ASTHMA

Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC)

Neil Pearce¹, Nadia Aït-Khaled², Richard Beasley³, Javier Mallol⁴, Ulrich Keil⁵, Ed Mitchell⁶, Colin Robertson⁷ and the ISAAC Phase Three Study Group

¹ Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand and Department of Biomedical Sciences and Human Oncology, University of Turin, Italy
² IUATLD, 68 Bd Saint Michel, Paris, France
³ Medical Research Institute of New Zealand, Wellington, New Zealand
⁴ Department of Pediatric and Respiratory Medicine, University of Santiago de Chile (USACH), Santiago, Chile
⁵ Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Germany
⁶ Medical and Health Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
⁷ Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, Victoria, Australia

Correspondence to:
Professor Neil Pearce
Centre for Public Health Research, Massey University Wellington Campus, Private Box 756, Wellington, New Zealand; n.e.pearce{at}massey.ac.nz

Background: Phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) was designed to allow worldwide comparisons of the prevalence of asthma symptoms. In phase III the phase I survey was repeated in order to assess changes over time.

Methods: The phase I survey was repeated after an interval of 5–10 years in 106 centres in 56 countries in children aged 13–14 years (n = 304 679) and in 66 centres in 37 countries in children aged 6–7 years (n = 193 404).

Results: The mean symptom prevalence of current wheeze in the last 12 months changed slightly from 13.2% to 13.7% in the 13–14 year age group (mean increase of 0.06% per year) and from 11.1% to 11.6% in the 6–7 year age group (mean increase of 0.13% per year). There was also little change in the mean symptom prevalence of severe asthma or the symptom prevalence measured with the asthma video questionnaire. However, the time trends in asthma symptom prevalence showed different regional patterns. In Western Europe, current wheeze decreased by 0.07% per year in children aged 13–14 years but increased by 0.20% per year in children aged 6–7 years. The corresponding findings per year for the other regions in children aged 13–14 years and 6–7 years, respectively, were: Oceania (–0.39% and –0.21%); Latin America (+0.32% and +0.07%); Northern and Eastern Europe (+0.26% and +0.05%); Africa (+0.16% and +0.10%); North America (+0.12% and +0.32%); Eastern Mediterranean (–0.10% and +0.79%); Asia-Pacific (+0.07% and –0.06%); and the Indian subcontinent (+0.02% and +0.06%). There was a particularly marked reduction in current asthma symptom prevalence in English language countries (–0.51% and –0.09%). Similar patterns were observed for symptoms of severe asthma. However, the percentage of children reported to have had asthma at some time in their lives increased by 0.28% per year in the 13–14 year age group and by 0.18% per year in the 6–7 year age group.

Conclusions: These findings indicate that international differences in asthma symptom prevalence have reduced, particularly in the 13–14 year age group, with decreases in prevalence in English speaking countries and Western Europe and increases in prevalence in regions where prevalence was previously low. Although there was little change in the overall prevalence of current wheeze, the percentage of children reported to have had asthma increased significantly, possibly reflecting greater awareness of this condition and/or changes in diagnostic practice. The increases in asthma symptom prevalence in Africa, Latin America and parts of Asia indicate that the global burden of asthma is continuing to rise, but the global prevalence differences are lessening.

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