Semin Respir Crit Care Med 2002; 23(4): 317-330
DOI: 10.1055/s-2002-34327
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Epidemiology of Asthma

Michael B. Keller, Steven R. Lowenstein
  • University of Colorado Health Sciences Center, Denver, Colorado
Further Information

Publication History

Publication Date:
26 September 2002 (online)

ABSTRACT

There is no illness more in need of epidemiological study than asthma. Despite significant advances in our understanding of the pathophysiology, course, and management of this disease, its prevalence, morbidity, and mortality appear to be on the rise, and the reasons are not entirely clear. Historically, epidemiological studies of asthma have suffered from the lack of a standardized definition of the disease and the lack of a ``gold standard'' with which to compare objective measures for diagnosing the illness. Recent studies have overcome some of these difficulties to provide solid epidemiological data on asthma from a global perspective. International studies have demonstrated that asthma prevalence varies significantly worldwide, with Western, English-speaking countries having the highest prevalence rates. In the United States, the prevalence of asthma has increased by nearly 75% in the past 2 decades. Young children, blacks, and Hispanics tend to be disproportionately affected by the disease. Asthma morbidity, as measured by emergency department visits, hospitalizations, and medication usage has been increasing worldwide, and asthma mortality, although still rare, has been increasing as well. Epidemiological studies have provided important information regarding the etiology and risk factors for asthma. The disease is emerging as a prototypical illness for the alliance of genetic and environmental disease determinants. Some of the most important conclusions relate to the developing immune system and the timing of certain allergic or infectious exposures that may predispose the child to develop asthma. Indeed, advances in epidemiological study will be critical if we are to intervene and reverse some of asthma's disturbing trends.

REFERENCES

  • 1 National Heart, Lung, and Blood Institute (NHLBI). Data Fact Sheet Asthma Statistics. Bethesda, MD: National Institutes of Health, Public Health Service 1999
  • 2 Weiss K B, Sullivan S D. The health economics of asthma and rhinitis: assessing the economic impact.  J Allergy Clin Immunol . 2001;  107 3-8
  • 3 National Heart, Lung, and Blood Institute/World Health Organization. Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention. Bethesda, MD: National Institutes of Health; 1995. NHLBI/WHO Workshop Report. Publication no. 95-3659
  • 4 Burney P. Interpretation of epidemiological surveys of asthma. In: Chadwick D, Cardew G, eds. The Rising Trends in Asthma New York: Wiley 1997: 111-121
  • 5 Peat J K, Toelle B G, Marks G B. Continuing the debate about measuring asthma in population studies.  Thorax . 2001;  56 406-411
  • 6 Toren K, Brisman J, Jarvholm B. Asthma and asthma-like symptoms in adults assessed by questionnaires: a literature review.  Chest . 1993;  104 600-608
  • 7 Pekkanen J, Pearce N. Defining asthma in epidemiological studies.  Eur Respir J . 1999;  14 951-957
  • 8 International Survey of Asthma and Allergy in Childhood: worldwide variation in prevalence of symptoms of asthma, allergic conjunctivitis, and atopic eczema. The ISAAC Steering Committee. Lancet 1998 351: 1225-1232
  • 9 Behrendt H, Kramer U, Dolgner R. Elevated levels of total IgE in East German children: atopy, parasites or pollutants?.  Allergol J . 1993;  2 31-40
  • 10 Chinn S, Jarvis D, Luczynska C M. Measuring atopy in a multi-centre epidemiological study.  Eur J Epidemiol . 1996;  12 155-162
  • 11 Toelle B G, Peat J K, Salome C M. Toward a definition of asthma for epidemiology.  Am Rev Respir Dis . 1992;  146 633-637
  • 12 Toelle B G, Marks G B, Belousova E. Longitudinal validation of an epidemiologic definition of asthma.  Respirology . 2000;  5(suppl) A6
  • 13 Burney P, Chinn S, Jarvis D. Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS).  Eur Respir J . 1996;  9 687-695
  • 14 Pearce N. Introduction. In: Pearce N, Beasley R, Burgess C, Crane J, eds. Asthma Epidemiology: Principles and Methods New York: Oxford University Press 1998: 4-15
  • 15 Beasley D M, Crane J, Christopher K W. Prevalence and etiology of asthma.  J Allergy Clin Immunol . 2000;  105 S466-S472
  • 16 Van Niekerk H C, Weinberg E G, Shore S C. Prevalence of asthma: a comparative study of urban and rural Xhosa children.  Clin Allergy . 1979;  9 319-324
  • 17 Von Mutius E, Weiland S K, Fritzsch, et al. Increasing prevalence of hay fever and atopy in Leipzig, East Germany.  Lancet . 1998;  351 862-866
  • 18 Stewart A W, Mitchell E A, Pearce N. The relationship of per capita gross national product to the prevalence of symptoms of asthma and other atopic diseases in children (ISAAC).  Int J Epidemiol . 2001;  30 173-179
  • 19 Centers for Disease Control (CDC). Behavioral Risk Factor Surveillance System User's Guide Atlanta, Ga: U.S. Department of Health and Human Services, CDC 1999
  • 20 Centers for Disease Control (CDC). Tracking Major Health Risks among Americans: The Behavioral Risk Factor Surveillance System. Atlanta, Ga: U.S. Department of Health and Human Services, CDC 2000
  • 21 Mannino D M, Homa D M, Pertowski C A. Surveillance for asthma: United States, 1960-1995.  Mor Mortal Wkly Rep CDC Surveill Summ . 1998;  47 1-27
  • 22 Schwartz J, Gold D, Dockery D W. Predictors of asthma and persistent wheeze in a national sample of children in the United States: association with social class, perinatal events and race.  Am Rev Respir . 1990;  142 555-562
  • 23 Lwebuga-Mukasa J S, Dunn-Georgiou E. The prevalence of asthma in children of elementary school age in western New York.  J Urban Health . 2000;  77 745-761
  • 24 Aligne C A, Auinger P, Byrd R S. Risk factors for pediatric asthma.  Am J Respir Crit Care Med . 2000;  162 873-877
  • 25 National Center for Health Statistics (NCHS). Current estimates from the National Health Interview Survey, 1990.  Vital and Health Statistics . 1997;  10 19-20
  • 26 McCaig L F. National Hospital Ambulatory Medical Care Survey: 1998 Emergency Department Summary. National Center for Health Statistics.  Vital and Health Statistics . 2000;  313 1-24
  • 27 Centers for Disease Control (CDC). Healthy People 2010. Respiratory Diseases. 24-2-24-27
  • 28 Kesten S, Rebuck A S, Chapman K R. Trends in asthma and chronic obstructive pulmonary disease therapy in Canada, 1985 to 1990.  J Allergy Clin Immunol . 1993;  92 499-506
  • 29 Weiss K B, Sullivan S D, Lyttle C S. Trends in the cost of illness for asthma in the United States, 1985-1994.  J Allergy Clin Immunol . 2000;  106 493-499
  • 30 Mitchell E A. International trends in hospital admission rates for asthma.  Arch Dis Child . 1985;  60 376-378
  • 31 Mullally D I, Howard W A, Hubbard T J. Increased hospitalizations for asthma among children in the Washington, DC area during 1961-81.  Ann Allergy . 1984;  53 15-19
  • 32 Anderson H R. Increase in hospital admissions for childhood asthma: trends in referral, severity, and readmissions from 1970 to 1985 in a health region of the United Kingdom.  Thorax . 1989;  44 614-619
  • 33 Dawson K P. The severity of acute asthma attacks in children admitted to hospital.  Aust Paed J . 1987;  23 167-168
  • 34 Hall M J, Popovic J R. 1998 Summary: National Hospital Discharge Survey. National Center for Health Statistics.  Vital and Health Statistics . 2000;  316 1-20
  • 35 Russo M J, McConnochie K M, McBride J T. Increase in admission threshold explains stable asthma hospitalization rates.  Pediatrics . 1999;  104 454-462
  • 36 Wissow L S, Gittelsohn A M, Szklo M. Poverty, race, and hospitalization for childhood asthma.  Am J Public Health . 1988;  78 777-782
  • 37 Silverstein M D, Reed C E, O'Connell E J. Long-term survival of a cohort of community residents with asthma.  N Engl J Med. . 1994;  331 1537-1541
  • 38 Burney P G. Epidemiologic trends. In: Barnes PJ, Grunstein M, Leff AR, eds. Asthma Philadelphia: Lippincott-Raven 1997: 35-47
  • 39 Jackson R, Sears M R, Beaglehole R, Rea H H. International trends in asthma mortality: 1970 to 1985.  Chest . 1988;  94 914-918
  • 40 Jackson R T, Beaglehole R, Rea H H. Mortality from asthma: a new epidemic in New Zealand.  BMJ . 1982;  285 771-774
  • 41 Sears M R, Taylor D. The B2 agonist controversy: observations, explanations and relationship to asthma epidemiology.  Drug Safety . 1994;  11 259-283
  • 42 Anto J M, Sunyer J. A point-source asthma outbreak.  Lancet . 1986;  1 900-903
  • 43 Weiss K B, Gergen P J, Wagener D K. Breathing better or wheezing worse?.  <~>The changing epidemiology of asthma morbidity and mortality. Annu Rev Public Health . 1993;  14 491-513
  • 44 Murphy S L. Deaths: final data for 1998. National Vital Statistics Reports.  National Center for Health Statistics . 48 2-5
  • 45 Grant E N, Lyttle C S, Weiss K B. The relation of socioeconomic factors and racial/ethnic differences in US asthma mortality.  Am J Public Health . 2000;  90 1923-1925
  • 46 Schwartz E, Kofie V Y, Rivo M. Black/white comparison of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986.  Int J Epidemiol . 1990;  19 591-598
  • 47 Weiss K B, Wagener D K. Geographic variation in US asthma mortality: small-area analyses of excess mortality, 1981-1985.  Am J Epidemiol . 1990;  132 S107-S115
  • 48 National Heart, Lung, and Blood Institute (NHLBI). NHLBI Chartbook: Data Fact Sheet on Asthma Statistics. Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; January 1999
  • 49 Taylor W R, Newacheck P W. Impact of childhood asthma on health.  Pediatrics . 1992;  90 657-662
  • 50 Lozano P, Fishman P, VonKorff M. Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization.  Pediatrics . 1997;  99 757-764
  • 51 Von Mutius E. The burden of childhood asthma.  Arch Dis Child . 2000;  ii2-ii5
  • 52 Martinez F D, Wright A L, Taussig L M. Asthma and wheezing in the first six years of life.  N Engl J Med . 1995;  332 133-138
  • 53 Duffy D L. Genetic epidemiology of asthma.  Epidemiol Rev . 1997;  19 129-143
  • 54 Edfors-Lubs M. Allergy in 7000 twin pairs.  Acta Allergol . 1971;  26 249-285
  • 55 Ronmark E, Lundback B, Jonsson E A. Incidence of asthma in adults-report from the Obstructive Lung Disease in Northern Sweden study.  Allergy . 1997;  52 1071-1081
  • 56 Cox H E, Moffatt M F, Faux J A. Association of atopic dermatitis to the beta subunit of the high affinity Immunoglobulin E receptor.  Br J Dermatol . 1998;  138 182-187
  • 57 Moffatt M F, Cookson W O. The genetics of asthma: maternal effects in atopic disease.  Clin Exp Allergy . 1998;  56-66
  • 58 Warner J A, Jones C A, Jones A C. Prenatal origins of allergic disease.  J Allergy Clin Immunol . 2000;  105(2 pt 2) S493-S498
  • 59 Hanrahan J P, Tager I B, Segal M R. Effect of prenatal smoking on infant lung function.  Am Rev Respir Dis . 1990;  141 A282
  • 60 Martinez F D, Cline M, Burrows B. Increased incidence of asthma in children of smoking mothers.  Pediatrics . 1992;  89 21-26
  • 61 Rook G A, Stanford J L. Give us this day our daily germs.  Immunol Today . 1998;  19 113-116
  • 62 Holt P G, McMenamin C, Nelson D. Primary sensitisation to inhalant allergens during infancy.  Pediatr Allergy Immunol . 1998;  1 3-15
  • 63 Sporik R, Holgate S, Platts-Mills T A, Cogswells J J. Exposure to house dust mite allergen Der pI and the development of asthma in children.  N Engl J Med . 1990;  323 502-507
  • 64 Rosenstreich D L, Eggleston P, Kattan M. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.  N Engl J Med . 1997;  336 1356-1363
  • 65 Ingram J M, Sporik R, Rose G. Quantitative assessment of exposure to dog (Can f 1) and cat (Fel d 1) allergens: relationship to sensitization and asthma among children living in Los Alamos, New Mexico.  J Allergy Clin Immunol . 1995;  96 449-456
  • 66 Halonen M, Stern D A, Lohman C. Two subphenotypes of childhood asthma that differ in maternal and paternal influences on asthma risk.  Am J Respir Care Med . 1999;  160 564-570
  • 67 Bjorksten B, Dumitrascu D, Foucard T. Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe.  Eur Respir J . 1998;  12 432-437
  • 68 Seaton A, Godden D J, Brown K. Increase in asthma: a more toxic environment or a more susceptible population?.  Thorax . 1994;  49 171-174
  • 69 Lai C KW. Common inhalant allergens in southern China. In: Proceedings of the 5th West Pacific Allergy Symposium, June 11-14, 1997, Seoul, Korea
  • 70 Yemaneberhan H, Bekele Z, Venn A. Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia.  Lancet . 1997;  350 85-90
  • 71 Halonen M, Martinez F D. A deficient capacity to produce interferon-gamma: is it a risk for asthma and allergies?.  Clin Exp Allergy . 1997;  27 1234-1236
  • 72 Shaheen S O, Aaby P, Hall A J. Measles and atopy in Guinea-Bissau.  Lancet . 1996;  347 1792-1796
  • 73 Shaheen S O, Aaby P, Hall A J. Cell mediated immunity after measles in Guinea-Bissau: historical cohort study.  BMJ . 1996;  313 969-974
  • 74 Lewis S A, Britton J R. Measles infection, measles vaccination and the effect of birth order in the aetiology of hay fever.  Clin Exp Allergy . 1998;  28 1493-1500
  • 75 Shirakawa T, Enomoto T, Shimazu S, Hopkin J M. The inverse association between tuberculin responses and atopic disorder.  Science . 1997;  275 77-79
  • 76 Matricardi P M, Rosmini F, Ferrigno L. Cross-sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus.  BMJ . 1997;  314 999-1003
  • 77 Strachan D P. Hay fever, hygiene, and household size.  BMJ . 1989;  299 1259-1260
  • 78 Mattes J, Karmaus W. The use of antibiotics in the first year of life and development of asthma: which comes first?.  Clin Exp Allergy . 1999;  29 729-732
  • 79 Marbury M C, Maldonado G, Waller L. Lower respiratory illness, recurrent wheezing, and day-care attendance.  Am J Respir Crit Care Med . 1997;  155 156-161
  • 80 Ball T M, Castro-Rodriguez J A, Griffith K A. Siblings, day-care attendance, and the risk of asthma and wheezing during childhood.  N Engl J Med . 2000;  343 538-543
  • 81 Rona R J, Duran-Tauleria E, Chinn S. Family size, atopic disorders in parents, asthma in children, and ethnicity.  J Allergy Clin Immunol . 1997;  99 454-460
  • 82 Posonby A L, Couper D, Dwyer T. Cross-sectional study of the relation between sibling number and asthma, hay fever, and eczema.  Arch Dis Child . 1998;  79 328-333
  • 83 Bjorksten B. Risk factors in early childhood for the development of atopic diseases.  Allergy . 1994;  49 400-407
  • 84 Martinez F D, Antognoni G, Macri F. Parental smoking enhances bronchial responsiveness in nine-year-old children.  Am Rev Respir Dis . 1988;  138 518-523
  • 85 Zeiger R S, Heller S. The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance.  J Allergy Clin Immunol . 1995;  95 1179-1190
  • 86 Takemura Y, Sakurai Y, Honjo S. Relation between breastfeeding and the prevalence of asthma: the Tokorozawa Childhood Asthma and Pollinosis Study.  Am J Epidemiol . 2001;  154 115-119
  • 87 Von Mutius E. The environmental predictors of allergic disease.  J Allergy Clin Immunol . 2000;  105 9-19
  • 88 Weiss S T. Diet as a risk factor for asthma. In: Chadwick D, Cardew G, eds. The Rising Trends in Asthma New York: Wiley 1997: 244-253
  • 89 Alm J S, Swartz J, Lilja G. Atopy in children of families with an anthroposophic lifestyle.  Lancet . 1999;  353 1485-1488
  • 90 Environmental Protection Agency. National Air Quality and Emissions Trends Report 1990. Research Triangle Park, NC: Office of Air Quality Planning and Standards; 1991 EPA-450/4/91-023
  • 91 Von Mutius E, Martinez F D, Fritzsch C. Prevalence of asthma and atopy in two areas of West and East Germany.  Am J Respir Crit Care Med . 1994;  149 358-364
  • 92 Koenig J Q. Air pollution and asthma.  J Allergy Clin Immunol . 1999;  104 717-722
  • 93 Scott C R, Smith J M, Michaeleen M. Characteristics of youth-onset noninsulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus at diagnosis.  Pediatrics . 1997;  100 84-91
  • 94 Skloot G, Permutt S, Togins A. Airway hyperresponsiveness in asthma: a problem of limited smooth muscle relaxation with inspiration.  J Clin Invest . 1995;  96 2393-2403
  • 95 Halterman J S, Aligne C A, Auinger P. Inadequate therapy for asthma among children in the United States.  Pediatrics . 2000;  272-276
  • 96 Suissa S, Ernst P, Benayoun S. Low-dose inhaled corticosteroids and the prevention of death from asthma.  N Engl J Med . 2000;  343 332-336
  • 97 Holgate S T. Summary. In: Chadwick D, Cardew G, eds. The Rising Trends in Asthma New York: Wiley 1997: 258-267
  • 98 Spitzer W O, Suissa S, Ernst P. The use of beta-agonists and the risk of death and near death from asthma.  N Engl J Med . 1992;  326 501-506
  • 99 Death from asthma in two regions of England. British Thoracic Association. BMJ (Clin Res Ed) 1982 285: 1251-1255
  • 100 Sur S, Crotty T B, Kephart G M. Sudden-onset fatal asthma: a distinct entity with few eosinophils and relatively more neutrophils in the airway submucosa?.  Am Rev Respir Dis . 1993;  148 713-719
  • 101 McFadden E R, Warren E L. Observations on asthma mortality.  Ann Intern Med . 1997;  127 142-147
  • 102 American College of Physicians. Inner-City Health Care.  Ann Intern Med . 1997;  127 485-490
  • 103 Mak H, Johnston P, Abbey H. Prevalence of asthma and health service utilization of asthmatic children in an inner city.  J Allergy Clin Immunol . 1982;  70 367-372
  • 104 Burt C W, Knapp D E. Ambulatory care visits for asthma: United States, 1993-94.  Vital and Health Statistics . 1996;  277 1-20
  • 105 Crain E F, Kercsmar C, Weiss K B, Mitchell H, Lynn H. Reported difficulties in access to quality care for children with asthma in the inner city.  Arch Pediatr Adolesc Med . 1998;  152 333-339
  • 106 Kattan M, Mitchell H, Eggleston P. Characteristics of inner-city children with asthma: the National Cooperative Inner-City Asthma study.  Pediatr Pulmonol . 1997;  24 253-262
  • 107 Abramson M J, Bailey M J, Couper F J. Are asthma medications and management related to deaths from asthma?.  Am J Respir Crit Care Med . 2001;  163 12-18
  • 108 Peat J, Li J. Reversing the trend: reducing the prevalence of asthma.  J Allergy Clin Immunol . 1999;  103 1-10
  • 109 Lilienfeld D E. Definitions of epidemiology.  Am J Epidemiol . 1978;  107 87-90
    >