BMJ 1994;308:1600-1604 (18 June)

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Trends in prevalence and severity of childhood asthma

H R Anderson, B K Butland, D P Strachan 

Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE.

Abstract

Objective : To test the null hypothesis and there has been no change in the prevalence or severity of childhood asthma over recent years.
Design : Repeated population prevalence survey with questionnaires completed by parents followed by home interviews with parents.
Setting : London borough of Croydon, 1978 and 1991.
Subjects : All children in one year of state and private primary schools aged 7 1/2 to 8 1/2 years at screening survey.
Main outcome measures : Trends in symptoms, acute severe attacks, and chronic disability.
Results : For 1978 and 1991 respectively, the response rates were 4147/4763 and 3070/3786, and home interviews were obtained from 273/288 and 319/395 parents of currently wheezy children. Between 1978 and 1991 there were significant relative increases in prevalence ratios in the 12 month prevalence of attacks of wheezing or asthma (1.16; 95% confidence interval 1.02 to 1.31), the one month prevalence of wheezing episodes (1.78, 1.15 to 2.74), and the one month prevalence of night waking (1.81; 1.01 to 3.23) but not in frequent (>=5) attacks over the past year (1.05; 0.79 to 1.40). There were substantial and significant decreases in the 12 months prevalence of absence from school of more than 10 days due to wheezing (0.52; 0.03 to 0.90), any days in bed (0.67; 0.44 to 1.01), and restriction of activities at home (0.51; 0.31 to 0.83) and an equivalent but not significant fall in speech limiting attacks (0.51; 0.24 to 1.11).
Conclusion : The small increase in the prevalence of wheezy children and relatively greater increase in persistent wheezing suggests a change in the environmental determinants of asthma. In contrast and paradoxically the frequency of wheezing attacks remains unchanged and there are indications that severe attacks and chronic disability have fallen by about half; this may be due to an improvement in treatment received by wheezy children.

Clinical implications

  • Clinical implications

  • The prevalence of asthma among children in Croydon has increased by 16% in the period 1978-91, a finding consistent with results of other studies in the United Kingdom

  • This is likely to reflect changes in environmental factors which are, as yet, unknown

  • In clear contrast there has been a substantial reduction by about half in the level of disability and of acute severe episodes

  • This may be explained in part by more treatment and greater use of inhaled steroids in this population

  • These findings indicate that the rising rates of hospital admissions for childhood asthma are unlikely to be explained by an increase in acute morbidity


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