Continuing decline in acute asthma episodes in the community

Transcutaneous Bilirubin Measurements Can Be Used to Measure Bilirubin Levels during Phototherapy

Objective

To determine whether transcutaneous bilirubin measurements (TcB) before and during phototherapy taken from covered skin during phototherapy correlate with total serum bilirubin (TSB) levels.

Study Design

In this prospective observational study, healthy term newborns who required TSB measurements were included. TcB measurements were taken from the forehead before starting and during phototherapy using the BiliChek device. Before starting phototherapy, part of the forehead was covered. Blood for TSB measurement was collected within 5 minutes of TcB measurements. Correlations and mean differences between TcB and TSB before and during phototherapy were calculated.

Result

Paired TSB and TcB measurements before and during phototherapy in 151 newborns were performed. The mean gestational age was 38.8 weeks and birth weight was 3.1 kg; 53% were male. Before starting phototherapy, TSB and TcB were 183.8 ± 41.6 and 190.5 ± 43 μmol/l, respectively. During phototherapy, TSB and TcB were 191.8 ± 39.4 and 187.8 ± 45.3 μmol/l, respectively. Linear regression analysis showed a significant correlation between TcB and TSB before starting phototherapy and during phototherapy (r: 0.85; p < 0.001 and r: 80.0; p < 0.001), respectively. Before starting phototherapy, the mean difference between TSB and TcB was 6.2 ± 23.2 μmol/l, with a 95% CI of -39.3 to 51.7 μmol. During phototherapy, the mean difference was -2.8 ± 23.5 μmol/l, with a 95% CI of -48.9 to 43.3 μmol/l.

Conclusion

TcB measurements from covered skin in jaundiced term infants during phototherapy correlate with TSB and can be used to monitor bilirubin levels during phototherapy.

Epidemiology of asthma exacerbations and their relation with environmental factors in the Basque Country

BACKGROUND

Asthma is a highly prevalent chronic inflammatory disease characterised by reversible airflow obstruction and hyperreactivity and inflammation of the airways. Factors that cause and/or trigger asthma attacks include host-related factors (genetic predisposition, obesity and sex) and environmental factors (allergens, infections, occupational sensitisation, smoking status, pollution and diet).

OBJECTIVE

To describe the epidemiology of asthma exacerbations (AEs) in the Basque Country and to explore its relationship with potentially associated environmental variables. We studied a total of 31,579 emergency department (ED) visits and 28,189 hospitalisations due to asthma. We describe the trends, incidence, seasonality and the influence of age and sex, as well as of exposure to NO2 , CO, PM, O3 , and pollen, temperature, relative humidity and flu status. We calculated the Pearson's R correlation coefficient for the study variables.

RESULTS

The incidence was 486 and 88.9 cases per 100,000 people for ED visits and hospitalisations, respectively. Slightly over half (53.5%) of the ED cases were male, while females represented 62.6% of the hospital admissions. Hospitalisations are tending to decrease in children and increase in over 64-year-olds. Peaks in cases occur at the beginning of autumn in children and in winter in adults. AEs were correlated positively with exposure to NO2 , CO and to the influenza virus and negatively with temperature and exposure to O3 . These relationships vary, however, with age and season.

CONCLUSIONS AND CLINICAL RELEVANCE

Rates of hospitalisation for AEs and trends in these rates over time are different in adults and children with the patterns varying by sex, season and environmental conditions.

Is asthma a vanishing disease? A study to forecast the burden of asthma in 2022

Background

Recent evidence regarding temporal trends of asthma burden has not been consistent, with some countries reporting decreases in prevalence of asthma. In Ontario, the province in Canada with the highest population, the prevalence of asthma rose at a rate of 0.5% per year between 1996 and 2005. These estimates were based on population-based health services use data spanning more than a decade and provide a powerful source to forecast the trends of asthma burden. The objective of this study was to use observed population trends data of asthma incidence and prevalence to forecast future disease burden.

Methods

The Ontario Asthma Surveillance Information System (OASIS) used health administrative databases to identify and track all individuals in the province with asthma. Individuals with asthma identified between April 1, 1996 and March 31, 2010 were included. Exponential smoothing models were applied to annual data to project incidence to the year 2022, prevalence was estimated by applying the cumulative projected incidence to the projected population.

Results

While asthma incidence is falling, the absolute number of prevalent cases will continue to rise. We projected that almost 1 in 8 individuals in Ontario will have asthma by the year 2022, suggesting that asthma will continue to be a major burden on individuals and the health care system.

Conclusions

These projections will help inform health care planners and decision-makers regarding resource allocation to optimize asthma outcomes.

S, DUMITRESCU D, MARSHALL M, MIRESTEAN I, MURESAN M, IACOB D, FARCAU M, ICHIM GE, NANULESCU MV. Epidemiological survey 6 years apart: increased prevalence of asthma and other allergic diseases in schoolchildren aged 13-14 years in cluj-napoca, romania (based on isaac questionnaire)

BACKGROUND

The prevalence of asthma and allergy has increased during recent decades.

OBJECTIVE

We investigate the prevalence of asthma and other allergic diseases in children aged 13-14 years and we evaluate the trend of prevalence after an interval of 6 years.

MATERIAL AND METHODS

We used a core questionnaire designed by the International Study of Asthma and Allergy in Children. In 1991, the questionnaire was administered to 2,866 children from a Romanian city and during 2001 to 1,657 children from the same area.

RESULTS

The prevalence of asthma increased from 3.3% in 1995 to 5.5% in 2001 (p<0.001). In 1995, 4.3% of children reported asthma-related symptoms, significantly fewer than the percentage 6 years later (13.6%; p<0.00001). Similar results were obtained with regard to allergic rhinitis (13.6% versus 20%; p<0.00001) and eczema (11.5% versus 16.2%; p=0.00015). As far as gender differences are concerned, in the first stage of study all three allergic disorders were found to occur more frequently in females. In the study undertaken in 2001, females proved to have a higher prevalence of asthma (p=0.226), but a lower prevalence for allergic rhinitis (p=0.121) and eczema (p=0.064).

CONCLUSIONS

The prevalence of asthma and allergy increased significantly during the past 6 years.

Trends in prevalence of childhood and parental asthma in Merseyside, 1991-2006

BACKGROUND

To determine changes in prevalence of parental and childhood asthma in Merseyside between 1991 and 2006.

METHODS

Four standardized cross-sectional respiratory surveys using a parent-completed questionnaire were completed in 1991 (n = 1171), 1993 (n = 2368) 1998 (n = 1964) and in 2006 (n = 1074) among primary school children attending the same schools in lower socio-economic areas of Merseyside. Main outcome measures were prevalence of doctor diagnosed asthma (DDA) and the symptom triad of cough, wheeze and breathlessness (C+W+B+).

RESULTS

Between 1991 and 1998 prevalence of DDA increased (P < 0.001), but in 2006 this decreased from 29.8 to 19.4% (P < 0.001). Prevalence of C+W+B+ increased from 7.8 to 8.0% by 1998, then decreased to 6.7% in 2006 (P = 0.39). Between 1998 and 2006, childhood hospital admissions for respiratory illness decreased from 11.3 to 9.7% (P = 0.23). During this period paternal asthma prevalence increased from 8.6 to 10.7% (P = 0.001) and maternal asthma from 11.2 to 13.4% (P = 0.09).

CONCLUSIONS

An increase in the prevalence of DDA and asthmatic respiratory symptoms occurred in children prior to 1998, but this had decreased by 2006. Prevalence of parental asthma increased during the same period.

Is the prevalence of asthma declining? Systematic review of epidemiological studies

Asthma prevalence has increased very considerably in recent decades such that it is now one of the commonest chronic disorders in the world. Recent evidence from epidemiological studies, however, suggests that the prevalence of asthma may now be declining in many parts of the world, which, if true is important for health service planning and also because this offers the possibility of generating and testing new aetiological hypotheses. Our objective was to determine whether the prevalence of asthma is declining worldwide. We undertook a systematic search of EMBASE, Medline, Web of Science and Google Scholar, for high quality reports of cohort studies, repeat cross-sectional studies and analyses of routine healthcare datasets to examine international trends in asthma prevalence in children and adults for the period 1990-2008. There were 48 full reports of studies that satisfied our inclusion criteria. The large volume of data identified clearly indicate that there are, at present, no overall signs of a declining trend in asthma prevalence; on the contrary, asthma prevalence is in many parts of the world still increasing. The reductions in emergency healthcare utilization being reported in some economically developed countries most probably reflect improvements in quality of care. There remain major gaps in the literature on asthma trends in relation to Africa and parts of Asia. There is no overall global downward trend in the prevalence of asthma. Healthcare planners will for the foreseeable future, therefore, need to continue with high levels of anticipated expenditure in relation to provision of asthma care.

Changes in the prevalence of asthma, eczema and hay fever in pre-pubertal children: a 40-year perspective

Surveys of primary schools children in Aberdeen carried out in 1964, 1989, 1994 and 1999 suggested a slowing of the increase in parent-reported wheeze between 1994 and 1999. To assess whether this pattern had continued, questionnaires were distributed to 5712 children aged 7-12 years in the same schools in 2004. A total of 3271 (57.3%) completed questionnaires were returned. As in earlier surveys the results were divided into those for younger children (school years 3-4; age 7-9 years) and older children (school years 5-7; age 9-12 years). Compared with 1999, the 2004 results showed a decrease in the proportion of children with wheeze in the last 3 years from 30.1% to 23.3% (P < 0.001) in the younger group and from 27.6% to 25.1% (P = 0.052) in the older group. There was no significant change in the lifetime prevalence of asthma in either the younger or the older group, but the lifetime prevalence of eczema and hay fever increased by around 10% in both the younger and older groups (all P < 0.001). The differences in the time trends for the different conditions suggest that the causal factors for wheeze and asthma differ from those for other allergic diseases of childhood.

Acute respiratory admissions in Thessaloniki, Greece: 14-year follow-up

BACKGROUND

Acute exacerbations of respiratory diseases are a common cause of hospitalization among infants and children.

AIM

To assess the epidemiological characteristics of asthma, bronchiolitis and croup among hospitalized children in Thessaloniki, from 1990 to 2003 included.

METHODS

Data from the patient registry with discharge diagnosis "asthma", "bronchiolitis" and "croup" were analyzed retrospectively, in five Paediatric Departments of Thessaloniki. Age and sex of the patients, as well as the month of admission were taken into consideration.

RESULTS

A total of 8762 admissions of children (aged 3 months-14 years) with the diagnosis of asthma, "bronchiolitis" and "croup", were identified. Sex distribution was 65.86% males (64.86% bronchiolitis, 65.26% asthma and 70.31% croup). Asthma admissions decreased by 53.65%, croup admissions decreased by 4.73%, while bronchiolitis admissions increased by 25.03%, during the study period. A clear seasonal variation was found in all the three diseases, with the lowest incidence during summer months. Moreover there were two peaks for asthma (one during spring and a second during autumn), one peak for bronchiolitis (during winter early spring) and one peak for croup (during autumn).

CONCLUSIONS

Paediatric asthma and croup admissions have declined during the last 14 years, in contrast with bronchiolitis admissions, which showed an increased tendency. More frequent use of inhaled steroids and induction of asthma education programs may have contributed to decreasing asthma admission rates.

The natural history of fatal childhood asthma--a case from the Isle of Wight Birth Cohort

Subjects with severe and unstable asthma are at high risk of fatal asthma attack. We describe a case of fatal childhood asthma in an 11-year old girl whose asthma was apparently stable with supranormal lung function and identify additional characteristics that should be considered as increasing the risk for fatal asthma. This opportunity was provided by this girl's participation in the Isle of Wight Whole Population Birth Cohort Study. Prospectively collected data identified her as an early-onset persistent wheezer with significant allergic comorbidity. She was highly atopic with multiple allergen sensitization and a total IgE exceeding 5000 Ku/L (normal range: 0-180 ku/l) at 10 years. Additionally at that age, whilst possessing normal lung function (FEV(1) 2.15 Litres; 110% predicted), she was found to have marked bronchial hyper-responsiveness (PC(20) Methacholine 1.71 mg/ml). At the age of 11 years, despite apparent clinical stability and use of regular controller asthma therapy, she suffered a fatal acute asthma attack that may have been related to acute allergen exposure. This report provides further insight into factors associated with fatal childhood asthma. We propose that highly atopic children with early onset persistent asthma are at a higher risk of fatal asthma even if their asthma is apparently stable and lung function is normal. Marked bronchial hyper-responsiveness provides a clue and should be assessed if there is concern.

Relationship between social inequalities and ambulatory care-sensitive hospitalizations persists for up to 9 years among children born in a major Canadian urban center

OBJECTIVE

Hospitalizations for ambulatory care-sensitive (ACS) conditions have been considered a marker for access to timely and effective primary care, but there are few pediatric studies. Our purpose was to examine socioeconomic disparities in ACS and non-ACS admissions among birth cohorts in a universal health insurance setting.

METHODS

We examined ACS and all hospitalizations of children born from 1993 to 2000 in Toronto, Canada, by birth year, calendar year, and socioeconomic status (SES). SES was evaluated by using quintiles of mean neighborhood income from the 1996 Canadian census. Cohort, age, and temporal effects were described for all admissions, ACS admissions, and specific ACS conditions. Attributable risk by SES was calculated by using rates for the highest and lowest SES quintiles.

RESULTS

Among 255,284 children born in Toronto during 1993-2001, ACS conditions were responsible for 28% of hospitalizations during the first 2 years of life and close to half of admissions during the third year. Low income was associated with 50% higher rates of ACS hospitalizations (relative risk [RR] = 1.50, 95% confidence interval [95% CI] 1.43-1.58), including asthma (RR = 1.69, 95% CI 1.54-1.86) and bacterial pneumonia (RR = 1.59, 95% CI 1.40-1.81), the leading causes of admission. Socioeconomic disparities in ACS and all admissions occurred in every cohort, every calendar year, and every age group.

CONCLUSIONS

The relationship between socioeconomic disadvantage and both ACS and all-cause hospitalization in children was large, consistent across many conditions, remained stable over time, and persisted up to 9 years of age. These effects occurred in a universal health insurance setting without direct financial barriers to physician or hospital care. The effect of SES on hospitalizations in children in our setting appears to be mediated by factors other than financial access to care.

Trends in hospitalization for childhood asthma in Finland in 1996-2004

AIM

To discuss trends based on data on all asthma-related admissions of children under 15 years of age.

METHODS

retrospective analysis of records of the Finnish National Research and Development Centre for Welfare and Health in 1996-2004. The analysis was stratified for age.

RESULTS

Out of the total of 23,715 such admissions, 66.8% involved boys. The number of all admissions for boys aged 0-under 3 years declined by 42.7% (relative to the child population) between 1996 and 2004, that for boys aged 3-under 5 years by 55.1% and that for boys aged 5-under 15 years by 59.0%, the figures for the corresponding age groups of girls being 53.0, 48.7 and 66.1%, respectively. The overall rate of first admissions for asthma among children (relative to population) declined by 36.8% during that period. CONCLUSIONS. The hospitalization of children for asthma has declined in Finland in recent times in all age and both sex groups. This favourable development coincides with the systematically programmed national shift into effective anti-inflammatory therapy in the paediatric age groups.

Morbidity profiles of patients consulting during influenza and respiratory syncytial virus active periods

We compared the burden of illness due to a spectrum of respiratory diagnostic categories among persons presenting in a sentinel general practice network in England and Wales during periods of influenza and of respiratory syncytial virus (RSV) activity. During all periods of viral activity, incidence rates of influenza-like illness, bronchitis and common cold were elevated compared to those in baseline periods. Excess rates per 100,000 of acute bronchitis were greater in children aged <1 year (median difference 2702, 95% CI 929-4867) and in children aged 1-4 years (994, 95% CI 338-1747) during RSV active periods rather than influenza; estimates for the two viruses were similar in other age groups. Excess rates of influenza-like illness in all age groups were clearly associated with influenza virus activity. For common cold the estimates of median excess rates were significantly higher in RSV active periods for the age groups <1 year (3728, 95% CI 632-5867) and 5-14 years (339, 95% CI 59-768); estimates were similar in other age groups for the two viruses. The clinical burden of disease associated with RSV is as great if not greater than influenza in patients of all ages presenting to general practitioners.

50 years of asthma: UK trends from 1955 to 2004

Trends in asthma indicators from population surveys (prevalence) and routine statistics (primary care, prescriptions, hospital admissions and mortality) in the UK were reviewed from 1955 to 2004. The prevalence of asthma increased in children by 2 to 3-fold, but may have flattened or even fallen recently. Current trends in adult prevalence are flat. The prevalence of a life-time diagnosis of asthma increased in all age groups. The incidence of new asthma episodes presenting to general practitioners increased in all ages to a plateau in the mid 1990s and has declined since. During the 1990s, the annual prevalence of new cases of asthma and of treated asthma in general practice showed no major change. Hospital admissions increased from the early 1960s, more so in children, until the late 1980s and have fallen since. Asthma mortality showed two waves, a shorter and more intense one in the mid 1960s and a longer and less intense one in the late 1970s and early 1980s. The relative roles of diagnostic transfer, coding changes, medical care and epidemiological factors are discussed.

Four candles. Original perspectives and insights into 18th century hospital child healthcare

It has only recently been recognised that for more than a century before the opening of Great Ormond Street Hospital for Children (1852) children were treated and even admitted in English Voluntary Hospitals. Among the earliest English 18th century records, that contain the patient's age, are those found at the Northampton General Hospital within an archive dating from its foundation as the Northampton Infirmary in 1744. They afford a fascinating glimpse into both inpatient and outpatient child health. Although there are no medical notes as such, the hospital archive has recently rediscovered 1743 statutes, contemporary patient literature entitled Some Friendly Advice to a Patient (written by the Northampton Infirmary's founding physician Dr (later Sir) James Stonhouse), minute books, contemporary engravings of the outside and inside of the hospital and inpatient menus. Thus we can speculate with a high degree of certainty as to what would be the then current infirmary environment and treatments for illustrative examples of the children seen in the period 1744-45 (two inpatients and two outpatients). Interestingly one of the inpatient cases, Elizabeth Ager, a child with fever, was admitted against the infirmary regulations, suggesting already a stretching of boundaries in favour of paediatric admissions. This paper gives a flavour of 18th century hospital child healthcare in an era before the formal recognition of paediatrics as a medical specialty and preceding by more than a century the construction of specialist provision through the foundation of the first children's hospitals.

Childhood asthma in South London: trends in prevalence and use of medical services 1991-2002

BACKGROUND

Hospital admission rates for asthma in Britain rose during the 1980s and fell during the 1990s, but less is known about recent trends in the prevalence of asthma.

METHODS

In 1991 and 2002 the same questionnaire was distributed to parents of all school pupils in year 3 (aged 7-8 years) in the London borough of Croydon. Parents of currently wheezy children were then invited for home interview (100% targeted in 1991, 66% in 2002).

RESULTS

The prevalence of wheeze during the previous year increased from 12.9% in 1991 to 17.8% in 2002 (prevalence ratio 1.39 (95% CI 1.23 to 1.56)). Increases were observed in frequent (1.54 (95% CI 1.16 to 2.03)) and infrequent attacks, severe speech limiting episodes (2.25 (95% CI 1.34 to 3.77)), and night waking (1.36 (95% CI 1.07 to 1.72)), and in the reported use of steroids (19.9% v 64.1% of currently wheezy children). Nevertheless, the proportions reporting a visit to the GP at his/her surgery for wheeze in the previous year (prevalence ratio 1.15 (95% CI 0.91 to 1.45)) or an outpatient visit (0.98 (95% CI 0.49 to 1.94)) changed little and an increase in reported casualty attendance (1.66 (95% CI 0.89 to 3.07)) was non-significant.

CONCLUSIONS

There is evidence of an increase in the prevalence of asthma among British primary school children between 1991 and 2002. The absence of a corresponding increase in health service utilisation data may reflect more widespread prophylactic treatment and/or changes in the use and provision of medical services.

Asthma prevalence in 1973, 1988 and 2003

BACKGROUND

A study was undertaken to see whether the prevalence of asthma has changed since a survey was conducted in 1988, using the same methods that showed an increase during the previous 15 years.

METHODS

A survey of 12 year old children was conducted in schools in South Wales where surveys had taken place in 1973 and 1988. The survey comprised a parentally completed questionnaire and an exercise challenge test, performed when no bronchodilator had been recently used.

RESULTS

In 1973, 1988, and 2003, questionnaires were obtained for 817, 965 and 1148 children, respectively; the exercise test was performed by 812, 960 and 1019 children, respectively. The prevalence of reported wheeze in the last year rose during each 15 year period (9.8%, 15.2%, 19.7%), with an even steeper rise in reported asthma ever (5.5%, 12.0%, 27.3%). There was a continued increase in wheeze attributed to running, in terms of all children (5.8%, 10.5%, 16.0%) and also as the proportion of those with a history of wheeze (34.1%, 47.0%, 57.3%). The use of inhaled corticosteroids (not available in 1973) increased fourfold between 1988 and 2003. The prevalence of exercise induced bronchoconstriction rose between 1973 and 1988 but had declined by 2003.

CONCLUSIONS

The rise in the prevalence of asthmatic symptoms has continued since 1988. This appears to conflict with a reported recent decline, unless asthma prevalence peaked in the 1990s. The decline in exercise induced bronchoconstriction is probably attributable to better control of the disease as more children are now using inhaled corticosteroids as preventive treatment.

Recent changes in the prevalence of diseases presenting for health care

BACKGROUND

Practice-based morbidity surveys inform on the prevalence of diseases presenting for health care. The last major survey in England and Wales was conducted in 1991.

AIM

To reveal changes in disease prevalence between 1991 and 2001.

DESIGN OF STUDY

Population-based analysis of persons presenting to GPs. Annual prevalence of diseases reported in the Weekly Returns Service (WRS) of the Royal College of General Practitioners in 2001 was compared with prevalence reported in Morbidity Statistics from General Practice, Fourth National Study (MSGP4).

SETTING

Thirty-eight general practices contributing to the WRS, monitoring a population of 326,000 in 2001.

METHOD

Prevalence was determined from Read codes for morbidity entered in the respective survey years. Diseases and disease groups were defined from Read codes mapping to the chapters, major sub-groups and 3-digit codes of the International Classification of Disease version 9 (ICD9). Age-standardised prevalence rates per 10,000 registered persons and 99% confidence intervals (CIs) were calculated using the national census population for 2001 as the standard. Survey differences in prevalence were identified from non-overlapping CIs.

RESULTS

There was a general reduction in the prevalence of disease caused by infection and an increase of degenerative disorders. The prevalence of mental disorders, skin disease and musculoskeletal disorders showed little change. Particular increases were noted for other malignant and benign neoplasms of the skin, hypothyroidism and diabetes. There were marked reductions for disorders of the conjunctiva, ear infections, acute myocardial infarction and heart failure, respiratory infections and injuries.

CONCLUSIONS

The role of the GP continues to change. These results confirm the importance of the management of chronic diseases as the dominant (though not the sole) role of the GP. The results demonstrate the use of the WRS as a source of data on disease prevalence.

No increase in the prevalence of asthma, allergies, and atopic sensitisation among children in Germany: 1992-2001

BACKGROUND

From 1970 to 1990 increasing rates of asthma and allergic sensitisation were observed in several countries. The aim of this study was to investigate time trends in the prevalence of asthma and allergic sensitisation among school children in Germany between 1992 and 2001.

METHODS

Parental reports of asthma, hay fever, and wheezing and measurements of specific serum IgE antibodies were investigated in six serial cross sectional surveys of 9-11 year old school children in three study areas in south west Germany.

RESULTS

A total of 6762 school children of mean age 10 years (mean participation rate 77.9%) took part in the investigation in the three study areas. Over the 9 year study period no increase in the prevalence of current wheezing and asthma was observed. In addition, the prevalence of atopic sensitisation remained unchanged during the observation period.

CONCLUSIONS

These data, using parental reports and objective measures of allergy, suggest that there has been no further increase in the prevalence of asthma and atopy since 1992. The epidemic may thus have reached a plateau.

Diverging prevalence trends of atopic disorders in Norwegian children. Results from three cross-sectional studies

BACKGROUND

During the last decades there has been extensive epidemiological research to explore the increasing prevalence of asthma and allergy in childhood. The worldwide variations in prevalence of these diseases necessitate regional rapports. Furthermore, time-trend analyses with comparable methods are important in order to monitor the rapidly changing prevalence of these diseases.

METHODS

Three cross-sectional questionnaire-based studies of asthma and allergy in schoolchildren were conducted in the counties of Troms and Finnmark, in northern Norway in 1985, 1995 and 2000. The two former studies included children from randomly selected primary schools (n = 1794/1985, n = 1432/1995). The latter study was a part of ISAAC-II Europe study (n = 3853). Identical items of asthma and allergy were employed. The analyses comprised only children 9-11 years of age.

RESULTS

The prevalence of asthma was 9.3, 13.2 and 13.8% in 1985, 1995 and 2000, respectively. However, great gender differences were detected; the prevalence of asthma increased in males from 1995 to 2000, from 14.1 to 17.0%, RR = 1.2 (95% CI 1.0-1.5), but decreased in females 1995 to 2000, from 12.3 to 10.5%, RR = 0.9 (95% CI 0.7-1.1). Furthermore, in children with asthma, a changing trend was found in the external factors that perceived symptoms, from typical allergens towards other, unspecific agents. The prevalence of self-reported atopic eczema/dermatitis syndrome (AEDS) was 13.4, 21.1 and 20.8% in 1985, 1995 and 2000, respectively. The prevalence of self-reported allergic rhinoconjunctivitis was in 16.5, 24.7 and 29.6% 1985, 1995 and 2000, respectively, RR (2000/1995) = 1.2 (95% CI 1.1-1.3).

CONCLUSION

The prevalence of asthma in girls has reached a plateau and even decreased from 1995 to 2000 which is in contrast to the asthma prevalence in boys that tends to continuously increase. The prevalence of AEDS which increased substantially between 1985 and 1995 did not change from 1995 to 2000. However, the prevalence of allergic rhinoconjunctivitis increased steadily from 1985, 1995 to 2000.

Asthma epidemiology: has the crisis passed?

PURPOSE OF REVIEW

Asthma is a difficult, resource-intensive disease that can result in symptoms, hospitalization and, in rare cases, death. In the past few decades, there has been an abundance of evidence showing the prevalence of asthma to be increasing in certain regions. However, reports have recently emerged suggesting that asthma prevalence has stabilized. This has led to debate among researchers whether increases in asthma prevalence have come to an end. We reviewed recent literature in search of answers to the ongoing debate on whether the asthma crisis is over.

RECENT FINDINGS

In contrast with past reports, several recent studies have reported a stabilization of asthma prevalence. However, based on repeated cross-sectional studies, findings regarding the stabilization of asthma prevalence have been inconsistent, especially when considering the heterogeneity of the disease, which can result in a variety of patterns concerning asthma diagnosis, symptoms, and allergic sensitization. Temporal trends considering physician visits, hospitalizations, and mortality have been more consistent, with stabilizing and decreasing patterns of asthma burden in recent years.

SUMMARY

Because reasons for the original increases in asthma prevalence remain unclear, an explanation for the apparent stabilization of asthma prevalence reported in some studies also remains elusive. This is compounded by the difficulty in defining asthma accurately in population studies and inconsistencies in the results of prevalence estimation among repeated cross-sectional studies. Efforts should be made to continue monitoring asthma prevalence and to begin monitoring asthma prevalence in regions where environmental and social changes are occurring.

Deprivation, smoking, and quality of life in asthma

AIMS

To explore associations of deprivation and smoking, with prevalence of asthma, wheeze, and quality of life.

METHODS

Survey, using International Study of Asthma and Allergies in Childhood (ISAAC) methodology, of children aged 13-14 years attending Scottish schools previously surveyed in 1995.

RESULTS

4665/5247 (89%) pupils completed questionnaires. 3656/4665 (78.4%) had missed school for any reason in the last 12 months, 587 (12.6%) because of asthma or wheeze. Compared to children with 1-3 wheeze attacks per year, those with >12 attacks in the last year were more likely to have missed school, twice as likely to have missed physical education in the last month, to report interference with home activities, or to have visited accident and emergency departments, and three times more likely to have been hospitalised. Deprivation was not independently associated with self-reported asthma or wheeze, but was associated with school absence, either for any reason or specifically for asthma or wheeze, but not with use of services such as accident and emergency visits, doctor visits, or hospital admissions. Active smoking was associated with wheezy symptoms, and active and passive smoking with use of medical services. These associations were independent of wheeze severity, treatment taken, and other associated atopic conditions. Smoking also had an impact on school absence and home and school activities.

CONCLUSIONS

Deprivation does not affect the prevalence of asthma or wheeze. Exposure to cigarette smoke was associated with the increased use of services. Deprivation and smoking have independent adverse effects on the quality of life in subjects with asthma or wheeze.