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Thorax 59:646-651 doi:10.1136/thx.2004.021642
  • Asthma

Increase in diagnosed asthma but not in symptoms in the European Community Respiratory Health Survey

  1. S Chinn1,
  2. D Jarvis1,
  3. P Burney1,
  4. C Luczynska1,
  5. U Ackermann-Liebrich2,
  6. J M Antó3,
  7. I Cerveri4,
  8. R de Marco5,
  9. T Gislason6,
  10. J Heinrich7,
  11. C Janson8,
  12. N Künzli2,9,
  13. B Leynaert10,
  14. F Neukirch10,
  15. J Schouten11,
  16. J Sunyer3,
  17. C Svanes12,
  18. P Vermeire13,
  19. M Wjst7
  1. 1Department of Public Health Sciences, King’s College London, London SE1 3QD, UK
  2. 2Institute of Social and Preventive Medicine, University of Basel, CH 4051 Basel, Switzerland
  3. 3Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), 08009 Barcelona, Spain
  4. 4Division of Respiratory Diseases, IRCCS “San Matteo” Hospital, University of Pavia, 27100 Pavia, Italy
  5. 5University of Verona, Department of Medicine and Public Health, Division of Epidemiology and Statistics, 8-37134 Verona, Italy
  6. 6Department of Allergy, Respiratory Medicine and Sleep, University Hospital (E7), 105 Reykjavik, Iceland
  7. 7Institute of Epidemiology, GSF—National Research Center for Environment and Health, D-85764 Neuherberg, Germany
  8. 8Respiratory Medicine and Allergology, University of Uppsala, 75185 Uppsala, Sweden
  9. 9Keck School of Medicine, University of Southern California, Los Angeles, California 90089-9013, USA
  10. 10INSERM—The French Institute of Health and Medical Research, Unit 408–Epidemiology, Faculty of Medicine X Bichat, 75870 Paris Cedex 18, France
  11. 11Department of Health Sciences, University of Groningen, 9713 AV Groningen, The Netherlands
  12. 12Department of Medicine, Haraldsplass Hospital, 5009 Bergen, Norway
  13. 13University of Antwerp (Campus Drie Eiken), B-2610 Antwerp, Belgium
  1. Correspondence to:
    Professor S Chinn
    Department of Public Health Sciences, King’s College London, London SE1 3QD, UK; sue.chinnkcl.ac.uk
  • Received 16 January 2004
  • Accepted 30 March 2004

Abstract

Background: Information on the epidemiology of asthma in relation to age is limited and hampered by reporting error. To determine the change in the prevalence of asthma with age in young adults we analysed longitudinal data from the European Community Respiratory Health Survey.

Methods: A self-administered questionnaire was completed by 11 168 randomly selected subjects in 14 countries in 1991–3 when they were aged 20–44 years and 5–11 years later from 1998 to 2003. Generalised estimating equations were used to estimate net change in wheeze, nocturnal tightness in chest, shortness of breath, coughing, asthma attacks in the last 12 months, current medication, “diagnosed” asthma, and nasal allergies.

Results: Expressed as change in status per 10 years of follow up, subjects reporting asthma attacks in the previous 12 months increased by 0.8% of the population (95% CI 0.2 to 1.4) and asthma medication by 2.1% (95% CI 1.6 to 2.6), while no statistically significant net change was found in reported symptoms. Reported nasal allergies increased, especially in the youngest age group.

Conclusions: As this cohort of young adults has aged, there has been an increase in the proportion treated for asthma but not in the proportion of those reporting symptoms suggestive of asthma. Either increased use of effective treatments has led to decreased morbidity among asthmatic subjects or those with mild disease have become more likely to label themselves as asthmatic.

Footnotes

  • The coordination of ECRHS II was supported by the European Commission as part of their Quality of Life programme.

  • The following bodies funded the local studies in ECRHS II:

    Aarhus: Danish Lung Association; Albacete: Fondo de Investigaciones Santarias (FIS) (grant code: 97/0035-01, 99/0034-01 and 99/0034-02), Hospital Universitario de Albacete, Consejeria de Sanidad; Antwerp: FWO (Fund for Scientific Research)-Flanders Belgium (grant code: G.0402.00), University of Antwerp, Flemish Health Ministry; Barcelona: SEPAR, Public Health Service (grant code: R01 HL62633-01), Fondo de Investigaciones Santarias (FIS) (grant code: 97/0035-01, 99/0034-01 and 99/0034-02) CIRIT (grant code: 1999SGR 00241)); Basel: Swiss National Science Foundation, Swiss Federal Office for Education & Science, Swiss National Accident Insurance Fund (SUVA); Bergen: Norwegian Research Council, Norwegian Asthma & Allergy Association (NAAF), Glaxo Wellcome AS, Norway Research Fund; Bordeaux: Institut Pneumologique d’Aquitaine; Erfurt: GSF-National Research Centre for Environment & Health, Deutsche Forschungsgemeinschaft (DFG) (grant code FR 1526/1-1); Galdakao: Basque Health Department; Goteborg: Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences & Allergy Research, Swedish Asthma & Allergy Foundation, Swedish Cancer & Allergy Foundation; Grenoble: Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, Ministere de l’Emploi et de la Solidarite, Direction Generale de la Sante, CHU de Grenoble, Comite des Maladies Respiratoires de l’Isere; Hamburg: GSF—National Research Centre for Environment & Health, Deutsche Forschungsgemeinschaft (DFG) (grant code MA 711/4-1); Ipswich and Norwich: National Asthma Campaign (UK); Huelva: Fondo de Investigaciones Santarias (FIS) (grant code: 97/0035-01, 99/0034-01 and 99/0034-02); Melbourne: National Health and Medical Research Council of Australia; Montpellier: Programme Hospitalier de Recherche Clinique—DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, CHU de Grenoble, Ministere de l’Emploi et de la Solidarite, Direction Generale de la Sante, Aventis (France), Direction Régionale des Affaires Sanitaires et Sociales Languedoc-Roussillon; Oviedo: Fondo de Investigaciones Santarias (FIS) (grant code: 97/0035-01, 99/0034-01 and 99/0034-02); Paris: Ministere de l’Emploi et de la Solidarite, Direction Generale de la Sante, UCB-Pharma (France), Aventis (France), Glaxo France, Programme Hospitalier de Recherche Clinique—DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, CHU de Grenoble; Pavia: Glaxo-SmithKline Italy, Italian Ministry of University and Scientific and Technological Research (MURST), Local University Funding for research 1998 and 1999 (Pavia, Italy); Portland: American Lung Association of Oregon, Northwest Health Foundation, Collins Foundation, Merck Pharmaceutical; Reykjavik: Icelandic Research Council, Icelandic University Hospital Fund; Tartu: Estonian Science Foundation; Turin: ASL 4 Regione Piemonte (Italy), AO CTO/ICORMA Regione Piemonte (Italy), Ministero dell’Università e della Ricerca Scientifica (Italy), Glaxo Wellcome spa (Verona, Italy); Umeå: Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences & Allergy Research, Swedish Asthma & Allergy Foundation, Swedish Cancer & Allergy Foundation; Uppsala: Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences & Allergy Research, Swedish Asthma & Allergy Foundation, Swedish Cancer & Allergy Foundation; Verona: University of Verona; Italian Ministry of University and Scientific and Technological Research (MURST); Glaxo-SmithKline Italy.

    Financial support for ECRHS I for centres in ECRHS II: Belgian Science Policy Office, National Fund for Scientific Research; Ministère de la Santé, Glaxo France, Insitut Pneumologique d’Aquitaine, Contrat de Plan Etat-Région Languedoc-Rousillon, CNMATS, CNMRT (90MR/10, 91AF/6), Ministre delegué de la santé, RNSP, France; GSF, and the Bundesminister für Forschung und Technologie, Bonn, Germany; Ministero dell’Università e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grant RSF n. 381/05.93, Italy; Norwegian Research Council project no. 101422/310; Dutch Ministry of Wellbeing, Public Health and Culture, Netherlands; Ministero Sanidad y Consumo FIS (grants #91/0016060/00E–05E and #93/0393), and grants from Hospital General de Albacete, Hospital General Juan Ramón Jiménenz, Consejeria de Sanidad Principado de Asturias, Spain; The Swedish Medical Research Council, the Swedish Heart Lung Foundation, the Swedish Association against Asthma and Allergy; Swiss National Science Foundation grant 4026–28099; National Asthma Campaign, British Lung Foundation, Department of Health, South Thames Regional Health Authority, UK; United States Department of Health, Education and Welfare Public Health Service (grant #2 S07 RR05521–28).

    Project Leader: P Burney; Statistician: S Chinn; Principal Investigator: D Jarvis; Project Coordinator: J Knox; Principal Investigator: C Luczynska; Assistant Statistician: J Potts; Data Manager: S Arinze.

    Steering Committee for ECRHS II: Professor J M Antó, Institut Municipal d’Investigació Mèdica (IMIM-IMAS), Universitat Pompeu Fabra (UPF); Professor P Burney, King’s College London (Project Leader); Dr I Cerveri, University of Pavia; Professor S Chinn, King’s College London; Professor R de Marco, University of Verona; Dr T Gislason, Iceland University Hospital; Dr J Heinrich, GSF—Institute of Epidemiology; Assoc Professor C Janson, Uppsala University; Dr D Jarvis, King’s College London; Miss J Knox, King’s College London; Dr N Künzli, University of Basel and University of Southern California Los Angeles; Dr B Leynaert, Institut National de la Santé et de la Recherche Médicale (INSERM); Dr C Luczynska, King’s College London; Dr F Neukirch, Institut National de la Santé et de la Recherche Médicale (INSERM); Dr J Schouten, University of Groningen; Dr J Sunyer, Institut Municipal d’Investigació Mèdica (IMIM-IMAS), Universitat Pompeu Fabra (UPF); Dr C Svanes, University of Bergen; Professor P Vermeire, University of Antwerp; Dr M Wjst, GSF—Institute of Epidemiology.

    Principal Investigators and Senior Scientific Team: Belgium: South Antwerp & Antwerp City (P Vermeire, J Weyler, M Van Sprundel, V Nelen); Denmark: Aarhus (EJ Jensen); Estonia: Tartu (R Jogi, A Soon); France: Paris (F Neukirch, B Leynaert, R Liard, M Zureik), Grenoble (I Pin, J Ferran-Quentin); Germany: Erfurt (J Heinrich, M Wjst, C Frye, I Meyer); Iceland: Reykjavik (T Gislason, E Bjornsson, D Gislason, T Blondal, A Karlsdottir); Italy: Turin (M Bugiani, P Piccioni, E Caria, A Carosso, E Migliore, G Castiglioni), Verona (R de Marco, G Verlato, E Zanolin, S Accordini, A Poli, V Lo Cascio, M Ferrari), Pavia (A Marinoni, S Villani, M Ponzio, F Frigerio, M Comelli, M Grassi, I Cerveri, A Corsico); Netherlands: Groningen & Geleen (J Schouten, M Kerkhof); Norway: Bergen (A Gulsvik, E Omenaas, C Svanes, B Laerum); Spain: Barcelona (JM Antó, J Sunyer, M Kogevinas, JP Zock, X Basagana, A Jaen, F Burgos), Huelva (J Maldonado, A Pereira, JL Sanchez), Albacete (J Martinez-Moratalla Rovira, E Almar), Galdakao (N Muniozguren, I Urritia), Oviedo (F Payo); Sweden: Uppsala (C Janson, G Boman, D Norback, M Gunnbjornsdottir), Goteborg (K Toren, L Lillienberg, AC Olin, B Balder, A Pfeifer-Nilsson, R Sundberg), Umea (E Norrman, M Soderberg, K Franklin, B Lundback, B Forsberg, L Nystrom); Switzerland: Basel (N Künzli, B Dibbert, M Hazenkamp, M Brutsche, U Ackermann-Liebrich); UK: Norwich (D Jarvis, B Harrison), Ipswich (D Jarvis, R Hall, D Seaton).

    Centres taking part at their own expense: Australia: Melbourne (M Abramson, R Woods, EH Walters, F Thien); France: Bordeaux (A Taytard, C Raherison), Montpellier (J Bousquet, P Demoly); Germany: Hamburg (K Richter); USA: Portland (M Osborne, S Buist, W Vollmer, L Johnson).