Paper

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 doi: 10.1136/bmj.316.7125.118 (Published 10 January 1998)
Cite this as: BMJ 1998;316:118
  1. Balvinder Kaur, clinical lecturer in public health medicinea,
  2. H Ross Anderson, professor of epidemiology and public healtha,
  3. Jane Austin, community paediatrician associate specialistb,
  4. Michael Burr, senior lecturer in public health medicinec,
  5. Leigh S Harkins, statisticiana,
  6. David P Strachan, reader in epidemiologya,
  7. John O Warner, professor of child healthd
  1. a Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE
  2. b Highland Communities NHS Trust, Child Health Department, Royal Northern Infirmary, Inverness IV3 5SF
  3. c Centre for Applied Public Health Medicine, Temple of Peace and Health, Cathays Park, Cardiff CF1 3NW
  4. d Southampton General Hospital, Southampton S016 6YD
  1. Correspondence to: Dr Kaur
  • Accepted 16 September 1997

Abstract

Objective: To investigate variations in the prevalence of self reported symptoms, diagnosis, and treatment of asthma in 12–14 year old children.

Design: Self completion questionnaire.

Setting: Great Britain.

Subjects: All pupils aged 12–14 years in a stratified cluster sample 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% response rate). The national 12 month prevalence of any wheezing, speech limiting wheeze, four or more attacks of wheeze, and frequent night waking with wheeze was 33.3% (n=9155), 8.8% (2427), 9.6% (2634), and 3.7% (1023) respectively. The prevalence of ever having had a diagnosis of asthma was 20.9% (5736). In total, 19.8% (5438/27 507) of pupils reported treatment with anti-asthma drugs in the past year, but, of pupils reporting frequent nocturnal wheeze in the past year, 33.8% (342/1012) had no diagnosis of asthma 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 discernible north-south or east-west gradient. Wheeze prevalence was slightly higher in non-metropolitan areas (35.0%, 6155/17 605) than in metropolitan areas (30.3%, 3000/9902). The prevalence of self reported asthma diagnosis and inhaler use showed no discernible national, regional, north-south, or east-west geographical pattern but was higher in non-metropolitan areas.

Conclusion: Prevalence of self reported symptoms, diagnosis, and treatment of asthma was high among 12–14 year olds throughout Great 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.

Footnotes

  • Funding: National Asthma Campaign.

  • Conflict of interest: None.

  • Contributors: HRA, JA, MB, DPS, and JOW conceived of the original idea; BK and HRA performed the literature review; BK, HRA, JA, MB, DPS, and JOW designed the study; and all the authors were responsible for collecting and analysing data, interpreting the results, and writing the article. BK is guarantor of the article.

    1. Have you ever had wheezing or whistling in the chest at any time in the past? Yes/No If you have answered “No” please skip to question 11

    2. Have you had wheezing or whistling in the chest in the last 12 months? Yes/No If you have answered “No” please skip to question 11

    3. How many attacks of wheezing have you had in the last 12 months? None/1-3/4-12/More than 12

    4. In the last 12 months, how often, on average, has your sleep been disturbed due to wheezing? Never woken with wheezing/Less than one night per week/One or more nights per week

    5. In the last 12 months, has wheezing ever been severe enough to limit your speech to only one or two words at a time between breaths? Yes/No

    6. In the last 12 months, how much did this wheezing interfere with your daily activities? Not at all/A little/A moderate amount/A lot

      Exercise

    7. In the last 12 months, has your chest sounded wheezy during or after exercise? Yes/No

    8. In the last 12 months, has your chest sounded wheezy when you HAD NOT recently taken exercise? Yes/No

      Colds

    9. In the last 12 months, have you had wheezing or whistling in the chest when you HAD a cold or flu? Yes/No

    10. In the last 12 months, have you had wheezing or whistling in the chest when you DID NOT have a cold or flu? Yes/No

    11. Have you ever had asthma? Yes/No

    12. In the last 12 months, have you taken any treatment (medicines, tablets, inhalers) for wheezing or asthma? Yes/No If “Yes,” what? Inhaler Yes—Name/Describe No Medicine/Tablets Yes—Name/Describe No

      Cough

    13. In the last 12 months, have you had a dry cough at night, apart from a cough associated with a cold or chest infection? Yes/No

    14. Do you usually have a cough when you HAVE a cold? Yes/No

    15. Do you usually have a cough when you DO NOT have a cold? Yes/No

      Phlegm

    16. Do you usually seem congested in the chest or cough up phlegm (mucus) when you HAVE a cold? Yes/No

    17. Do you usually seem congested in the chest or cough up phlegm (mucus) when you DO NOT have a cold? Yes/No

    18. In the last 12 months, how many times have you had a cold or flu? (tick one answer only) Never/1-3 times/4-6 times/7 or more times

    (This full text of questions—with instructions, options, and skips indicated—does not reflect the layout of the questionnaire.)

  • Accepted 16 September 1997

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