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García-Marcos L, Chiang CY, Asher MI, Marks GB, El Sony A, Masekela R, Bissell K, Ellwood E, Ellwood P, Pearce N, Strachan DP, Mortimer K, Morales E, Ajeagah GA, Alkhayer G, Alomary SA, Ambriz-Moreno MJ, Arias-Cruz A, Awasthi S, Badellino H, Behniafard N, Bercedo-Sanz A, Brożek G, Bucaliu-Ismajli I, Cabrera-Aguilar A, Chinratanapisit S, Del-Río-Navarro BE, Douros K, El Sadig H, Escalante-Dominguez AJ, Falade AG, Gacaferri-Lumezi B, García-Almaráz R, Garcia-Muñoz R, Ghashi V, Ghoshal AG, González-Díaz C, Hana-Lleshi L, Hernández-Mondragón LO, Huang JL, Jiménez-González CA, Juan-Pineda MÁ, Kochar SK, Kuzmicheva K, Linares-Zapien FJ, Lokaj-Berisha V, López-Silvarrey A, Lozano-Sáenz JS, Mahesh PA, Mallol J, Martinez-Torres AE, Masekela R, Mérida-Palacio JV, Mohammad Y, Moreno-Gardea HL, Navarrete-Rodriguez EM, Ndikum AE, Noor M, Ochoa-Lopez G, Pajaziti L, Pellegrini-Belinchon J, Perez-Fernández V, Priftis K, Ramos-García BC, Ranasinghe JC, Robertson S, Rodriguez-Perez N, Rutter CE, Sacre-Hazouri JA, Salvi S, Sanchez JF, Sánchez JF, Sanchez-Coronel MG, Saucedo-Ramirez OJ, Singh M, Singh N, Singh V, Sinha S, Sit N, Sosa-Ferrari SM, Soto-Martínez ME, Urrutia-Pereira M, Yeh KW, Zar HJ, Zhjeqi V. Asthma management and control in children, adolescents, and adults in 25 countries: a Global Asthma Network Phase I cross-sectional study. Lancet Glob Health 2023; 11:e218-e228. [PMID: 36669806 PMCID: PMC9885426 DOI: 10.1016/s2214-109x(22)00506-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Asthma is one of the most common non-communicable diseases globally. This study aimed to assess asthma medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood across different country settings. METHODS We used data from the Global Asthma Network Phase I cross-sectional epidemiological study (2015-20). A validated, written questionnaire was distributed via schools to three age groups (children, 6-7 years; adolescents, 13-14 years; and adults, ≥19 years). Eligible adults were the parents or guardians of children and adolescents included in the surveys. In individuals with asthma diagnosed by a doctor, we collated responses on past-year asthma medicines use (type of inhaled or oral medicine, and frequency of use). Questions on asthma symptoms and health visits were used to define past-year symptom severity and extent of asthma control. Income categories for countries based on gross national income per capita followed the 2020 World Bank classification. Proportions (and 95% CI clustered by centre) were used to describe results. Generalised structural equation multilevel models were used to assess factors associated with receiving medicines and having poorly controlled asthma in each age group. FINDINGS Overall, 453 473 individuals from 63 centres in 25 countries were included, comprising 101 777 children (6445 [6·3%] with asthma diagnosed by a doctor), 157 784 adolescents (12 532 [7·9%]), and 193 912 adults (6677 [3·4%]). Use of asthma medicines varied by symptom severity and country income category. The most used medicines in the previous year were inhaled short-acting β2 agonists (SABA; range across age groups, 29·3-85·3% participants) and inhaled corticosteroids (12·6-51·9%). The proportion of individuals with severe asthma symptoms not taking inhaled corticosteroids (inhaled corticosteroids alone or with long-acting β2 agonists) was high in all age groups (934 [44·8%] of 2085 children, 2011 [60·1%] of 3345 adolescents, and 1142 [55·5%] of 2058 adults), and was significantly higher in middle-to-low-income countries. Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines. Asthma management plans were used by 4049 (62·8%) children, 6694 (53·4%) adolescents, and 3168 (47·4%) adults; and 2840 (44·1%) children, 6942 (55·4%) adolescents, and 4081 (61·1%) adults had well controlled asthma. Independently of country income and asthma severity, having an asthma management plan was significantly associated with the use of any type of inhaled medicine (adjusted odds ratio [OR] 2·75 [95% CI 2·40-3·15] for children; 2·45 [2·25-2·67] for adolescents; and 2·75 [2·38-3·16] for adults) or any type of oral medicine (1·86 [1·63-2·12] for children; 1·53 [1·40-1·68] for adolescents; and 1·78 [1·55-2·04] for adults). Poor asthma control was associated with low country income (lower-middle-income and low-income countries vs high-income countries, adjusted OR 2·33 [95% CI 1·32-4·14] for children; 3·46 [1·83-6·54] for adolescents; and 4·86 [2·55-9·26] for adults). INTERPRETATION Asthma management and control is frequently inadequate, particularly in low-resource settings. Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries. FUNDING International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca, UK National Institute for Health Research, UK Medical Research Council, European Research Council, the Spanish Instituto de Salud Carlos III. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Luis García-Marcos
- Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children‘s Hospital, University of Murcia and IMIB Bio-medical Research Institute, Murcia, Spain,ARADyAL Allergy Network, Murcia, Spain,Correspondence to: Prof Luis García-Marcos, Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children‘s Hospital, University of Murcia and IMIB Bio-medical Research Institute, 30120 Murcia, Spain
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France,Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, and Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - M Innes Asher
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Guy B Marks
- Respiratory and Environmental Epidemiology, University of New South Wales, Sydney, NSW, Australia
| | - Asma El Sony
- Epidemiological Laboratory for Public Health, Research and Development, Khartoum, Sudan
| | - Refiloe Masekela
- Inkosi Albert Luthuli Central Hospital, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karen Bissell
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kevin Mortimer
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Eva Morales
- Department of Public Health Sciences, University of Murcia and IMIB Bio-medical Research Institute, Murcia, Spain
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Larenas-Linnemann D, Michels A, Dinger H, Shah-Hosseini K, Mösges R, Arias-Cruz A, Ambriz-Moreno M, Barajas MB, Javier RC, de la Luz Cid Del Prado M, Moreno MAC, Almaráz RG, García-Cobas CY, Garcia Imperial DA, Muñoz RG, Hernández-Colín D, Linares-Zapien FJ, Luna-Pech JA, Matta-Campos JJ, Jiménez NM, Medina-Ávalos MA, Hernández AM, Maldonado AM, López DN, Pizano Nazara LJ, Sanchez ER, Ramos-López JD, Rodríguez-Pérez N, Rodríguez-Ortiz PG. Allergen sensitization linked to climate and age, not to intermittent-persistent rhinitis in a cross-sectional cohort study in the (sub)tropics. Clin Transl Allergy 2014; 4:20. [PMID: 24976949 PMCID: PMC4073512 DOI: 10.1186/2045-7022-4-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allergen exposure leads to allergen sensitization in susceptible individuals and this might influence allergic rhinitis (AR) phenotype expression. We investigated whether sensitization patterns vary in a country with subtropical and tropical regions and if sensitization patterns relate to AR phenotypes or age. METHODS In a national, cross-sectional study AR patients (2-70 y) seen by allergists underwent blinded skin prick testing with a panel of 18 allergens and completed a validated questionnaire on AR phenotypes. RESULTS 628 patients were recruited. The major sensitizing allergen was house dust mite (HDM) (56%), followed by Bermuda grass (26%), ash (24%), oak (23%) and mesquite (21%) pollen, cat (22%) and cockroach (21%). Patients living in the tropical region were almost exclusively sensitized to HDM (87%). In the central agricultural zones sensitization is primarily to grass and tree pollen. Nationwide, most study subjects had perennial (82.2%), intermittent (56.5%) and moderate-severe (84.7%) AR. Sensitization was not related to the intermittent-persistent AR classification or to AR severity; seasonal AR was associated with tree (p < 0.05) and grass pollen sensitization (p < 0.01). HDM sensitization was more frequent in children (0-11 y) and adolescents (12-17 y) (subtropical region: p < 0.0005; tropical region p < 0.05), but pollen sensitization becomes more important in the adult patients visiting allergists (Adults vs children + adolescents for tree pollen: p < 0.0001, weeds: p < 0.0005). CONCLUSIONS In a country with (sub)tropical climate zones SPT sensitization patterns varied according to climatological zones; they were different from those found in Europe, HDM sensitization far outweighing pollen allergies and Bermuda grass and Ash pollen being the main grass and tree allergens, respectively. Pollen sensitization was related to SAR, but no relation between sensitization and intermittent-persistent AR or AR severity could be detected. Sensitization patterns vary with age (child HDM, adult pollen). Clinical implications of our findings are dual: only a few allergens -some region specific- cover the majority of sensitizations in (sub)tropical climate zones. This is of major importance for allergen manufacturers and immunotherapy planning. Secondly, patient selection in clinical trials should be based on the intermittent-persistent and severity classifications, rather than on the seasonal-perennial AR subtypes, especially when conducted in (sub)tropical countries.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Alexandra Michels
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Hanna Dinger
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Kijawasch Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Ralph Mösges
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany ; University of Cologne, Cologne, Germany
| | - Alfredo Arias-Cruz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Centro Regional de Alergia e Inmunología Clínica, Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León
| | - Marichuy Ambriz-Moreno
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Martín Bedolla Barajas
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínica, División de Medicina Interna, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ruth Cerino Javier
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; CEINTAP (centro de investigación y tratamiento del asma pediátrico), Hospital Regional de Alta Especialidad del Niño. Dr. Rodolfo Nieto Padrón, Villahermosa, Tabasco, Mexico
| | - María de la Luz Cid Del Prado
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Manuel Alejandro Cruz Moreno
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Clinica Santa Cruz, Villahermosa, Tabasco
| | - Roberto García Almaráz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy Department, Hospital Infantil de Tamaulipas, Cd.Victoria, Tamaulipas, Mexico
| | - Cecilia Y García-Cobas
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Inmunología y Alergia, UMAE Hospital de Especialidades, CMNO, IMSS, Guadalajara, Jalisco, Mexico
| | - Daniel A Garcia Imperial
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy Department, Hospital Médica Tec 100, Querétaro, Querétaro, Mexico
| | - Rosa Garcia Muñoz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Dante Hernández-Colín
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínica, División de Medicina Interna, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Francisco J Linares-Zapien
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Centro de Diagnostico y Tratamiento de Enfermedades Alérgicas y Asma de Toluca, Toluca, Estado de México
| | - Jorge A Luna-Pech
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Inmunología y Alergia, UMAE Hospital de Especialidades, CMNO, IMSS, Guadalajara, Jalisco, Mexico
| | - Juan J Matta-Campos
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy and Clinical Immunology Department, Hospital of specializations CMN 'Siglo XXI', Mexico, DF, Mexico
| | - Norma Martinez Jiménez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Miguel A Medina-Ávalos
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Alejandra Medina Hernández
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Coordination of evidence based medicine (EBM), Facultad de medicina. Universidad Autonoma de Queretaro, Querétaro, Querétaro, Mexico
| | - Alberto Monteverde Maldonado
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Doris N López
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico
| | - Luis J Pizano Nazara
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Clinical immunology & allergy department, Clínica Hospital San Jose, Cd.Obregón, Sonora, Mexico
| | - Emmanuel Ramirez Sanchez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Allergy and immunology department, General Hospital of Cancun "Dr. Jesus Kumate Rodriguez', Cancun, Quintana Roo, Mexico
| | - José D Ramos-López
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Servicio de Alergia e Inmunología Clínic, Seguro Social, Hospital General de Zona No2, Potosí, Potosí, Mexico
| | - Noel Rodríguez-Pérez
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Pediatrics and Immunology, Autonomous university of Tamaulipas, H.Matamoros, Tamaulipas, Mexico
| | - Pablo G Rodríguez-Ortiz
- Mexican Study Group on Allergic Rhinitis and Skin Sensitivity. Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra; Delegación Tlalpan, México, DF 14050, Mexico ; Hospital Star Médica Mérida, Mérida, Yucatan, Mexico
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