Asthma diagnosis and treatment
Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys

https://doi.org/10.1016/j.jaci.2004.04.042Get rights and content

Abstract

Background

In 1995, the Global Initiative for Asthma (GINA) guidelines recommended goals for the management of asthma, which were updated in 2002. However, there are no recent international surveys on the real management of asthma.

Objective

The Asthma Insights and Reality surveys are the first large-scale surveys aimed at determining international variations in the severity, control, and management of asthma in children and adults.

Methods

A cross-section of households in 29 countries in North America, Europe, and Asia were surveyed to identify from the general population asthmatic patients with symptoms within the last year or who were taking current asthma medication. A standard questionnaire was administered to 7786 adults, and, through a proxy, to 3153 children with asthma. Objective and subjective patient perception of asthma control and severity were assessed, including access to medical care, health care use, missed work-school, and medication use.

Results

Despite variations at a country level, a substantial effect of asthma on patients' lives was observed, with considerable loss of schooldays and workdays. The current level of asthma control worldwide falls far short of the goals for long-term management in international guidelines. A significant proportion of patients continue to have symptoms and lifestyle restrictions and to require emergency care. The proportion of adult asthmatic patients who were current smokers was also high. However, the use of anti-inflammatory preventative medication, even in patients with severe persistent asthma, was low, ranging from 26% in Western Europe to 9% in Japan, as was the use of objective lung function testing. The correlation between self-perceived severity of asthma and objective assessment of severity on the basis of GINA criteria was consistently poor in all areas.

Conclusion

We conclude that there is direct evidence for suboptimal asthma control in many patients worldwide, despite the availability of effective therapies, with long-term management falling far short of the goals set in the GINA guidelines.

Section snippets

Methods

All surveys used the same standard protocol. The surveys were conducted in 29 countries in Western Europe (France, Germany, Italy, the Netherlands, Spain, Sweden, and the United Kingdom), Central and Eastern Europe (Bulgaria, Croatia, Czech Republic, Hungary, Latvia, Lithuania, Poland, Romania, Russia, Slovakia, Slovenia, and Ukraine), Asia-Pacific (China, Hong Kong, Korea, Malaysia, Philippines, Singapore, Taiwan, and Vietnam), the United States, and Japan.

Results

A total of 10,939 asthmatic patients (3153 children and 7786 adults) participated in the 29 countries surveyed. Basic demographic characteristics are presented in Table II. In all countries but Hong Kong, the majority of adult participants were women. In all countries other than Singapore and Latvia, most participating children were boys. The prevalence of smokers among adult asthmatic patients ranged from 5.6% in Latvia to 28.9% in Japan. Across all regions, the prevalence of adult asthmatic

Discussion

The global AIR surveys provide direct evidence for suboptimal asthma control in many patients worldwide, despite the availability of effective therapies, with long-term management falling far short of the goals in the GINA guidelines.1

Conclusion

The AIR surveys constitute the first large-scale international assessment of asthma effect and management in children and adults, with data from 10,939 patients in 29 countries. They allow us to conclude that the overall results observed in North America, Europe, Japan, and the Asia-Pacific region are comparable and equally poor when assessed against the goals specified in the GINA guidelines. Every effort should be made to encourage the widespread availability of peak flowmeters and written

Acknowledgements

We thank Dr John Boyle for his invaluable consultation, Dr Onno van Schayck for helpful comments on the manuscript, and Michael Ho for editorial assistance. The following investigators have also participated in local surveys: Teresita S. de Guia, MD, Philippine Heart Centre, Quezon City, Philippines; Kyohsuke Ishihara, MD, Department of Internal Medicine, Kobe West City Hospital; You-Young Kim, MD, PhD, Seoul National University Hospital, Seoul, Korea; Sow-Hsong Kuo, MD, National Taiwan

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