Epidemiological studies of the very high prevalence of asthma and related symptoms among school children in Costa Rica from 1989 to 1998

Abstract

The aim of our study was to determine the prevalence of asthma and related respiratory symptoms in school children from Costa Rica during the last 10 years, from 1989 to 1998. Using nationally representative samples of school children from Costa Rica during the last 10 years we have performed three studies. Altogether 9,931 children were investigated. The age groups: study I, 5-17 years (n = 2,682), study II, 6-7 years (n = 2,944), 13-14 years (n = 3,200) and study III, 10 years (n = 1,105). The diagnostic criteria for asthma used in these studies was as follows: study I (1989), diagnosis by a doctor in combination with the presence of four kinds of respiratory symptoms; studies II (1995) and III (1998), history of wheeze in the past 12 months. The two latter were part of the International Study of Asthma and Allergies in Childhood (ISAAC). A very high prevalence of a history of wheezing was found in the three studies (46.8%, 42.9%, and 45.1%) as well as a diagnosis of asthma (23.4%, 27.7% and 27.1%). The physician's diagnosis of asthma reported in the first study (23%) increased from 23.1 in study II to 27.7% in study III (p = 0.004). This increment could be a real increase in asthma prevalence, or be due to a better awareness about asthma. In study II the group of 6-7-year-olds had respiratory symptoms significantly more often than 13-14-year-olds (p < 0.001). Boys more often had a history of wheezing (p = 0.001), wheeze during the previous 12 months (p = 0.01) and an asthma diagnosis at the age of 6-7 years (p = 0.002) than girls, but girls had more respiratory symptoms than boys at the age of 13-14 years (p < 0.005). Wheezing in the past 12 months was more common for those living in urban areas aged 6-7 years (p = 0.04), and there was an increase of wheeze after exercise (p = 0.01). For the 13-14-year-olds the risk of wheezing was higher during the previous 12 months if they lived in temperate areas (<20 degrees C) and at a high altitude (>1,000 m). Living in a rural area and in a warm region (>20 degrees C), increased the risk of dry cough during the previous 12 months in the group of 13-14-year-olds. In conclusion, Costa Rica is located in the tropics with a very high humidity, an enormous variety of flora and fauna and a very high prevalence of mite and cockroach allergens, which provide important risk factors that may explain the high prevalence of asthma and asthma-related symptoms. Further possible factors, such as the change towards a more Western life style, resulting in fewer infections and parasitic diseases in the first years of life and changes in bedding material, may also be unresolved. Increased environmental pollution may add to the very high prevalence of asthma and related respiratory symptoms. The very extensive exposure to mites and cockroaches in bed material and in homes with poor ventilation may be an important factor, but many asthmatic children behave as non atopic, with a viral respiratory infection as a major precipitating factor.