National surveillance for asthma - United States, 1980-2004. MMWR Surveill Summ

Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia 30333, USA.
MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 11/2007; 56(8):1-54.
Source: PubMed

ABSTRACT Asthma, a chronic respiratory disease with episodic symptoms, increased in prevalence during 1980-1996 in the United States. Asthma has been the focus of numerous provider interventions (e.g., improving adherence to asthma guidelines) and public health interventions during recent years. Although the etiology of asthma is unknown, adherence to medical treatment regimen and environmental management should reduce the occurrence of exacerbations and lessen the hardship of this disease. CDC has outlined a public health approach to asthma that includes comprehensive analyses of national surveillance data on prevalence, health-care use and mortality, and a strategy to improve the timeliness and geographic specificity of asthma surveillance data.
This report presents national data on asthma for self-reported prevalence (1980-1996 and 2001-2004); self-reported attacks (1997-2004); visits to physicians' offices (1980-2004), hospital outpatient departments (1992-2004), and emergency departments (1992-2004); hospitalizations (1980-2004); and deaths (1980-2004).
The National Health Interview Survey includes questions about asthma prevalence and asthma attacks. Physicians' office visit data are collected in the National Ambulatory Medical Care Survey, emergency department and hospital outpatient data in the National Hospital Ambulatory Medical Care Survey, hospitalization data in the National Hospital Discharge Survey, and death data in the Mortality component of the National Vital Statistics System.
From 1980 to 1996, 12-month asthma prevalence increased both in counts and rates, but no discernable change was identified in asthma attack estimates since 1997 or in current asthma prevalence from 2001 to 2004. During the period of increasing prevalence, patient encounters (office visits, emergency department visits, outpatient visits, and hospitalizations) for asthma increased. However, rates for these encounters, when based on the population with asthma, did not increase. Although the rate of asthma deaths increased during 1980-1995, the rate of deaths has decreased each year since 2000. During 2001-2003, current asthma prevalence was higher in children (8.5%) compared with adults (6.7%), females (8.1%) compared with males (6.2%), blacks (9.2%) compared with whites (6.9%), those of Puerto Rican descent (14.5%) compared with those of Mexican descent (3.9%), those below the federal poverty level (10.3%) compared with those at or above the federal poverty level (6.4% to 7.9%), and those residing in the Northeast (8.1%) compared with those residing in other regions (6.7% to 7.5%). Among persons with current asthma, whites and blacks were equally likely to report an attack during the preceding 12 months. Women with current asthma were more likely to report asthma attacks than men, and children were more likely than adults. The rate for asthma health-care encounters, regardless of place (physician office, emergency department, outpatient department, or hospital), when based on the population with asthma, did not differ by race. However, whites with current asthma had higher rates for physician offices, and blacks had higher rates for hospital-based sites (e.g., outpatient clinics and emergency departments).
The findings in this report suggest that from 1980 through the mid-1990s, increases in asthma prevalence played a substantial role in the increases in patient encounter measures used in asthma surveillance. Because no primary strategies for preventing asthma have been identified, efforts to control asthma exacerbations through interventions that promote adhering to proper medical regimens and reducing exposures to causes of asthma exacerbations should continue to be pursued.

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    • "Asthma in children and adolescents has increased in prevalence in recent decades and has become a major public health issue in developed and developing countries (Eder et al., 2006; Hansen et al., 2013; Moorman et al., 2007; Soriano et al., 2003; Wehrmeister et al., 2012; Yan et al., 2005). In the United States, the prevalence of asthma in children and adolescents has doubled from approximately 3.5% in early 1980 to 8.5% in early 2000 (Moorman et al., 2007), and 5.6 million school-age children and adolescents were reported to have asthma in 2006. In Norway, a questionnaire-based survey among children aged 7e14 years showed a significantly increasing prevalence of asthma, from 7.3% in 1985 to 17.6% in 2008 (Hansen et al., 2013). "
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    ABSTRACT: Previous studies have suggested an immunological dysfunction in mood disorders, but rarely have investigated the temporal association between allergic diseases and mood disorders. Using the Taiwan National Health Insurance Research Database, we attempted to investigate the association between asthma in early adolescence and the risk of unipolar depression and bipolar disorder in later life. In all, 1453 adolescents with asthma aged between 10 and 15 years and 5812 age-/gender-matched controls were selected in 1998-2000. Subjects with unipolar depression and bipolar disorder that occurred up to the end of follow-up (December 31 2010) were identified. Adolescents with asthma had a higher incidence of major depression (2.8% vs. 1.1%, p < 0.001), any depressive disorder (6.1% vs. 2.6%, p < 0.001), and bipolar disorder (1.0% vs. 0.3%, p < 0.001) than the control group. Cox regression analysis showed that asthma in early adolescence was associated with an increased risk of developing major depression (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.14-2.89), any depressive disorder (HR: 1.74, 95% CI: 1.27-2.37), and bipolar disorder (HR: 2.27, 95% CI: 1.01-5.07), after adjusting for demographic data and comorbid allergic diseases. Adolescents with asthma had an elevated risk of developing mood disorders in later life. Further studies would be required to investigate the underlying mechanisms for this comorbid association and elucidate whether prompt intervention for asthma would decrease the risk of developing mood disorders.
    Journal of Psychiatric Research 11/2013; 49(1). DOI:10.1016/j.jpsychires.2013.10.015 · 4.09 Impact Factor
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    • "Asthma is a major public health problem. Its worldwide prevalence is estimated at 10% and is still increasing [1] [2] [3] [4]. Small percentage of asthmatic patients (5–10%) are not well controlled despite the use of high dose inhaled corticosteroids (ICS), long acting bronchodilators (LABA), plus add on treatment. "
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    ABSTRACT: With the judicious use of inhaled corticosteroids (ICS) and B2 agonists most patients with asthma are easily controlled and managed. However, approximately 5–10% of asthmatics did not respond to standard therapy and are classified as “difficult to treat asthma, DTA”. Many factors can contribute to poor response to conventional therapy. For these patients, a systematic approach is needed to identify false (non-genuine) DTA from true (genuine) intractable DTA. It is essential to sort through and address the above issues before reverting to other therapy. Objectives The aim of the present study is to evaluate a systematic approach to indentify the patients of false (non-genuine) to true (genuine) DTA and to recognize the underlying different precipitating factors. Conclusion In apparently DTA there is a high prevalence of false (non-genuine) cases. Identification and management can be achieved by detailed systematic assessment.
    01/2013; 63(1). DOI:10.1016/j.ejcdt.2013.10.009
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    ABSTRACT: Surveillance for incident asthma in the general population could provide timely information about asthma trends and new, emerging etiologic factors. We sought to determine the feasibility of an asthma incidence surveillance system using voluntary reporting of asthma by outpatient clinics and emergency departments (EDs). Voluntary reporting occurred from July 2002 through June 2006. We classified reported asthma based on a case definition adapted from one developed by the Council of State and Territorial Epidemiologists. We validated the case definition by having pulmonologists review data from participant interviews, medical record abstractions, and pulmonary function test (PFT) results. The positive predictive value (PPV) of meeting any of the case definition criteria for asthma was 80% to 82%. The criterion of taking at least one rescue and one controller medication had the highest PPV (97% to 100%). Only 7% of people meeting the incident case definition had a PFT documented in their medical record, limiting the usefulness of PFT results for case classification. Compared with pediatric participants, adult participants were more likely to be uninsured and to obtain asthma care at EDs. The surveillance system cost $5129 per enrolled person meeting the incident case definition and was difficult to implement in participating clinics and EDs because asthma reporting was not mandatory and informed consent was necessary. The project was useful in evaluating the case definition's validity and in describing the participants' characteristics and health-care use patterns. However, without mandatory reporting laws, reporting of incident asthma in the general population by clinicians is not likely to be a feasible method for asthma surveillance.
    Public Health Reports 124(2):267-79. · 1.64 Impact Factor
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