Abstract
Childhood asthma is responsible for significant morbidity and health care expenditures in the United States. The incidence of asthma is greatest in early childhood, and the prevalence is projected to continue rising in the absence of prevention and intervention measures. The prevention of asthma will likely require a multifaceted intervention strategy; however, few randomized controlled trials have assessed such approaches. The purpose of this review was to use previous meta-analyses to identify the most impactful risk factors for asthma development and evaluate the effect of risk factor reduction on future childhood asthma prevalence. Common and modifiable risk factors with large effects included acute viral respiratory infections, antibiotic use, birth by cesarean section, nutritional disorders (overweight, obesity), second hand smoke exposure, allergen sensitization, breastfeeding, and sufficient prenatal vitamin D level. Evaluation and estimates of risk factor modification on populations at risk should guide scientists and policymakers toward high impact areas that are apt for additional study and intervention.
Highlights
Asthma is the leading chronic disease among children, affecting 8.4% of children in the United States and up to 14% worldwide [1, 2]
We identified thirty-two meta-analyses examining the association between individual risk factors and asthma development
Assuming each risk factor plays an independent role, approximately 51% of asthma cases are attributable to two exposures that occur during infancy (RSV lower respiratory tract infection and antibiotic use)
Summary
Asthma is the leading chronic disease among children, affecting 8.4% of children in the United States and up to 14% worldwide [1, 2]. The economic impact and loss of productivity are enormous compared to other childhood illnesses [3]. The overall prevalence of asthma in the US has been increasing over the past 30 years in all demographic groups [4]. A similar increase in prevalence is noted throughout the developing world, the association with economic development is not uniform [5]. There are no demonstrated effective interventions for the primary prevention of asthma [6]. The rise in asthma and allergy prevalence is happening at a rate that cannot be fully explained by genetic factors. A positive family history is a highly predictive risk factor, its positive predictive value for the development of childhood asthma only ranges from 11 to 37%. The marked increase in prevalence over a short time period suggests that multiple environmental risk factors
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