMSI), there were 54 130 admissions for asthma (asthma as the principal diagnosis) in 2007. Between 1998 and 2007, the annual rate of admission for asthma decreased. However, no decreasing trend was observed in children and, in adults, admission rates seem to have been stable since 2004. The increase in the rate of admission for acute respiratory failure (ARF) associated with asthma (ARF as the principal diagnosis and asthma as an associated diagnosis) does not compensate for the decrease in the admission rate for asthma that was observed in adults. Data on emergency department visits show evidence of strong seasonal variations in asthma exacerbations.

Prevalence of asthma among adult females and males in the United States: results from the National Health and Nutrition Examination Survey (NHANES), 2001-2004

BACKGROUND

The prevalence of asthma has increased over the last three decades with females exhibiting a higher prevalence of asthma than males. The objective of this study was to obtain gender-specific estimates of the prevalence of current and ever asthma and describe the relationships between risk factors and asthma by gender in US men and women ages 20 to 85.

METHODS

Data for this study came from two cycles (2001-2002 and 2003-2004) of National Health and Nutrition Examination Survey (NHANES) and included 9,243 eligible adults: 4,589 females and 4,654 males. Multiple logistic regression was used to investigate gender-specific associations between race/ethnicity, body mass index (BMI), sociodemographic characteristics, and smoking habits for current asthma and ever asthma.

RESULTS

The prevalence of current asthma was 8.8% for women and 5.8% for men, while the prevalence of ever having been diagnosed with asthma was higher (13.7% and 10.4% for women and men, respectively). Current asthma was less prevalent in Mexican American women (1.9%) and men (0.9%) born in Mexico as compared to Mexican Americans born in the U.S. (8.7% and 5.2% for women and men, respectively) or for any other ethnic group. Approximately 20% of extremely obese women and men had ever been diagnosed with asthma; among this group, 15% reported they had current asthma. Results from multiple logistic regression models indicate that extreme obesity and living in poverty were strongly associated with current and ever asthma for both women and men, as was former smoking and ever asthma for men.

CONCLUSION

As compared to previous NHANES reports, our results indicate that the prevalence of asthma among U.S. adults continues to increase. Further, our findings of marked differences among subgroups of the population suggest asthma-related disparities for impoverished persons and greater prevalence of asthma among obese and extremely obese US adults.

Prevalence, incidence and persistence of anti-asthma medication use in 2- to 29-year-olds: a nationwide prescription study

PURPOSE

The purpose of this study was to examine gender- and age-specific prevalence, incidence, and the type of anti-asthma medications used in the Norwegian population aged 2-29 years during 2005-2007 and to estimate the share of individuals who regularly redeemed medications over a 3-year period.

METHODS

We retrieved data from the nationwide Norwegian Prescription Database for all individuals 2-29 years old (n = 1.7 million) who received anti-asthma medications during 2005-2007. Medications included inhaled short- and long-acting beta(2)-agonists, inhaled corticosteroids, fixed-dose combinations of inhaled beta(2)-agonists and corticosteroids, and leukotriene antagonists.

RESULTS

In 2007, 5.5% (92,074 individuals) of Norwegians aged 2-29 years received anti-asthma medication, and this figure was stable throughout 2005-2007. Prevalence and incidence were higher among males than females but shifted to female dominance during adolescence. The share of anti-asthma medication users who received inhaled corticosteroids was high in preschool children but decreased by age. Conversely, use of inhaled beta(2)-agonists as monotherapy and of fixed combinations increased with age. Fewer than half the individuals were "persistent" to medication treatment for 3 years by redeeming prescriptions regularly (at least once a year).

CONCLUSIONS

In this nationwide study, annual prevalence of anti-asthma medication use was stable during 2005-2007. The gender- and age-specific profile of prevalence and incidence correspond well with other studies. Fewer than half the individuals redeemed prescriptions regularly over 3 years.

[Prevalence of asthma among children in France]

OBJECTIVE

To estimate the prevalence of asthma among children in France.

METHODS

Data from 3 French national studies were analyzed: the Decennial Health Interview Survey conducted in 2003 among a representative sample of households and 2 surveys conducted among representative samples of schoolchildren from 9(th) grade in 2003-2004 and 5(th) grade in 2004-2005. In the Decennial Health Interview Survey, data on respiratory health were collected using a self-administered questionnaire that was filled in by 1675 children aged 11-14 years living in selected households. For the studies among schoolchildren, 7104 children from 5(th) grade and 7284 from 9(th) grade were interviewed by the school nurse or physician using a standardized questionnaire.

RESULTS

The cumulative prevalence of asthma varied from 12.3 to 13.4% depending on the survey and the prevalence of current wheeze (wheezing in the past year) varied from 8.3 to 10.1%. The prevalence of current asthma (current wheeze in a child having already had an asthma attack or treatment for wheezing or asthma in the past year) was nearly 9% in 5(th)-grade and 9(th)-grade schoolchildren. Asthma was not controlled (at least 4 attacks, 1 awakening per week, 1 severe attack, 4 unplanned medical visits, or 1 hospitalization in the past year) in 38.5% of the 598 asthmatic teenagers from 9(th) grade, and 29.2% did not declare any anti-inflammatory drug treatment in the past week in spite of the absence of asthma control.

CONCLUSION

The prevalence of current asthma among children in France is estimated at 9%. Asthma control and treatment remain insufficient. Improving therapeutic and educational management of asthma among children and teenagers is necessary.

Time trends in prevalence and severity of childhood asthma and allergies from 1995 to 2002 in France

OBJECTIVE

To assess time trends in symptoms of asthma, allergic rhinitis and atopic eczema among adolescents in Languedoc Roussillon, France.

METHODS

Two cross-sectional surveys were conducted 7 years apart using the same protocol. School-based samples of 3383 participants in the 1995 survey and 1642 participants in the 2002 survey respectively were recruited.

RESULTS

There was a tendency towards stagnation in current symptoms of asthma, rhinoconjunctivitis and eczema. Indices related to lifetime diagnosis of asthma, hay fever and eczema increased. For all the conditions, indices of severity also showed a decrease in the 7-year study period.

CONCLUSIONS

Our study shows that symptoms of asthma, allergic rhinitis and eczema were stable, supporting the effectiveness of national asthma prevention and management guidelines for such diseases. The increase in indices related to lifetime diagnosis could be the result of increased public and professional awareness of the diseases and changes in diagnostic labelling in recent years.

The allergic sensitization in infants with atopic eczema from different countries

BACKGROUND

No study has compared allergic sensitization patterns in infants with atopic eczema from different countries. The aim of this study was to investigate the patterns of allergic sensitization in a cohort of infants with atopic eczema participating in a multicentre, international study.

METHODS

Two thousand one hundred and eighty-four infants (mean age 17.6 months) with atopic eczema from allergic families were screened in 94 centres in 12 countries to participate in a randomized trial for the early prevention of asthma. Clinical history, Severity Scoring of Atopic Dermatitis Index, measurements for total serum IgE and specific IgE antibodies to eight food and inhalant allergens were entered into a database before randomization to treatment. A history of type of feeding in the first weeks of life and exposure to animals was recorded.

RESULTS

A total of 52.9% of the infants had raised total IgE, and 55.5% were sensitized to at least one allergen. There was a wide difference in the total IgE values and in the sensitization rates to foods and aeroallergens among infants from different countries. The highest prevalence rates of allergen-sensitized infants were found in Australia (83%), the UK (79%) and Italy (76%). Infants from Belgium and Poland consistently had the lowest sensitization rates. In each country, a characteristic pattern of sensitization was found for aeroallergens (house dust mite > cat > grass pollen > Alternaria), but not for food allergens.

CONCLUSIONS

In infants with atopic eczema, there is a wide variation in the pattern of allergic sensitization between countries, and data from one country are not necessarily generalizable to other countries.