Prevalence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great Britain (international study of asthma and allergies in childhood, ISAAC UK)

BMJ 1998;316:118-124 (10 January)

General practice

Prevalence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great Britain (international study of asthma and allergies in childhood, ISAAC UK)

Balvinder Kaur, clinical lecturer in public health medicine,^a H Ross Anderson, professor of epidemiology and public health,^a Jane Austin, community paediatrician associate specialist,^b Michael Burr, senior lecturer in public health medicine,^c Leigh S Harkins, statistician,^a David P Strachan, reader in epidemiology,^a John O Warner, professor of child health ^d

^a Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE, ^b Highland Communities NHS Trust, Child Health Department, Royal Northern Infirmary, Inverness IV3 5SF, ^c Centre for Applied Public Health Medicine, Temple of Peace and Health, Cathays Park, Cardiff CF1 3NW, ^d Southampton General Hospital, Southampton S016 6YD

Correspondence to: DrKaur

Objective: To investigate variations in the prevalence of selfreported symptoms, diagnosis, and treatment of asthma in 12-14year old children.
Design: Self completion questionnaire.
Setting: Great Britain.
Subjects: All pupils aged 12-14 years in a stratified clustersample of 93 large mixed secondary schools in 1995.
Main outcome measures: Self reported prevalence of symptoms,diagnosis, and treatment of asthma at four geographical levels.
Results: 27 507 questionnaires were completed (85.9% responserate). The national 12 month prevalence of any wheezing, speechlimiting wheeze, four or more attacks of wheeze, and frequentnight waking with wheeze was 33.3% (n=9155), 8.8% (2427), 9.6%(2634), and 3.7% (1023) respectively. The prevalence of everhaving had a diagnosis of asthma was 20.9% (5736). In total,19.8% (5438/27 507) of pupils reported treatment with anti-asthmadrugs in the past year, but, of pupils reporting frequent nocturnalwheeze in the past year, 33.8% (342/1012) had no diagnosis ofasthma and 38.6% (395/1023) denied receiving inhaler therapy.The 12 month prevalence of wheeze was highest in Scotland (36.7%,1633/4444), but in England and Wales there was no discerniblenorth-south or east-west gradient. Wheeze prevalence was slightlyhigher in non-metropolitan areas (35.0%, 6155/17 605) than inmetropolitan areas (30.3%, 3000/9902). The prevalence of selfreported asthma diagnosis and inhaler use showed no discerniblenational, regional, north-south, or east-west geographical patternbut was higher in non-metropolitan areas.
Conclusion: Prevalence of self reported symptoms, diagnosis,and treatment of asthma was high among 12-14 year olds throughoutGreat Britain with little geographical or urban-rural variation.Underdiagnosis and undertreatment were substantial.

Key messages

We investigated the prevalence of self reported symptoms, diagnosis, and treatment of asthma in 12-14 year old children in Great Britain
A third of subjects reported wheezing in the past year, and a fifth reported ever having had a diagnosis of asthma—higher prevalences than reported previously
Prevalences of symptoms generally varied by a factor of 1.3 or less across Great Britain but, in contrast to previous reports, were significantly higher in Scotland than England and in non-metropolitan areas than metropolitan ones
Asthma may still be undiagnosed and undertreated—4% of pupils reported having had a diagnosis of asthma but were still experiencing moderate or greater disruption of their lives, while 1-3.4% reported moderate to severe symptoms but were undiagnosed and untreated
The limited geographical variation in prevalences of symptoms and diagnosis of asthma suggests that the causes of asthma are widely distributed in Great Britain and that factors which do vary geographically—such as climate, diet, and outdoor environment—are not the main determinants of prevalence.

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