Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973-86.

Department of Public Health Medicine, United Medical School of Guy's, London.
BMJ Clinical Research (Impact Factor: 14.09). 06/1990; 300(6735):1306-10. DOI: 10.1136/bmj.300.6735.1306
Source: PubMed

ABSTRACT To estimate changes in the prevalence of reported symptoms of respiratory disease and reported diagnoses of asthma and bronchitis in primary school children in England between 1973 and 1986.
Mixed longitudinal survey.
Representative sample of English primary schools in 22 areas.
15,000 Boys and 14,156 girls each studied at least once between 1973 and 1986.
Whether, according to the parent or guardian, the child had wheezed, wheezed on most days or nights, or had attacks of bronchitis or asthma in the past year.
Within age groups trends in successive annual cohorts showed an increasing prevalence of asthma for each annual birth cohort (boys, 6.9%, p less than 0.001; girls, 12.8%, p less than 0.001) and of wheeze on most days or nights (boys, 4.3% per cohort, p less than 0.001; girls, 6.1% per cohort, p less than 0.001) and a falling prevalence of bronchitis (boys, -4.7% per cohort, p less than 0.001; girls, -5.8% per cohort, p less than 0.001). There was a smaller increase in the prevalence of wheeze whether or not it occurred on most days or nights, and this increase was significant only among the girls (boys, 1.0% per cohort, p greater than 0.05; girls, 1.7% per cohort, p less than 0.05). Although the rate of increase of "asthma" was greater than the rate of decrease in "bronchitis," the baseline prevalence of asthma was much lower than that of bronchitis, and the total proportion of children with either diagnosis declined slightly over the whole period. The main change was an increase in the proportion of children whose parents stated that they had persistent wheeze and yet did not have a report of either "asthma" or "bronchitis."
These results suggest that there has been a true increase in morbidity that is not simply due to changes in diagnostic fashion. The increase is large enough to explain much if not all of the increase in admission to hospital and mortality, and it underlines the importance of an understanding of the aetiology of asthma in tackling the causes of the recent increase.

1 Follower
  • Source
    eLS, 09/2010; , ISBN: 9780470015902
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The clinical data of 217 asthma-affected sib pair families who had been recruited to conduct a genome-wide scan with 408 microsatellite markers was analysed and interpreted. This set of data was derived from standardized questionnaires, skin prick tests and analysis of specific IgE-antibodies to inhalant allergens. An asthma score indicating the severity of the disease was established on the basis of clinical parameters, subsequently followed by an investigation for possible influences. An early onset of the disease, specific triggers of asthma attacks – especially physical exercise – as well as specific sensitization to common inhalant allergens – in particular, the sensitization to cat allergen – seem to influence asthma severity significantly. In addition, the correlation between specific allergic sensitization in asthmatic children and in their parents was investigated. Thus, for nearly all inhalant allergens, which were under consideration, one can conclude that a specific allergic sensitization in children is significantly associated with a specific sensitization to the same allergen in both of their parents. Furthermore, some specific allergies in children seem to be stronger influenced by paternal than by maternal sensitization. Several clinical characteristics of the disease show a stronger correlation between affected siblings than between non-related asthmatics. The combination of the present data with the results of the genome-wide scan could further advance the clarification of the pathogenesis of asthma with its complex genetic and environmental interactions.
  • Source
    Article: Asthma.
    [Show abstract] [Hide abstract]
    ABSTRACT: 1. Asthma is defined as variable wheezy breathlessness. Cough rather than wheezing may be a presenting symptom, especially in children. Many asthmatics have predominantly nocturnal symptoms. 2. A severe attack is suggested by any of the following factors: a respiratory rate of > 25 breaths/minute, a tachycardia of > 110 beats/minute, a reduction by more than 40% in the normal peak expiratory flow rate (PEFR) or less than 200 l/min if usual PEFR not known), an inspiratory fall in arterial blood pressure of 10 mmHg. 3. The initial treatment of an acute attack includes nebulized beta 2 agonist bronchodilators. A pressurized aerosol given by a Volumatic or Nebuhaler device may also be effective. A short course of steroids should be initiated promptly starting with 30-60 mg of oral prednisolone as a single dose. Intravenous aminophylline should not be given to patients taking oral theophylline or aminophylline. 4. Signs of an imminent threat to life include: a silent chest on auscultation, cyanosis, bradycardia, exhaustion, confusion, or unconsciousness. 5. Indications for urgent referral to hospital include a PEFR < 40% of normal (or less than 200 l/minute for adults) 15-30 minutes after nebulized salbutamol, any life-threatening features and if any other features of a severe attack persist after initial treatment. The threshold for admission will also be affected by the social circumstances. 6. The first line treatment of chronic asthma is inhaled beta 2 agonists. Correct inhaler techniques should be reinforced on several occasions.(ABSTRACT TRUNCATED AT 250 WORDS)
    Occasional paper (Royal College of General Practitioners) 12/1992;


Available from