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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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Soto-Martínez ME, Yock-Corrales A, Camacho-Badilla K, Abdallah S, Duggan N, Avila-Benedictis L, Romero JJ, Soto-Quirós ME. The current prevalence of asthma, allergic rhinitis, and eczema related symptoms in school-aged children in Costa Rica. J Asthma 2018; 56:360-368. [PMID: 29693462 DOI: 10.1080/02770903.2018.1455860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Asthma prevalence in Costa Rica is among the highest worldwide. We aimed to determine the prevalence of asthma among school-age children in the Central Highland Area of Costa Rica. METHODS Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was performed. Parents or guardians of children aged 6-13 years completed written questionnaires. RESULTS Total of 2817 school-aged children returned these questionnaires (74.1% return rate). The prevalence of asthma, rhinitis, and eczema was 21.9%, 42.6%, and 19.2%, respectively. The co-existence of the 3 diseases was seen in 22.6% of children with asthma. Boys had a slightly higher prevalence of these conditions, and younger children had higher prevalence of asthma and eczema, but lower prevalence of rhinitis than older children. The use of acetaminophen and antibiotics in the first 12 months of life showed a significant association with the prevalence of asthma, rhinitis, and eczema. Wheezing with exercise, dry cough at night, and ever rhinitis was highly associated with asthma symptoms in the last 12 months. In contrast, no association was found between children exposed to smoking at home. Frequent traffic next to the house was reported more frequently by the parents of children with asthma, although no significant association was found. CONCLUSION The prevalence of asthma showed a significant decrease compared to previous studies. However, there was an unexpected high prevalence of rhinitis. Exposure to acetaminophen and antibiotic during the first year of life was highly associated with asthma symptoms.
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Affiliation(s)
- M E Soto-Martínez
- a Respiratory Department , Hospital Nacional de Niños , Costa Rica.,b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica.,c School of Public Health, Tullane University , New Orleans , LA , USA
| | - A Yock-Corrales
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica.,c School of Public Health, Tullane University , New Orleans , LA , USA.,d Emergency Department , Hospital Nacional de Niños , Costa Rica
| | - K Camacho-Badilla
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica.,c School of Public Health, Tullane University , New Orleans , LA , USA.,e Department of Infectious Diseases , Hospital Nacional de Niños , San José , Costa Rica
| | - S Abdallah
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica
| | - N Duggan
- c School of Public Health, Tullane University , New Orleans , LA , USA
| | - L Avila-Benedictis
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica
| | - J J Romero
- f School of Veterinary Medicine, Population Medicine Research Program, National University of Costa Rica , Heredia , Costa Rica
| | - M E Soto-Quirós
- a Respiratory Department , Hospital Nacional de Niños , Costa Rica.,b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica
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Avila L, Soto-Martínez ME, Soto-Quirós ME, Celedón JC. Asthma, current wheezing, and tobacco use among adolescents and young adults in Costa Rica. J Asthma 2006; 42:543-7. [PMID: 16169786 DOI: 10.1080/02770900500214791] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine the prevalence of asthma and the relation between tobacco use and asthma among university students in Costa Rica. METHODS Cross-sectional study of 1279 adolescents and young adults enrolled in careers in the health sciences in public and private universities in Costa Rica. RESULTS Of the 1279 study participants, 105 (8.2%) had current asthma, and 136 (10.6%) reported wheezing in the previous 12 months (current wheezing). Among individuals with either current wheezing or current asthma, none was using anti-inflammatory medications for asthma (e.g., inhaled corticosteroids). Approximately one third of the study participants reported any cigarette smoking. Young adults who had current wheezing were 5.8 times more likely to smoke at least 10 cigarettes per day than those who had no current wheezing [95% confidence interval (CI) for odds ratio (OR) = 3.3-10.2, p < 0.001]. Similar results were observed when an alternative definition of asthma (current asthma) was used in the analysis (OR for smoking at least 10 cigarettes per day = 4.4, 95% CI = 2.3-8.5, p < 0.001). CONCLUSIONS Adequate public health measures are needed to prevent tobacco use in Costa Rican adolescents and to promote smoking cessation among young adults. Young adults with asthma living in Latin American countries with high asthma prevalence, such as Costa Rica, should be better educated with regard to asthma and the risks of tobacco use.
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Affiliation(s)
- Lydiana Avila
- Division of Pediatric Pulmonology, Hospital Nacional de Niños, San José, Costa Rica
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