BMJ  2004;329:489-490 (28 August), doi:10.1136/bmj.38139.666447.F7 (published 24 June 2004)

Primary care

Respiratory symptoms and atopy in children in Aberdeen: questionnaire studies of a defined school population repeated over 35 years

¹ Department of Medical Paediatrics, Royal Aberdeen Children's Hospital, Aberdeen AB25 2ZG, ² Birmingham Heartlands Hospital, Birmingham B9 5SS, ³ Child Health Department, Doncaster Royal Infirmary, Doncaster

Introduction

In westernised countries, up to a third of children currently have asthma. Part of this "epidemic" has resulted from a change in diagnostic criteria. In Aberdeen in 1964, asthma was diagnosed in 73 of 261 (28%) participating children with wheeze, in 1989 in 331 of 675 (49%),¹ and in 1994 in 654 of 1025 (64%).² Thus, even if the prevalence of wheeze had remained constant, the prevalence of diagnosed asthma would have increased, supporting the view that the recent increases in childhood asthma are explained by changing diagnostic fashion³ as well as changes in underlying symptoms. Although a weakness of these studies is their lack of objective measurements, such as bronchial hyper-reactivity, they do include items on suggestive symptoms and thus do not rely entirely on varying fashions in medical diagnosis.

Current trends in the prevalence of childhood asthma and asthma-like symptoms vary from clear increases in some countries to stabilisation or even a fall in others.⁴ We examined the situation in the United Kingdom by doing a further study in Aberdeen, using the same protocol as in 1989¹ and 1994.²

Participants, methods, and results

In May 1999, we distributed our questionnaire to the parents of all children attending primary school classes 5 to 7 (mainly aged 9 to 12 years with outliers aged 7, 8, and 13 years) in the schools that had participated in the 1964, 1989, and 1994 studies. The responses were entered into an SPSS database along with the earlier studies.

We distributed questionnaires to the parents of 4209 children; 3537 (84%) were returned. Prevalence of asthma or wheeze and the proportion of children with respiratory symptoms reporting a diagnosis of asthma changed little, although we found small but significant increases in the diagnosis of both eczema and hay fever between 1994 and 1999 (table).

View this table: [in this window] [in a new window]   Prevalence of respiratory symptoms and diagnoses of asthma, eczema, and hayfever in children in Aberdeen in 1964, 1989, 1994, and 1999. Values are No (%) unless otherwise stated

 

The male to female ratio for the diagnosis of asthma has narrowed considerably in the past 35 years, with almost complete disappearance of the previous male preponderance.

Comment

In Aberdeen, the prevalence of symptoms suggestive of asthma now seems to be stable. The proportion of children with symptoms in whom asthma has been diagnosed is high, suggesting that the widespread publicity given to asthma has paid off. Indeed, a higher rate of diagnosis might well be undesirable, leading to asthma drugs being given inappropriately—for instance, to children with chronic cough.⁵ Nevertheless, the continuing increases between 1994 and 1999 in diagnosed eczema and hay fever suggest that the tendency for children to develop allergies is still increasing, although these increases may also in part reflect changes in diagnostic fashion.

What is already known on this topic During the past 15 years, the prevalence of childhood asthma and symptoms suggestive of asthma have risen What this study adds The rate of rise in the prevalence of childhood asthma has slowed, although a quarter of primary school children have been diagnosed as having asthma at some time in their lives Most of the recent increase can be attributed to increased diagnosis in children with symptoms; increase in wheeze is barely significant

---

This article was posted on bmj.com on 24 June 2004: http://bmj.com/cgi/doi/10.1136/bmj.38139.666447.F7

Contributors: AD, SDK, and HW shared responsibility for the planning and day to day running of the 1999 study. TN shared responsibility for the planning of the 1989, 1994, and 1999 studies and for the day to day running of the 1989 study. MO shared responsibility for the design of the 1994 and 1999 studies and for the day to day running of the 1994 study. All authors analysed the data, discussed and interpreted the results, and prepared this report. GR had overall responsibility for funding, design and supervision of the 1989, 1994, and 1999 studies. GR is guarantor.

Funding: Grampian University Hospitals Children's Respiratory Fund, into which GR paid his earnings from drug trials, medico-legal reports, lectures, adoption medical examinations, etc. A generous donation was received in memory of Stuart Kerr.

Competing interests: None declared.

Ethical approval: Grampian Research Ethics Committee.

References

1. Ninan TK, Russell G. Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart. BMJ 1992;304: 873-5.
2. Omran M, Russell G. Continuing increase in respiratory symptoms and atopy in Aberdeen schoolchildren. BMJ 1996;312: 34.[Free Full Text]
3. Hill R, Williams J, Tattersfield A, Britton J. Change in use of asthma as a diagnostic label for wheezing illness in schoolchildren. BMJ 1989;299: 898.
4. Ronchetti R, Villa MP, Barreto M, Rota R, Pagani J, Martella S, et al. Is the increase in childhood asthma coming to an end? Findings from three surveys of schoolchildren in Rome, Italy. Eur Respir J 2001;17: 881-6.[Abstract/Free Full Text]
5. Chang AB, Phelan PD, Carlin JB, Sawyer SM, Robertson CF. A randomised, placebo controlled trial of inhaled salbutamol and beclomethasone for recurrent cough. Arch Dis Child 1998;79: 6-11.[Abstract/Free Full Text]

(Accepted 12 May 2004)

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Asthma prevalence has not increased in Aberdeen
BMJ 2004 329: 0. [Full Text]

This article has been cited by other articles:

• McLeish, S, Turner, S W (2007). Gene environment interactions in asthma. Arch. Dis. Child. 92: 1032-1035 [Abstract] [Full text]  
• Kuschner, W. G., Eder, W., Ege, M. J., von Mutius, E. (2007). The Asthma Epidemic. NEJM 356: 1073-1073 [Full text]  
• Anthracopoulos, M. B, Liolios, E., Panagiotakos, D. B, Triantou, K., Priftis, K. N (2007). Prevalence of asthma among schoolchildren in Patras, Greece: four questionnaire surveys during 1978-2003. Arch. Dis. Child. 92: 209-212 [Abstract] [Full text]  
• Trujillo-Vargas, C. M., Werner-Klein, M., Wohlleben, G., Polte, T., Hansen, G., Ehlers, S., Erb, K. J. (2007). Helminth-derived Products Inhibit the Development of Allergic Responses in Mice. Am. J. Respir. Crit. Care Med. 175: 336-344 [Abstract] [Full text]  
• Sole, D., Melo, K. C., Camelo-Nunes, I. C., Freitas, L. S., Britto, M., Rosario, N. A., Jones, M., Fischer, G. B., Naspitz, C. K. (2007). Changes in the Prevalence of Asthma and Allergic Diseases among Brazilian Schoolchildren (13-14 years old): Comparison between ISAAC Phases One and Three. J Trop Pediatr 53: 13-21 [Abstract] [Full text]  
• Ross Anderson, H, Gupta, R., Strachan, D. P, Limb, E. S (2007). 50 years of asthma: UK trends from 1955 to 2004. Thorax 62: 85-90 [Abstract] [Full text]  
• Gupta, R, Sheikh, A, Strachan, D P, Anderson, H R (2007). Time trends in allergic disorders in the UK. Thorax 62: 91-96 [Abstract] [Full text]  
• Eder, W., Ege, M. J., von Mutius, E. (2006). The asthma epidemic.. NEJM 355: 2226-2235 [Full text]  
• Butland, B K, Strachan, D P, Crawley-Boevey, E E, Anderson, H R (2006). Childhood asthma in South London: trends in prevalence and use of medical services 1991-2002. Thorax 61: 383-387 [Abstract] [Full text]  
• Russell, G (2006). The childhood asthma epidemic.. Thorax 61: 276-277 [Full text]  
• Burr, M L, Wat, D, Evans, C, Dunstan, F D J, Doull, I J M, on behalf of the British Thoracic Society Research, (2006). Asthma prevalence in 1973, 1988 and 2003. Thorax 61: 296-299 [Abstract] [Full text]  
• van Schayck, C. P., Smit, H. A. (2005). The prevalence of asthma in children: a reversing trend. Eur Respir J 26: 647-650 [Abstract] [Full text]  
• Toelle, B G, Marks, G B (2005). The ebb and flow of asthma. Thorax 60: 87-88 [Full text]  
• Martindale, S., McNeill, G., Devereux, G., Campbell, D., Russell, G., Seaton, A. (2005). Antioxidant Intake in Pregnancy in Relation to Wheeze and Eczema in the First Two Years of Life. Am. J. Respir. Crit. Care Med. 171: 121-128 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Increases in childhood allergies and asthma may relate to an increasing prevalence of zinc deficiency

Ellen C G Grant
bmj.com, 29 Aug 2004 [Full text]

Alpha and Omega, the beginning and the end...

Dr. Herbert H. Nehrlich
bmj.com, 30 Aug 2004 [Full text]

Zinc and essential fatty acids in asthma

Ellen C G Grant
bmj.com, 31 Aug 2004 [Full text]

Nutritional factors in childhood asthma

George Russell, et al.
bmj.com, 13 Sep 2004 [Full text]

Studies of nutritional supplementation, in asthma or other diseases, which fail to monitor nutritional status, are unscientific.

Ellen C G Grant
bmj.com, 14 Sep 2004 [Full text]