Estimated Prevalence Of Asthma Research Articles

Adult asthma prevalence and trend analysis by urban-rural status across sociodemographic characteristics-United States, 2012-20.

Asthma prevalence estimates among adults are limited for urban-rural classification across sociodemographic characteristics. This study examined current asthma prevalence and annual trends by 6-level urban-rural categories across sociodemographic characteristics among US adults. Asthma prevalence for 2020 and annual trends for 2012-20 were estimated using Behavioral Risk Factor Surveillance System data. The 2013 National Center for Health Statistics urban and rural categories were used to define urban-rural status. Current asthma prevalence was higher in medium (9.7%; prevalence ratio 1.103 [95% CI 1.037, 1.174]) and small (9.9%; 1.111 [1.031, 1.197]) metro than in large fringe metropolitan (8.6%), was higher in micropolitan (10.2%) than in both large fringe (8.6%; 1.115 [1.042, 1.194]) and large central metropolitan (8.8%; 1.080 [1.001, 1.066]) areas. Prevalence by sociodemographic characteristics varied between urban-rural scheme; the prevalence was significantly higher among adults aged 55-64 years in micropolitan (11.9%), women in small metro (12.8%), and other race non-Hispanic in noncore (most rural) (13.6%) areas, adults without a high school diploma in micropolitan areas (13.8%), household income <100% of federal poverty level in micropolitan areas (15.7%), and adults with insurance coverage in micropolitan areas (10.3%) compared to the corresponding populations in other urban-rural categories. During 2012-20, an increasing trend in prevalence was observed only in medium metro areas, with an annual percentage change of 0.81. Asthma prevalence differed by 6-level urban-rural categories. These findings might be helpful in establishing effective asthma control programs and targeting resource allocation at the local level.

Association between asthma and sugar-sweetened beverage consumption in the United States pediatric population

Objectives United States (US) youth consume an average of 10 teaspoons of added sugar from sugar-sweetened beverages (SSB) on any given day. Few population-based studies have examined the association between SSB consumption and asthma in children and adolescents. This study aimed to examine the association between SSB consumption and asthma in the US pediatric population. Design Analytical cross-sectional study. Setting and Participants A total of 9,938 children aged 2-to-17 years old who participated in the 2011-2016 National Health and Nutrition Examination Surveys. SSB consumption was categorized into 3 groups based on the caloric intake from 24-hour food recall data as follows: 1) no consumption (0 kcal/day); 2) moderate consumption (1-499 kcal/day); and 3) heavy consumption (≥ 500 kcal/day). The primary outcome of interest was self-reported current asthma condition. Results Asthma prevalence estimates were significantly higher in heavy (16.4%) and moderate (11.0%) SSB consumers versus non-consumers (7.5%) (p < 0.05 for both comparisons). The adjusted odds of asthma were twice that among children with heavy SSB consumption (aOR 2.01, 95% confidence interval [CI] 1.31-3.08) versus non-SSB consumers. The odds of asthma were higher among those who consumed fruit drinks (aOR 2.51, 95% CI 1.55-4.08), non-diet soft drinks (aOR 1.89, 95% CI 1.23-2.89) and sweet tea (aOR 1.87, 95% CI 1.13-3.09) compared to nondrinkers. The effect was independent of obesity status (p-interaction = 0.439). Conclusions Findings here suggest a dose-response relationship between SSB intake and asthma diagnosis, therefore controlling SSB consumption may potentially improve pulmonary health risk in the US pediatric population.

Pediatric Asthma: Prevalence and Socio-Cultural Factors Affecting Asthma Management in a Rural Area of Northern Karnataka.

Context:Asthma prevalence and severity is increasing among Indian children. There is the paucity of data on pediatric asthma in rural India and treatment received by asthmatics is not up-to-standard treatment guidelines.Aim:The aim is to estimate asthma prevalence and factors influencing access to standard asthmatic care among 5–15 years aged children.Settings and Design:Cross-sectional study conducted in rural north-Karnataka for 1 year.Subjects and Methods:The International Study of Asthma and Allergies in Childhood questionnaire was administered to participants followed by clinical examination. A child was considered as asthmatic if there was affirmative response to: (a) History of wheeze in the past 12 months, (b) Physician diagnosed/ever asthma, (c) history of taking inhaled/oral bronchodilators.Statistical Analysis:All characteristics were summarized descriptively.Results:Prevalence of Current-wheeze, Ever-asthma, and wheeze on exertion were 4%, 2%, and 3.7%, respectively. About 63.9% of asthmatics had severe-asthma and 44.4% reported severe attack of wheezing limiting speech. About 89% of current-wheezers used only oral medications for wheeze/asthma, 50% did not take medicines as per doctors' advice. None availed regular follow-up. Financial constraints and ignorance were major reasons cited.Conclusions:Illiteracy, poverty, lack of proper guidelines, and non-availability of inhalational medications have affected treatment adherence resulting in severe asthma.

Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: a systematic review.

BackgroundStatistical models are increasingly being used to estimate and project the prevalence and burden of asthma. Given substantial variations in these estimates, there is a need to critically assess the properties of these models and assess their transparency and reproducibility. We aimed to critically appraise the strengths, limitations and reproducibility of existing models for estimating and projecting the global, regional and national prevalence and burden of asthma.MethodsWe undertook a systematic review, which involved searching Medline, Embase, World Health Organization Library and Information Services (WHOLIS) and Web of Science from 1980 to 2017 for modelling studies. Two reviewers independently assessed the eligibility of studies for inclusion and then assessed their strengths, limitations and reproducibility using pre-defined quality criteria. Data were descriptively and narratively synthesised.ResultsWe identified 108 eligible studies, which employed a total of 51 models: 42 models were used to derive national level estimates, two models for regional estimates, four models for global and regional estimates and three models for global, regional and national estimates. Ten models were used to estimate the prevalence of asthma, 27 models estimated the burden of asthma – including, health care service utilisation, disability-adjusted life years, mortality and direct and indirect costs of asthma – and 14 models estimated both the prevalence and burden of asthma. Logistic and linear regression models were most widely used for national estimates. Different versions of the DisMod-MR- Bayesian meta-regression models and Cause Of Death Ensemble model (CODEm) were predominantly used for global, regional and national estimates. Most models suffered from a number of methodological limitations – in particular, poor reporting, insufficient quality and lack of reproducibility.ConclusionsWhilst global, regional and national estimates of asthma prevalence and burden continue to inform health policy and investment decisions on asthma, most models used to derive these estimates lack the required reproducibility. There is a need for better-constructed models for estimating and projecting the prevalence and disease burden of asthma and a related need for better reporting of models, and making data and code available to facilitate replication.

Trends in worldwide asthma prevalence.

This review of trends in worldwide asthma prevalence starts with defining how asthma prevalence is measured in populations and how it is analysed. Four population studies of asthma across at least two regions are described: European Community Respiratory Health Survey (ECRHS), the International Study of Wheezing in Infants (EISL), the International Study of Asthma and Allergies in Childhood (ISAAC) and the World Health Survey (WHS). Two of these (ISAAC and WHS) covered all the regions of the world; each using its own standardised questionnaire-based methodology with cross-sectional study design, suitable for large populations. EISL (2005 and 2012) and ISAAC (1996-1997 and 2002-2003) have undertaken a second cross-sectional population survey from which trends are available: EISL in three centres in two countries; ISAAC 106 centres in 56 countries (13-14 year olds) and 66 centres in 37 countries (6-7 year olds). Key results from these studies are presented. Unfortunately, there is no new worldwide data outside of EISL since 2003. Global Burden of Disease estimates of asthma prevalence have varied greatly. Recent reliable worldwide data on asthma prevalence and trends is needed; the Global Asthma Network Phase I will provide this in 2021.

Asthma in urban Aboriginal children: A cross-sectional study of socio-demographic patterns and associations with pre-natal and current carer smoking.

To describe socio-demographic patterns of asthma prevalence in urban Aboriginal children and quantify associations between asthma prevalence and pre-natal maternal and current carer smoking. Analyses used carer-reported survey data for 1290 urban Aboriginal children aged 2-17 years from the Study of Environment on Aboriginal Resilience and Child Health. Multilevel log-binomial regression was used to estimate asthma prevalence ratios (PRs) for child- and family-level socio-demographic factors, pre-natal maternal smoking and current carer smoking. Smoking-related PRs were compared with general-population estimates derived from meta-analyses of published cross-sectional data. Overall, 33.9% of children had ever had asthma, and 12.9% had received treatment for asthma in the past month. Prevalence estimates declined with increasing household income and increasing household size (posterior probabilities of decreasing trend >0.98), while children exposed to pre-natal maternal smoking had a higher risk of asthma ever than unexposed children (PR 1.18 (95% credible interval 1.00-1.40)). Recently treated asthma prevalence was not significantly associated with pre-natal maternal (0.98 (0.71-1.41)) or current carer smoking (0.97 (0.68-1.37)); however, there was substantial uncertainty in our PR estimates, and 95% credible intervals contained general-population estimates derived from the meta-analyses (1.37 (1.17-1.65) for pre-natal smoking, 1.28 (1.15-1.44) for current parental or household smoking). Among urban Aboriginal children in the Study of Environment on Aboriginal Resilience and Child Health cohort, asthma prevalence declines as household income and household size increase, while children exposed to pre-natal maternal smoking are at increased risk of ever having asthma. Our results emphasise the importance of reducing smoking in Aboriginal communities, particularly among pregnant women.

Estimated Prevalence of Asthma in US Children With Developmental Disabilities

The prevalence of asthma in US children with various developmental disabilities and delays is unclear, including how estimates vary by ethnic group. To report asthma prevalence estimates by various disability categories and developmental delays in a diverse sample of the US pediatric population. This population-based cross-sectional study encompassed a total of 71 811 families with children or adolescents aged 0 to 17 years (hereinafter referred to as children) who participated in the 2016 and 2017 National Survey of Children's Health. Data were collected from June 10, 2016, to February 10, 2017, for the 2016 survey and from August 10, 2017, to February 10, 2018, for the 2017 survey. Data were analyzed from September 20, 2019, to April 5, 2020. Developmental disability, including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, intellectual and/or learning disability, and vision, hearing, and/or speech delay. Delay was defined as not meeting growth milestones with unknown cause. Weighted asthma prevalence estimates and 95% CIs were generated for children with and without disabilities. A total of 71 811 participants (mean [SE] age, 8.6 [0.1] years; 36 800 boys [51.1%; 95% CI, 50.2%-52.0%]; 50 219 non-Hispanic white [51.4%; 95% CI, 50.6%-52.3%]) were included in our final analytical sample, of whom 5687 (7.9%; 95% CI, 7.5%-8.4%) had asthma and 11 426 (15.3%; 95% CI, 14.7%-16.0%) had at least 1 disability. Overall asthma prevalence estimates were 10 percentage points higher in children with a disability (16.1%; 95% CI, 14.3%-17.8%) vs children without a disability (6.5%; 95% CI, 6.0%-6.9%). The odds of asthma were significantly higher in children with a disability (odds ratio [OR], 2.77; 95% CI, 2.39-3.21) or delay (OR, 2.22; 95% CI, 1.78-2.77) vs typically growing children. Adjusted models remained significant for all disability categories (overall adjusted OR, 2.21; 95% CI, 1.87-2.62). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities vs non-Hispanic whites (19.8% [95% CI, 16.6%-23.0%] vs 12.6% [95% CI, 11.1%-14.0%]; P < .001). These results suggest that US children with various developmental disabilities or delay may have higher odds for developing asthma vs their typically developing peers. These findings support asthma screening in pediatric health care settings among patients with developmental disabilities and delays, particularly among those from ethnic minority backgrounds. In addition, very young children with asthma should be screened for disabilities and delays, because temporality cannot be determined by the current data source and analytical approach.

The disease burden of childhood asthma in China: a systematic review and meta-analysis.

BackgroundIn China, childhood asthma prevalence showed a remarkable increase in the past decades. An updated epidemiological assessment of childhood asthma in China with a focus on prevalence and time trends is required.MethodsWe systematically searched three main Chinese databases and one English database to identify epidemiological studies of the prevalence of childhood asthma in China. Asthma cases were defined according to one of the five sets of Chinese diagnostic criteria which were established by the Children Respiratory Disease Group. We estimated age- and sex-specific prevalence of asthma using a multilevel mixed-effects logistic regression. We presented the time trends of asthma prevalence between 1990 and 2020 by age, sex and setting (urban vs rural), and also estimated the number of children affected by asthma in 2010.ResultsIn 1990, the prevalence of asthma ranged from 0.13% (95% confidence interval (CI) = 0.10-0.20) in rural girls aged 14 years to 1.34% (95% CI = 1.11-1.67) in urban boys aged five years. In 2010, the overall prevalence of asthma in Chinese children aged 0-14 years was 2.12% (95% CI = 1.83-2.51), corresponding to 5.16 million children living with asthma. Children aged 5-9 years were with the highest prevalence estimate of 2.65% (95% CI = 2.31-3.12) and those aged 10-14 years were with the lowest (1.48%, 95% CI = 1.26-1.78). In 2020, it is expected that this disparity will continue, with the prevalence of asthma being at the lowest level among rural girls aged 14 years (1.11%, 95% CI = 0.82-1.54) and at the highest level among urban boys aged four years (10.27%, 95% CI = 8.61-12.18). Over the 30 years (1990-2020), the prevalence of asthma in children aged 0-14 years has increased in both sexes and settings, which was consistently the lowest in rural girls and the highest in urban boys.ConclusionsThis study shows that childhood asthma has been increasingly prevalent in China. Asthma is more frequent in boys and in rural areas. The detailed and systematic estimates of asthma prevalence in this study constitute the best currently available basis for policymaking, planning, and allocation of health and welfare resources related to the burden of childhood asthma in China.

Non-response did not affect prevalence estimates of asthma and respiratory symptoms - results from a postal questionnaire survey of the general population

BackgroundA high participation rate is warranted in order to ensure validity in surveys of the general population. However, participation rates in such studies have declined during the last decades. ObjectiveTo evaluate the reasons for and potential effects of non-response in a large population-based survey about asthma and respiratory symptoms in Northern Sweden. MethodsWithin the Obstructive Lung Disease In Norrbotten (OLIN) studies, a random sample of 12,000 adults aged 20–79 was invited to a postal questionnaire survey about asthma, allergic rhino-conjunctivitis and respiratory symptoms in 2016. Three reminders were sent. A random sample of 500 non-responders was invited to a telephone interview. ResultsThe participation rate in the initial mailing was 41.4%, and 9.2%, 5.0%, and 2.6% in the subsequent three reminders and totally 58.3% (n = 6854) responded. Of 500 non-responders selected for telephone interviews, 320 were possible to reach and 272 participated. Male sex, younger age, and current smoking were associated with both late and non-response. The prevalence of asthma and most respiratory symptoms did not differ significantly between responders and non-responders while allergic rhino-conjunctivitis and smoking was more common among non-responders. Reminders increased the participation rate but did not alter risk ratios for smoking and occupational exposures. Reasons for non-response were mainly lack of time and having forgotten to answer. ConclusionsWith a response rate of 58.3%, neither the prevalence estimates of asthma, respiratory symptoms nor the associations to risk factors were affected by non-response, while allergic rhino-conjunctivitis and smoking was underestimated in this Swedish population.

United States prevalence of pediatric asthma by environmental tobacco smoke exposure, 2016–2017

Objectives We sought to update the prevalence estimates of parent-reported asthma diagnosis by Environmental Tobacco Smoke (ETS) exposure in the United States (US) pediatric population. Methods This cross-sectional study included 71,811 families with children who participated in the 2016–2017 National Survey of Children’s Health (NSCH). Weighted asthma prevalence estimates were calculated for ETS-exposed and non-exposed children. Chi-square analysis compared asthma prevalence between the two exposure groups and logistic regression analysis generated adjusted odds ratios (aORs) of asthma diagnosis by ETS exposure by sex, race/ethnicity, and household education and income level. Results Asthma prevalence estimates were significantly higher in ETS-exposed vs. non-exposed children (10.7% vs. 7.8%, p < 0.001). Children with a smoker in the house are 30% more likely to have an asthma diagnosis vs. children with no smokers in the house (aOR 1.29, 95% Confidence Interval [CI] 1.09–1.52). Significant predictors for ETS exposure included < high school education and lower family income. Conversely, non-Hispanic black and Hispanic children were less likely to have ETS exposure vs. non-Hispanic white children. Conclusions ETS exposure is a significant risk factor for asthma in the US pediatric population. Smoking cessation initiatives targeting non-Hispanic white parents from lower socioeconomic may improve children’s chronic pulmonary health risk.

Asthma prevalence and the impact of nutritional status on prescribed asthma medications in children

Introduction. Asthma and obesity are the most common chronic health disorders in children. Although heredity plays a significant role in their development, environmental factors and early exposure have contributed to the increasing incidence of both disorders in recent decades. The aim of the study was to estimate asthma prevalence in schoolchildren in Indjija, Srem District, Serbia, and to investigate differences in nutritional status of children with asthma as well as differences between their nutritional status and prescribed asthma medications. Material and Methods. A cross-sectional retrospective cohort study was conducted at the Primary Health Center in Indjija. Of all the medical records of children aged 6 - 14 years, a cohort of children with asthma was formed. The retrospective study evaluated their nutritional status and the prescribed asthma medications. Results. The prevalence of asthma in children aged 6 - 14 was 6.9%. Children with asthma were significantly more overweight and obese (40.5%) than children without asthma. Boys accounted for 63.7% of children with asthma, with a statistically significant gender difference. Abnormal nutritional status was found in 44.3% of children with asthma and boys with asthma were significantly more obese (23%) compared to girls (7.8%). Overweight and obese children with asthma were not prescribed significantly more medications to relieve asthma symptoms than normal-weight children. Conclusion. The prevalence of asthma among schoolchildren in Indjija was 6.9%. Children with asthma were more likely to be overweight and obese than children without asthma, whereas boys with asthma were significantly more obese than girls. No significant differences were found between their nutritional status and prescribed asthma medications.

Association between Asthma and Developmental Disability and Delay in the United States Pediatric Population

Background. To date, few studies have systemically examined the association between asthma and various developmental disabilities and delays among pediatric populations. To address this scientific gap, we report here the asthma prevalence estimates by, and associations with, various disability categories and developmental delay in the United States (US) pediatric population. Methods: A total of 71 811 families with children/adolescents aged 0-to-17 years old who participated in the 2016-2017 National Survey of Children’s Health were included in this cross-sectional analytical sample. Weighted asthma prevalence estimates were calculated and compared between children with and without disabilities or delays. Disabilities included Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Cerebral Palsy, seizure, vision, hearing and speech, intellectual-, and learning disability. Delay was defined as not meeting growth milestones with unknown cause. Logistic regression analysis generated the odds of an asthma diagnosis by disability status adjusted for demographics and birth weight. Findings: Overall asthma prevalence estimates were 10% higher in children with a disability (~16%) versus children without a disability (~6%) (p<0·0001). The risk of asthma was nearly three times higher in children with a disability versus children with no disability (Odds Ratio [OR] 2·77, 95% Confidence Interval [CI] 2·39-3·21, p<0·0001) and two times higher among children with a developmental delay versus their peers with no delay (OR 2·22, 95% CI, 1·78-2·77, p<0·0001). Adjusted models remained significant for all disability categories (overall adjusted OR [aOR] 2·21, 95% CI 1·87-2·62, p<0.0001). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities versus non-Hispanic whites. Interpretation: Results suggest that US children with various developmental disabilities or delay are at higher odds for asthma versus their typically developing peers. These findings support asthma screening in pediatric healthcare settings among patients with developmental disabilities and delays, and particularly among those from ethnic minority backgrounds. Funding Statement: This study was not supported by any funding. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Our research was exempted from the University of Texas Institutional Review Board approval process because it is publicly available data.

The Projected Economic and Health Burden of Uncontrolled Asthma in the United States.

Rationale: Despite effective treatments, a large proportion of patients with asthma do not achieve sustained asthma control. The “preventable” burden associated with lack of proper control is likely taking a high toll at the personal and population level.Objectives: We predicted the future excess health and economic burden associated with uncontrolled asthma among American adolescents and adults for the next 20 years.Methods: We built a probabilistic model that linked state-specific estimates of population growth, aging, asthma prevalence, and asthma control levels. We conducted several meta-analyses to estimate the adjusted differences in healthcare resource use, quality-adjusted life years (QALYs), and productivity loss across control levels. We projected, nationally and at the state level, total direct and indirect (due to productivity loss) costs (in 2018 dollars) and QALYs lost because of uncontrolled asthma from 2019 to 2038.Measurements and Main Results: Total 20-year direct costs associated with uncontrolled asthma are estimated to be $300.6 billion (95% confidence interval [CI], $190.1 billion–411.1 billion). When indirect costs are added, total economic burden will be $963.5 billion (95% CI, $664.1 billion–1,262.9 billion). American adolescents and adults will lose an estimated 15.46 million (95% CI, 12.77 million–18.14 million) QALYs over this period because of uncontrolled asthma. Across states, the average 20-year per capita costs due to uncontrolled asthma ranged from $2,209 (Arkansas) to $6,132 (Connecticut).Conclusions: The burden of uncontrolled asthma is substantial and will continue to grow. Given that a substantial fraction of this burden is preventable, better adherence to evidence-informed asthma management strategies by care providers and patients has the potential to substantially reduce costs and improve quality of life.

A step closer to nationwide electronic health record-based chronic disease surveillance: characterizing asthma prevalence and emergency department utilization from 100 million patient records through a novel multisite collaboration.

The study sought to assess the feasibility of nationwide chronic disease surveillance using data aggregated through a multisite collaboration of customers of the same electronic health record (EHR) platform across the United States. An independent confederation of customers of the same EHR platform proposed and guided the development of a program that leverages native EHR features to allow customers to securely contribute de-identified data regarding the prevalence of asthma and rate of asthma-associated emergency department visits to a vendor-managed repository. Data were stratified by state, age, sex, race, and ethnicity. Results were qualitatively compared with national survey-based estimates. The program accumulated information from 100 million health records from over 130 healthcare systems in the United States over its first 14 months. All states were represented, with a median coverage of 22.88% of an estimated state's population (interquartile range, 12.05%-42.24%). The mean monthly prevalence of asthma was 5.27 ± 0.11%. The rate of asthma-associated emergency department visits was 1.39 ± 0.08%. Both measures mirrored national survey-based estimates. By organizing the program around native features of a shared EHR platform, we were able to rapidly accumulate population level measures from a sizeable cohort of health records, with representation from every state. The resulting data allowed estimates of asthma prevalence that were comparable to data from traditional epidemiologic surveys at both geographic and demographic levels. Our initiative demonstrates the potential of intravendor customer collaboration and highlights an organizational approach that complements other data aggregation efforts seeking to achieve nationwide EHR-based chronic disease surveillance.

Agreement between a health claims algorithm and parent-reported asthma in young children.

Asthma prevalence is commonly measured in national surveys by questionnaire. The Ontario Asthma Surveillance Information System (OASIS) developed a validated health claims diagnosis algorithm to estimate asthma prevalence. The primary objective was to assess the agreement between two approaches of measuring asthma in young children. Secondary objectives were to identify concordant and discordant pairs, and to identify factors associated with disagreement. A measurement study to evaluate the agreement between the OASIS algorithm and parent-reported asthma (criterion standard). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Multivariable logistic regression was used to determine factors associated with disagreement. Healthy children aged 1 to 5 years (n =3642) participating in the TARGet Kids! practice based research network 2008-2013 in Toronto, Canada were included. Prevalence of asthma was 14% and 6% by the OASIS algorithm and parent-reported asthma, respectively. The Kappa statistic was 0.43, sensitivity 81%, specificity 90%, PPV 34%, and NPV 99%. There were 3249 concordant and 393 discordant pairs. Statistically significant factors associated with asthma identified by OASIS but not parent report included: male sex, higher zBMI, and parent history of asthma. Males were less likely to have asthma identified by parent report but not OASIS. The OASIS algorithm identified more asthma cases in young children than parent-reported asthma. The OASIS algorithm had high sensitivity, specificity, and NPV but low PPV relative to parent-reported asthma. These findings need replication in other populations.

Asthma prevalence among women aged 18 to 44 in the United States: National health and nutrition examination survey 2001–2016

Objective: To provide updated prevalence estimates of asthma and asthma medication use for women of childbearing age in the United States.Methods: Using data from 11,383 women aged 18–44, including a subset of 1,245 pregnant women, enrolled in the National Health and Nutrition Examination Survey (2001–2016), we assessed the age-adjusted prevalence of self-reported diagnosed asthma. For women aged 18–44, we stratified by year, demographics, and other characteristics. Furthermore, we assessed asthma medication use among women aged 18–44 with asthma.Results: After age-adjustment, 9.9% (95% confidence interval (CI) 9.2%, 10.7%) of women aged 18–44 and 10.9% (95% CI 7.2%, 14.6%) of pregnant women reported having asthma. Asthma prevalence was highest in 2015–2016 (12.0% 95% CI 9.8%, 14.3%) and lowest in 2003–2004 (8.6% 95% CI 6.4%, 10.8%). Women aged 18–44 with Medicaid or State Children’s Health Insurance Program insurance coverage (16.8% 95% CI 14.5%, 19.2%), obesity (14.4% 95% CI 12.9%, 15.8%), diabetes (18.7% 95% CI 12.1%, 25.2%), hypertension (16.6% 95% CI 14.2%, 19.0%), and current smokers (12.8% 95% CI 11.4%, 14.2%) had the highest asthma prevalence. Of women with asthma, 38.3% (95% CI 34.5%, 42.1%) reported using asthma medications in the past 30 days.Conclusions: Among women of childbearing ages, asthma burden varies across demographic and clinical characteristics and has increased in recent years.

Prevalence of Asthma, Eczema and Allergic Rhinitis Symptoms in School Children of Kathmandu Valley: Results of a Questionnaire Survey

Introduction: Asthma is the most common chronic disease in children. This study was performed to determine the prevalence of asthma, eczema and allergic rhino-conjunctivitis symptoms in school children of Kathmandu.&#x0D; Methods: This questionnaire-based survey was conducted from December 2009 to August 2010 in 13 schools of Kathmandu among children aged six to seven years and 13 to 14 years based on questions adapted from International Study on Asthma and Allergies in Children (ISAAC) and translated into Nepali. Data were analysed using SPSS and prevalence of self-reported asthma-like symptoms, eczema and allergic rhinitis were assessed. &#x0D; Results: The questionnaire was distributed to 8269 children with a response rate of 68.54%. About 7.5% replied positively for "ever wheezed” (8.1% in older and 6.4% in young children) and 5.2% reported, "current wheeze" (4.2% in younger and 5.8% in older children). Boys had more frequent wheezing than girls in both age groups (p &lt; 0.05). More children had nocturnal cough not associated with cold or chest infection (16.0%) and exercise-induced symptoms (9.4%). The overall prevalence of eczema was 6.2%; younger children (7.2%) reporting symptoms more commonly than older children (5.6%). The reported prevalence of allergic rhinitis was 28.2% (31.2% in older as compared to 22.9% in younger children). Allergic symptoms like “current wheeze”, “eczema” and “allergic rhinitis” were frequently reported together.&#x0D; Conclusion: Asthma, eczema and allergic rhinitis are common in school children of Kathmandu. A multi-centre study across all ecological zones in both rural and urban settings including video questionnaire will more accurately estimate asthma prevalence and its trends in school children of Nepal.

Parents' and health-care workers' understanding of wheeze in children: a systematic review

BackgroundParent-reported wheeze is often used as a proxy for childhood asthma. However, discordance in labelling of wheeze among parents and health-care workers (HCWs) affects true estimates of population wheeze. This systematic review aimed to summarise the evidence of parents' and HCWs' understanding of wheeze in children, and the relevant factors affecting this knowledge. MethodsA systematic literature search was performed to identify studies published in English from Jan 1, 1990, to Nov 16, 2017, in the following databases: Medline, Embase, CINAHL, BNI, Cochrane Library, and PsycINFO. Studies were eligible if they assessed parents' or HCWs' understanding (or both) of wheeze or definition of wheeze in children, or the association between parentally reported (unconfirmed) wheeze and HCW-confirmed wheeze. Non-English language studies were excluded. The methodological quality of the included articles was evaluated with Joanna Briggs Institute critical appraisal checklists. This analysis is registered with PROSPERO, number CRD42017076635. FindingsThe initial search yielded 15 492 unique references, of which 21 met the inclusion criteria. The focus in nine studies was on parents, three focused on HCWs, and nine included both. Across studies, the mean percentage of parents correctly defining wheeze was 44·7% (SD 24·3; 95% CI 29·6–59·7), and the mean percentage correctly identifying it on video was 52·7% (12·8; 41·5–64·0). In one study, 97% of HCWs correctly defined wheeze, and, in another study, agreement between nurses and physicians in assessing wheeze severity was 52%. The mean percentage agreement between parent-reported wheeze and clinician-confirmed wheeze was 64·6% (15·4; 55·5–73·7). Parents' understanding of wheeze was affected by respiratory history in the parent or child, English as a first language, ethnicity, parental education, and method of ascertainment of symptoms. In HCWs, understanding was affected by their profession, age, and location. InterpretationParents' and HCWs' understanding of wheeze is inconsistent and is affected by parent-related, child-related, research-related, and HCW-related factors, with only moderate agreement between parent-reported and clinician-confirmed wheeze. These findings could have an important impact in epidemiological studies to estimate asthma prevalence, and in assessing respiratory symptoms in clinical practice. FundingNone.

Asthma Prevalence Among Medicaid-Enrolled Children

Small-area asthma prevalence measures, which are crucial for targeting interventions, are currently sparsely available for children. To provide measures of in-contact asthma prevalence for the 2012 Medicaid child population so as to highlight areas in need of targeted asthma interventions. Using the 2012 Medicaid Analytic eXtract claims files, we developed 2 prevalence metrics differentiated by persistent and diagnosed asthma. We developed prevalence measures at the state, county, and census tract levels, with statistical inferences to highlight areas of high prevalence where interventions should be focused. We compared the measures with asthma prevalence estimates derived from a sample of the child population that self-reported whether they have been diagnosed with asthma regardless of in-contact asthma. A total of 1.98 million (8.1%) and 1.71 million (6.9%) Medicaid-enrolled children were identified with in-contact asthma diagnosis and persistent asthma, respectively. Among 40 states, 17 had lower prevalence estimates for the Medicaid-enrolled children compared with similar child asthma self-reported prevalence estimates from the Centers for Disease Control and Prevention. High-prevalence regions spanned primarily in the southern Midwest region, from Texas to West Virginia and from Illinois to north Florida. There are large variations in the differences between the self-reported estimates from the Centers for Disease Control and Prevention for the general population and the in-contact estimates for the Medicaid-enrolled children, highlighting potential asthma misdiagnosis in the Medicaid population in many states. Small-area estimates point to areas of high prevalence, consistently throughout the south and southeast.

The impact of HIV on the prevalence of asthma in Uganda: a general population survey

BackgroundHIV and asthma are highly prevalent diseases in Africa but few studies have assessed the impact of HIV on asthma prevalence in high HIV burden settings. The objective of this analysis was to compare the prevalence of asthma among persons living with HIV (PLHIV) and those without HIV participating in the Uganda National Asthma Survey (UNAS).MethodsUNAS was a population-based survey of persons aged ≥12 years. Asthma was diagnosed based on either self-reported current wheeze concurrently or within the prior 12 months; physician diagnosis; or use of asthma medication. HIV was defined based on confidential self-report. We used Poisson regression with robust standard errors to estimate asthma prevalence and the prevalence ratio (PR) for HIV and asthma.ResultsOf 3416 participants, 2067 (60.5%) knew their HIV status and 103 (5.0%) were PLHIV. Asthma prevalence was 15.5% among PLHIV and 9.1% among those without HIV, PR 1.72, (95%CI 1.07–2.75, p = 0.025). HIV modified the association of asthma with the following factors, PLHIV vs. not PLHIV: tobacco smoking (12% vs. 8%, p = < 0.001), biomass use (11% vs. 7%, p = < 0.001), allergy (17% vs. 11%, p = < 0.001), family history of asthma (17% vs. 11%, p = < 0.001), and prior TB treatment (15% vs. 10%, p = < 0.001).ConclusionIn Uganda the prevalence of asthma is higher in PLHIV than in those without HIV, and HIV interacts synergistically with other known asthma risk factors. Additional studies should explore the mechanisms underlying these associations. Clinicians should consider asthma as a possible diagnosis in PLHIV presenting with respiratory symptoms.