BMJ 1994;308:1591-1596 (18 June)

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Changing prevalence of asthma in Australian children

J K Peat, R H Van Den Berg, W F Green, C M Mellis, S R Leeder, A J Wolcock 

Department of Medicine, University of Sydney, Sydney NSW 2006, Australia Allen and Hanburys Epidemiology Unit, Institute for Respiratory Medicine, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia Department of Community Medicine, Westmead Hospital, Westmead NSW 2145, Australia Correspondence to: Professor A J Woolcock, Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney NSW 2060, Australia.

Abstract

Objective : To investigate whether prevalence of asthma in children increased in 10 years.
Design : Serial cross sectional studies of two populations of children by means of standard protocol.
Setting : Two towns in New South Wales: Belmont (coastal and humid) and Wagga Wagga (inland and dry).
Subjects : Children aged 8-10 years: 718 in Belmont and 769 in Wagga Wagga in 1982; 873 in Belmont and 795 in Wagga Wagga in 1992.
Main outcome measures : History of respiratory illness recorded by parents in self administered questionnaire; airway hyperresponsiveness by histamine inhalation test; atopy by skin prick tests; counts of house dust mites in domestic dust.
Results : Prevalence of wheeze in previous 12 months increased in Belmont, from 10.4% (75/718) in 1982 to 27.6% (240/873) in 1992 (P<0.001), and in Wagga Wagga, from 15.5% (119/769) to 23.1% (183/795) (P<0.001). The prevalence of airway hyperresponsiveness increased twofold in Belmont to 19.8% (173/873) (P<0.001) and 1.4-fold in Wagga Wagga to 18.1% (P<0.05). The prevalence of airway hyperresponsiveness increased mainly in atopic children only, but the prevalence of atopy was unchanged (about 28.5% in Belmont and about 32.5% in Wagga Wagga). Numbers of house dust mites increased 5.5-fold in Belmont and 4.5-fold in Wagga Wagga.
Conclusions : We suggest that exposure to higher allergen levels has increased airway abnormalities in atopic children or that mechanisms that protected airways of earlier generations of children have been altered by new environmental fators.

Public health implications

  • Public health implications

  • Reporting of symptoms of childhood asthma has increased during the past decade, but it is unclear whether this is due to a true increase in incidence of symptoms or a decrease in under-recognition of asthma

  • In this study of prevalence of asthma, conducted in 1982 and 1992 with children aged 8-10, we included objective measurements of airway responsiveness and sensitisation to allergens

  • Prevalence of recent wheeze increased 1.5-fold to about 25%, and prevalence of airway hyperresponsiveness increased twofold to almost 20%

  • Most of the increase in airway hyperresponsiveness occurred in children sensitised to common allergens

  • Increased airway abnormalities may be due to higher allergen levels (numbers of house dust mites increased fivefold during study) or due to new environmental factors


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