Epidemiology of Pediatric Asthma

  • Gary W.K. Wong
Part of the Allergy Frontiers book series (ALLERGY, volume 1)

Childhood asthma is one of the most common chronic respiratory disorders affecting up to 30% of school children in the developed world. Many epidemiology studies have consistently documented an increasing trend of asthma over the past three decades [1]. A few recent reports suggested that there is a plateau or even decline in the trend of asthma prevalence [2–4]. Due to the lack of precise definitions of asthma and validation of survey instruments, reliable comparison of reported prevalence studies from different regions are very difficult. A number of large multicentered epidemiological studies using standardized instruments have been performed revealing important information on the prevalence and burden of asthma around the world [5–7]. They have also provided a framework to investigate the possible determinants of asthma. Studies in the rural areas have consistently showed a lower prevalence of asthma in children who have been brought up in a farming environment [8–11]. This chapter reviews the existing data on asthma epidemiology and summarizes the recent important findings from studies of the environmental determinants of childhood asthma.


Allergy Clin Immunol Childhood Asthma Allergen Exposure Asthma Prevalence Pediatric Asthma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Beasley R, Crane J, Lai CK, Pearce N (2000) Prevalence and etiology of asthma. J Allergy Clin Immunol 105:S466–S472.PubMedCrossRefGoogle Scholar
  2. 2.
    Toelle BG, Ng K, Belousova E, Marks GB (2004) Prevalence of asthma and allergy in schoolchildren in Belmont, Australia: three cross sectional surveys over 20 years. BMJ 328:386–387.PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson HR, Ruggles R, Strachan DP, Austin JB, Burr M, Jeffs D, Standring P, Steriu A, Goulding R (2004) Trends in prevalence of symptoms of asthma, hay fever, and eczema in 12–14 year olds in the British Isles, 1995–2002: questionnaire survey. BMJ 328:1052–1053.PubMedCrossRefGoogle Scholar
  4. 4.
    Wong GW, Leung TF, Ko FW, Lee KK, Lam P, Hui DS, Fok TF, Lai CK (2004) Declining asthma prevalence in Hong Kong Chinese schoolchildren. Clin Exp Allergy 34:1550–1555.PubMedCrossRefGoogle Scholar
  5. 5.
    The International Study of Asthma and Allergies in Childhood Steering Committee (1998) Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood. Eur Respir J 12:315–335.CrossRefGoogle Scholar
  6. 6.
    Janson C, Anto J, Burney P, Chinn S, de Marco R, Heinrich J, Jarvis D, Kuenzli N, Leynaert B, Luczynska C, Neukirch F, Svanes C, Sunyer J, Wjst M; European Community Respiratory Health Survey II (2001) The European Community Respiratory Health Survey: what are the main results so far? European Community Respiratory Health Survey II. Eur Respir J 18:598–611.PubMedCrossRefGoogle Scholar
  7. 7.
    Weiland SK, von Mutius E, Hirsch T, Duhme H, Fritzsch C, Werner B, Husing A, Stender M, Renz H, Leupold W, Keil U (1999) Prevalence of respiratory and atopic disorders among children in the East and West of Germany five years after unification. Eur Respir J 14:862–870.CrossRefGoogle Scholar
  8. 8.
    Braun-Fahrlander C, Gassner M, Grize L, Neu U, Sennhauser FH, Varonier HS, Vuille JC, Wuthrich B (1999) Prevalence of hay fever and allergic sensitization in farmer's children and their peers living in the same rural community. Clin Exp Allergy 29:28–34.PubMedCrossRefGoogle Scholar
  9. 9.
    von Ehrenstein OS, Von Mutius E, Illi S, Baumann L, Bohm O, von Kries R (2000) Reduced risk of hay fever and asthma among children of farmers. Clin Exp Allergy 30:187–193.CrossRefGoogle Scholar
  10. 10.
    Riedler J, Eder W, Oberfeld G, Schreuer M (2000) Austrian children living on a farm have less hay fever, asthma and allergic sensitization. Clin Exp Allergy 30:194–200.PubMedCrossRefGoogle Scholar
  11. 11.
    Kilpelainen M, Terho EO, Helenius H, Koskenvuo M (2000) Farm environment in childhood prevents the development of allergies. Clin Exp Allergy 30:201–208.PubMedCrossRefGoogle Scholar
  12. 12.
    Stein RT, Holberg CJ, Morgan WJ,. Stein RT, Holberg CJ, Morgan WJ, Wright AL, Lombardi E, Taussig L, Martinez FD (1997) Peak flow variability, methacholine responsiveness and atopy as markers for detecting different wheezing phenotypes in childhood. Thorax 52:946–952.PubMedCrossRefGoogle Scholar
  13. 13.
    Burney PG, Burney PG, Laitinen LA, Perdrizet S, Huckauf H, Tattersfield AE, Chinn S, Poisson N, Heeren A, Britton JR, Jones T (1989) Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison. Eur Respir J 2:940–945.PubMedGoogle Scholar
  14. 14.
    Pekkanen J, Pearce N (1999) Defining asthma in epidemiological studies. Eur Respir J 14:951–957.PubMedCrossRefGoogle Scholar
  15. 15.
    Peat JK, Toelle BG, Marks GB, Mellis CM (2001) Continuing the debate about measuring asthma in population studies. Thorax 56:406–411.PubMedCrossRefGoogle Scholar
  16. 16.
    Weinmayr G, Weiland SK, Bjorksten B, Brunekreef B, Buchele G, Cookson WO, Garcia-Marcos L, Gotua M, Gratziou C, van Hage M, von Mutius E, Riikjarv MA, Rzehak P, Stein RT, Strachan DP, Tsanakas J, Wickens K, Wong GW (2007) Atopic sensitisation and the international variation of asthma symptom prevalence in children. Am J Respir Crit Care Med Jun 15 (Epub ahead of print).Google Scholar
  17. 17.
    von Mutius E (1998) The rising trends in asthma and allergic disease. Clin Exp Allergy 28(S5):45–49.CrossRefGoogle Scholar
  18. 18.
    Wieringa MH, Vermeire PA, Brunekreef B (2001) Increased occurrence of asthma and allergy: critical appraisal of studies using allergic sensitization, bronchial hyper-responsiveness and lung function measurements. Clin Exp Allergy 31:1553–1563.PubMedCrossRefGoogle Scholar
  19. 19.
    Peat JK, van den Berg RH, Green WF, Mellis CM, Leeder SR, Woolcock AJ (1994) Changing prevalence of asthma in Australian children. BMJ 308:1591–1596.PubMedGoogle Scholar
  20. 20.
    von Mutius E, von Mutius E, Weiland SK, Fritzsch C, Duhme H, Keil U (1998) Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany. Lancet 351:862–866.CrossRefGoogle Scholar
  21. 21.
    Burr ML, Butland BK, King S, Vaughau-Williams E (1989) Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child 64:1118–1125.CrossRefGoogle Scholar
  22. 22.
    Nishima S (1993) A study on the prevalence of bronchial asthma in schoolchildren in western districts of Japan—comparison between the studies in 1982 and 1992 with the same methods and same districts. Arerugi 42:192–204.PubMedGoogle Scholar
  23. 23.
    Leung R, Wong GWK, Lau J, Ho A, Chan JKW, Choy D, Douglass C, Lai CKW (1997) Prevalence of asthma and allergy in Hong Kong schoolchildren: an ISAAC study. Eur Respir J 10:354–360.PubMedCrossRefGoogle Scholar
  24. 24.
    Wong GW, Li ST, Hui DS, Fok TF, Zhong NS, Chen YZ, Lai CK (2002) Individual allergens as risk factors for asthma and bronchial hyperresponsiveness in Chinese children. Eur Respir J 19:288–293.PubMedCrossRefGoogle Scholar
  25. 25.
    Wong GW, Hui DS, Chan HH, Fok TF, Leung R, Zhong NS, Chen YZ, Lai CK (2001) Prevalence of respiratory and atopic disorders in Chinese schoolchildren. Clin Exp Allergy 31:1225–1231.PubMedCrossRefGoogle Scholar
  26. 26.
    Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, Williams H (2006) Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 368:733–743.PubMedCrossRefGoogle Scholar
  27. 27.
    Strachan DP (2000) Family size, infection and atopy: the first decade of the “hygiene hypothesis.” Thorax 55:S2–S10.PubMedCrossRefGoogle Scholar
  28. 28.
    Romagnani S (2004) Immunologic influences on allergy and the TH1/TH2 balance. J Allergy Clin Immunol 113:395–400.PubMedCrossRefGoogle Scholar
  29. 29.
    Romagnani S (2004) The increased prevalence of allergy and the hygiene hypothesis: missing immune deviation, reduced immune suppression, or both? Immunology 112(3):352–363.PubMedCrossRefGoogle Scholar
  30. 30.
    Braun-Fahrlander C, Riedler J, Herz U, Eder W, Waser M, Grize L, Maisch S, Carr D, Gerlach F, Bufe A, Lauener RP, Schierl R, Renz H, Nowak D, von Mutius E (2002) Environmental exposure to endotoxin and its relation to asthma in school-age children. N Engl J Med 347:869–877.PubMedCrossRefGoogle Scholar
  31. 31.
    van Strien RT, Engel R, Holst O, Bufe A, Eder W, Waser M, Braun-Fahrlander C, Riedler J, Nowak D, von Mutius E (2004) Microbial exposure of rural school children, as assessed by levels of N-acetyl-muramic acid in mattress dust, and its association with respiratory health. J Allergy Clin Immunol 113:860–867.PubMedCrossRefGoogle Scholar
  32. 32.
    Sporik R, Holgate ST, Platts-Mills TA, Cogswell JJ (1990) Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med 323:502–507.PubMedGoogle Scholar
  33. 33.
    Lau S, Illi S, Sommerfeld C, Niggemann B, Bergmann R, von Mutius E, Wahn U (2000) Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study. Multicentre Allergy Study Group. Lancet 356:1392–1397.PubMedCrossRefGoogle Scholar
  34. 34.
    Woodcock A, Lowe LA, Murray CS, Simpson BM, Pipis SD, Kissen P, Simpson A, Custovic A; NAC Manchester Asthma and Allergy Study Group (2004) Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years. Am J Respir Crit Care Med 170:433–439.Google Scholar
  35. 35.
    Becker A, Watson W, Ferguson A, Dimich-Ward H, Chan-Yeung M (2004) The Canadian asthma primary prevention study: outcomes at 2 years of age. J Allergy Clin Immunol 113:650–656.PubMedCrossRefGoogle Scholar
  36. 36.
    Koopman LP, van Strien RT, Kerkhof M, Wijga A, Smit HA, de Jongste JC, Gerritsen J, Aalberse RC, Brunekreef B, Neijens HJ; Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Study (2002) Placebo-controlled trial of house dust mite-impermeable mattress covers: effect on symptoms in early childhood. Am J Respir Crit Care Med 166:307–313PubMedCrossRefGoogle Scholar
  37. 37.
    Cullinan P, MacNeill SJ, Harris JM, Moffat S, White C, Mills P, Newman Taylor AJ (2004) Early allergen exposure, skin prick responses, and atopic wheeze at age 5 in English children: a cohort study. Thorax 59:855–861.PubMedCrossRefGoogle Scholar
  38. 38.
    Arshad SH, Bateman B, Matthews SM (2003) Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study. Thorax 58:489–493.PubMedCrossRefGoogle Scholar
  39. 39.
    Celedon JC, Litonjua AA, Weiss ST, Gold DR (1999) Day care attendance in the first year of life and illnesses of the upper and lower respiratory tract in children with a familial history of atopy. Pediatrics 104:495–500.PubMedCrossRefGoogle Scholar
  40. 40.
    Kramer U, Heinrich J, Wjst M, Wichmann HE (1999) Age of entry to day nursery and allergy in later childhood. Lancet 353:450–454.PubMedCrossRefGoogle Scholar
  41. 41.
    Ball TM, Castro-Rodriguez JA, Griffith KA, Holberg CJ, Martinez FD, Wright AL (2000) Siblings, day-care attendance, and the risk of asthma and wheezing during childhood. N Engl J Med 24;343:538–543.CrossRefGoogle Scholar
  42. 42.
    Matricardi PM, Rosmini F, Ferrigno L, Nisini R, Rapicetta M, Chionne P, Stroffolini T, Pasquini P, D'Amelio R (1997) Cross sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus. BMJ 314:999–1003.PubMedGoogle Scholar
  43. 43.
    Shaheen SO, Aaby P, Hall AJ, Barker DJ, Heyes CB, Shiell AW, Goudiaby A (1996) Measles and atopy in Guinea-Bissau. Lancet 347:1792–1796.PubMedCrossRefGoogle Scholar
  44. 44.
    Shirakawa T, Enomoto T, Shimazu S, Hopkin JM (1997) The inverse association between tuberculin responses and atopic disorder. Science 275:77–79.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Gary W.K. Wong
    • 1
  1. 1.Department of Paediatrics and School of Public HealthChinese University of Hong Kong Prince of Wales HospitalShatinHong Kong

Personalised recommendations