Abstract
BackgroundChildhood asthma has risen dramatically not only in the western societies and now forms a major and still increasing public health problem. The aims of this study were to follow up at the age of ten the patterns of asthma symptoms and associations among children with a clinically diagnosed asthma in a sizeable urban-rural community and to in compare them with demographic controls using a standardised questionnaire.MethodsIn a defined region in Sweden with a population of about 150 000 inhabitants, all children (n = 2 104) born in 1990 were recorded. At the age of seven all primary care and hospital records of the 1 752 children still living in the community were examined, and a group of children (n = 191) was defined with a well-documented and medically confirmed asthma diagnosis. At the age of ten, 86 % of these cases (n = 158) and controls (n = 171) completed an ISAAC questionnaire concerning asthma history, symptoms and related conditions.ResultsDifferent types of asthma symptoms were highly and significantly over-represented in the cases. Reported asthma heredity was significantly higher among the cases. No significant difference in reported allergic rhinitis or eczema as a child was found between cases and controls. No significant difference concerning social factors or environmental exposure was found between case and controls. Among the control group 4.7 % of the parents reported that their child actually had asthma. These are likely to be new asthma cases between the age of seven and ten and give an estimated asthma prevalence rate at the age of ten of 15.1 % in the studied cohort.ConclusionA combination of medical verified asthma diagnosis through medical records and the use of self-reported symptom through the ISAAC questionnaire seem to be valid and reliable measures to follow-up childhood asthma in the local community. The asthma prevalence at the age of ten in the studied birth cohort is considerably higher than previous reports for Sweden. Both the high prevalence figure and allowing the three-year lag phase for further settling of events in the community point at the complementary roles of both hospital and primary care in the comprehensive coverage and control of childhood asthma in the community.
Highlights
Childhood asthma has risen dramatically in the western societies and forms a major and still increasing public health problem
Further examination of the epidemiology and natural history [20] of childhood asthma is warranted, especially in infancy since it starts before the age of six in about 80–90 per cent of the cases
For all of them still living in the region at the age of seven, the computerised medical records of the Department of Paediatrics at the University Hospital and at all 14 Primary Health Care (PHC) Units and at the two existing private Paediatrician Offices in the region were examined for the occurrence of the principal diagnosis asthma (ICD-9: 493)
Summary
Childhood asthma has risen dramatically in the western societies and forms a major and still increasing public health problem. Large research efforts have been directed to it, and especially the multinational International Study of Asthma and Allergies in Childhood (ISAAC) [4] has only in the last few years provided a wealth of additional data, e.g., on prevalence [5,6,7,8,9,10,11,12] and symptoms [8,13,14], which further document the worsening of the situation [15] in spite of increasing community awareness and number of children receiving inhaled steroids[11] and other treatment. In an international study of 12-year old children in 1994, questionnaire-reported asthma-prevalence was found to range from 16.8 % in New Zealand, 12 % in Wales and 11.5 % in South Africa to only 4% in Sweden [16]. Comprehensive coverage in a well-defined area might complement the mainly large-scale surveys that are so far available
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