Prevalence Of Asthma-like Symptoms Research Articles

Is the prevalence of adult asthma and allergic rhinitis still increasing? Results of an Italian study

Background: The prevalence of asthma and allergic rhinitis has increased worldwide during the 1970s and 1980s. Objective: This study was aimed at evaluating whether the increasing trend in prevalence persisted during the 1990s in the young adult Italian population. Methods: In 1998 to 2000 a screening questionnaire was sent by mail to a general population sample aged 20 to 44 years; nonresponders were contacted again first by mail and then by phone, achieving a final response rate of 78.1% (6876 of 8800). Prevalence estimates, adjusted to correct for nonresponse bias, were compared with those recorded in Italy in 1991 to 1993 during the European Community Respiratory Health Survey, when response rate had been slightly higher (87.6%). Temporal variations in symptom prevalence were analyzed by a logistic regression model, controlling for sex, age, site of residence (urban vs suburban areas), season of response, response rate, and type of contact (mail vs phone). Results: The prevalence of asthma attacks did not vary significantly from 1991 to 1993 (3.6%) to 1998 to 2000 (3.2%) (P = .188). The prevalence of asthma-like symptoms (wheezing, chest tightness, shortness of breath) tended to decrease in the age classes of 32.5 to 45 years, while increasing in the youngest age class (20 to 26 years). A clear-cut increase from 15.4% to 18.3% was observed for the prevalence of allergic rhinitis (P < .001), whereas the proportion of people under antiasthmatic treatment increased in suburban areas but not in urban areas (interaction time–site of residence, P < .001). Conclusion: Asthma prevalence has not increased during the last decade in Italy. The persistence of an increasing trend in allergic rhinitis prevalence deserves attention. (J Allergy Clin Immunol 2003;111:1232-8.)

Comparison of respiratory symptoms between schoolchildren in China and Japan

ABSTRACT Background Despite improvements in air pollution, the prevalence and incidence of bronchial asthma, which has attracted a great deal of attention in relation to air pollution, is tending to increase in Japan as well as worldwide. Severe air pollution conditions currently exist in China due to sulfur dioxide and particulate matter, resulting from coal burning and motor vehicle exhaust gases associated with the rapid increase in the number of vehicles. Methods Using the same questionnaire in China and Japan, we conducted a comparative study of the prevalence of various respiratory symptoms among schoolchildren in Anshan ( n = 4395), Taiyuan ( n = 3784 in 1997; n = 3995 in 1999) and Chengdu ( n = 7795 in 1991; n = 3000 in 1998) in China and in Yokohama ( n = 4161) in Japan. The pollution concentrations in the survey area of China resembled the concentrations observed in heavy industry areas in Japan in the 1970s. Results Comparisons between schoolchildren in Japan and China showed that the prevalence of persistent cough and persistent phlegm (persistent congestion and phlegm) was higher among schoolchildren in China (e.g. the prevalence of persistent cough in boys in China was 2.4-8.1%, whereas the rate was only 2.1% for boys in Yokohama), whereas the prevalence of wheezing and asthma-like symptoms was higher among schoolchildren in Japan (e.g. the prevalence of asthma-like symptoms was 0.2-1.8% for boys in China, whereas this rate was 9.6% in Yokohama, Japan). Conclusions If China follows the same path as Japan, that is, proceeds with conversion from coal to oil as its primary energy source, the popularization of motor vehicles and chemical contamination of food, housing and clothing, there is a risk that the prevalence of bronchial asthma in Chinese children will increase in the same way as it has in Japan. It is hoped that research will be conducted to determine the cause of the increases in bronchial asthma in Japan and that preventive measures will be established so that Chinese children do not repeat the experience of Japanese schoolchildren.

The prevalence of asthma and allergy among university freshmen in Eskisehir, Turkey

The aim of this study was to determine the current and cumulative prevalence of asthma, allergic rhinitis, atopic dermatitis and reactivities to allergen skin prick tests (SPT) among university freshmen.The data at the first stage were collated through the application of the European Community Respiratory Health Survey (-ECRHS- Stage I) questionnaire on 1603 students registering at various faculties and vocational colleges of Osmangazi University in Eskisehir, Turkey, in the academic year 1997–1998. At the second stage a physical examination as well as allergen SPTs were conducted on 151 students.Of the students within the study group, six (0·4%) had experienced an asthma attack within the previous 12 months, 11 (0·7%) had a past of asthma attacks and 123 (8·1%) reported wheezing attacks within the previous 12 months. The prevalence of asthma-like symptoms, rhinoconjunctivitis and dermatitis were found to be 17·0%, 10·0% and 5·9% respectively. Asthma and asthma-like symptoms were found to be significantly more prevalent among students who smoked. A positive SPT reaction to more than one allergen was found in 14·6% of the students. SPT positivity was 8·3% in asymptomatic students, 27·3% in asthmatic students, 14·5% in those with asthma-like symptoms, 28% in those with non-infectious rhinitis and 7·1% in those with dermatitis. In analysis of logistic regression, a history of atopy, as ascertained in the questionnaire, was seen to have a significant effect on SPT positivity.The rate of self-reported asthma and/or asthma-like symptoms among newly enrolled freshmen at the Osmangazi University was found to be lower than in other countries. Cigarette smoking was seen to increase such symptoms significantly, in comparison to non-smokers.

A new questionnaire for the repeat of the first stage of the European Community Respiratory Health Survey: a pilot study.

In the early 1990s a multicentre survey on asthma was performed on the young adult population (European Community Respiratory Health Survey - ECRHS). This study is to be repeated in order to estimate changes in the prevalence of asthma-like symptoms during the last decade and to assess the social and economic costs of the disease and their variations among countries. The self-administered questionnaire devised for this purpose is a two-page questionnaire. The first page contains the same items as those used in the first survey with four additional questions related to: 1) the frequency and severity of asthma attacks; 2) the presence of chronic bronchitis; 3) smoking habits; and 4) a visual analogue scale assessing perception of outdoor pollution. The second page aims to collect information regarding the direct and indirect costs of asthma. The influence of the length of the questionnaire on the response rate was assessed in a pilot study in Italy. Two random samples of 150 subjects received either the one-page questionnaire (first page) or the two-page questionnaire. The response rate was compared with that obtained from the first postal wave in the 1991-1992 survey. Although the response rate was unchanged when using the one-page questionnaire (45% versus 45%), it decreased by 7% when the two-page questionnaire was used (38% versus 45%). On the basis of these results, no problem should arise if four more questions are added to the one-page questionnaire. The slight reduction in the response rate of the two-page questionnaire is worrying but could be corrected by the use of telephone interviews.

Nonresponse bias in EC Respiratory Health Survey in Italy

In the three Italian centres involved in the European Community Respiratory Health Survey (ECRHS), prevalence of asthma-like symptoms was assessed through a mailback questionnaire. Since the nonresponse rate was not negligible, ranging 10-18%, we investigated whether nonresponse bias affected the results and, if so, whether the bias could be eliminated from the final estimates of prevalence. A screening questionnaire was sent by mail to 7,000 randomly selected subjects 20-44 yrs of age, and nonresponders were contacted again by phone. Additional information was collected on a subsample of the respondents through a clinical interview. A logistic regression analysis showed that, except for one symptom (awakening for coughing), symptom prevalence significantly decreased from the first to the subsequent contact, when controlling for age, sex, centre and season of interview. The decrease in symptom prevalence was largely independent of smoking habits and socioeconomic status, and was seemingly caused by a symptom-related self-selection. When correcting results according to a linear regression model, observed estimates appeared to be slightly overestimated, by 4-10%. A simulation with the Italian data showed that the bias increased steeply at nonresponse rate higher than 30%, a situation quite common in asthma surveys. In conclusion, nonresponse bias affects the results of ECRHS in Italy, slightly inflating prevalence estimates. To make reliable comparisons on international data in the presence of different nonresponse rates, a correction of the observed prevalence seems necessary.

Profile of Bronchospastic Disease in Puerto Rican Patients in New York City

A high prevalence of asthmalike symptoms was noted among patients of Puerto Rican descent attending Beth Israel and North Central Bronx Medical Centers in New York City, as compared with other ethnic groups. An evaluation of family and medical histories, pulmonary function data, and alpha 1-antitrypsin phenotypes was undertaken in such Puerto Rican patients and control subjects without asthma. The patients showed a higher proportion of MS and MV phenotypes. All the patients in both MM and variant phenotype groups, with the exception of four MM patients, had features indicative of asthma, with labile airway obstruction, and elevated serum immunoglobulin E and eosinophil levels. The latter was significantly higher in the patients with variant phenotypes than in MM patients. Patients with alpha 1-antitrypsin variants also had much shorter smoking histories as compared with the MM group, and all reported histories of asthma in first-degree relatives, as compared with 66% among the MM patients. We conclude that there is an increased incidence of asthma among Puerto Ricans in New York City, and that the antitrypsin variant phenotypes (specifically S and V) play a role in this incidence and its expression.

Contamination of streptomycin solutions with resistant bacteria.

In the early 1990s a multicentre survey on asthma was performed on the young adult population (European Community Respiratory Health Survey - ECRHS). This study is to be repeated in order to estimate changes in the prevalence of asthma-like symptoms during the last decade and to assess the social and economic costs of the disease and their variations among countries. The self-administered questionnaire devised for this purpose is a two-page questionnaire. The first page contains the same items as those used in the first survey with four additional questions related to: 1) the frequency and severity of asthma attacks; 2) the presence of chronic bronchitis; 3) smoking habits; and 4) a visual analogue scale assessing perception of outdoor pollution. The second page aims to collect information regarding the direct and indirect costs of asthma. The influence of the length of the questionnaire on the response rate was assessed in a pilot study in Italy. Two random samples of 150 subjects received either the one-page questionnaire (first page) or the two-page questionnaire. The response rate was compared with that obtained from the first postal wave in the 1991-1992 survey. Although the response rate was unchanged when using the one-page questionnaire (45% versus 45%), it decreased by 7% when the two-page questionnaire was used (38% versus 45%). On the basis of these results, no problem should arise if four more questions are added to the one-page questionnaire. The slight reduction in the response rate of the two-page questionnaire is worrying but could be corrected by the use of telephone interviews.