Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study

Asher, M Innes, Rutter, Charlotte E, Bissell, Karen, Chiang, Chen-Yuan, El Sony, Asma, Ellwood, Eamon, Ellwood, Philippa, García-Marcos, Luis, Marks, Guy B, Morales, Eva, Mortimer, Kevin, Pérez-Fernández, Virginia, Robertson, Steven, Silverwood, Richard J, Strachan, David P, Pearce, Neil, Bissell, Karen, Chiang, Chen-Yuan, Ellwood, Eamon, Ellwood, Philippa, Marks, Guy B, Masekela, Refiloe, Morales, Eva, Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871, Pearce, Neil, Strachan, David, Ellwood, Philippa, Ellwood, Eamon, Martinez-Torres, Antonela, Morales, Eva, Pérez-Fernández, Virginia, Pearce, Neil, Robertson, Stephen, Rutter, Charlotte, Silverwood, Richard, Strachan, David, Mallol, Javier, Soto-Martínez, Manuel, Cabrera Aguilar, Angelita, Douros, Konstantinos, Sabir, Mohammed, Singh, Meenu, Singh, Virendra, Sukumaran, Thevaruparambil Unny, Awasthi, Shally, Kabra, Sushil Kumar, Salvi, Sundeep, García-Almaráz, Roberto, Mérida-Palacio, J. Valente, Del Río Navarro, Blanca E, González-Díaz, Sandra Nora, Navarrete-Rodriguez, Elsy Maureen, Sánchez, José Félix, Falade, Adegoke G, Zar, Heather J, López-Silvarrey Varela, Angel, González Díaz, Carlos, Nour, Magde, Dib, Gazal, Mohammad, Yousser, Huang, Jing-Long, Chinratanapisit, Sasawan, Soto-Quirós, Manuel E, Vichyanond, Pakit, Aguilar, Pedro, Barba, Sergio, Kumar, Lata, Sharma, S K, Linares-Zapién, Francisco J, Onadeko, Babatunde O, Musa, Omer Abdel Aziz, Aguirre, Viviana, Baeza-Bacab, Manuel, Mohammad, Samira, Cortez, Eliana, Gratziou, Christina H, Chopra, Kamlesh, Hanumante, Neeta Milind, Nelson, Hugo, Rubio, Alfonso Delgado, Hsieh, Kue-Hsiung and Shah, Jayant (2021) 'Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study'. Lancet, Vol 398, Issue 10311, pp. 1569-1580.

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Abstract

Background
Asthma is the most common chronic disease in children globally. The Global Asthma Network (GAN) Phase I study aimed to determine if the worldwide burden of asthma symptoms is changing.
Methods
This updated cross-sectional study used the same methods as the International study of Asthma and Allergies in Childhood (ISAAC) Phase III. Asthma symptoms were assessed from centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both. We included individuals from two age groups (children aged 6–7 years and adolescents aged 13–14 years) who self-completed written questionnaires at school. We estimated the 10-year rate of change in prevalence of current wheeze, severe asthma symptoms, ever having asthma, exercise wheeze, and night cough (defined by core questions in the questionnaire) for each centre, and we estimated trends across world regions and income levels using mixed-effects linear regression models with region and country income level as confounders.
Findings
Overall, 119 795 participants from 27 centres in 14 countries were included: 74 361 adolescents (response rate 90%) and 45 434 children (response rate 79%). About one in ten individuals of both age groups had wheeze in the preceding year, of whom almost half had severe symptoms. Most centres showed a change in prevalence of 2 SE or more between ISAAC Phase III to GAN Phase I. Over the 27-year period (1993–2020), adolescents showed a significant decrease in percentage point prevalence per decade in severe asthma symptoms (–0·37, 95% CI –0·69 to –0·04) and an increase in ever having asthma (1·25, 0·67 to 1·83) and night cough (4·25, 3·06 to 5·44), which was also found in children (3·21, 1·80 to 4·62). The prevalence of current wheeze decreased in low-income countries (–1·37, –2·47 to –0·27], in children and –1·67, –2·70 to –0·64, in adolescents) and increased in lower-middle-income countries (1·99, 0·33 to 3·66, in children and 1·69, 0·13 to 3·25, in adolescents), but it was stable in upper-middle-income and high-income countries.
Interpretation
Trends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma.
Funding
International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca Educational Grant, National Institute for Health Research, UK Medical Research Council, European Research Council, and Instituto de Salud Carlos III.

Item Type:	Article
Subjects:	WF Respiratory System > WF 20 Research (General) WF Respiratory System > Lungs > WF 600 Lungs WS Pediatrics > Diseases of Children and Adolescents > By System > WS 280 Respiratory system
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/S0140-6736(21)01450-1
Depositing User:	Stacy Murtagh
Date Deposited:	12 Nov 2021 10:41
Last Modified:	12 Nov 2021 10:41
URI:	https://archive.lstmed.ac.uk/id/eprint/19420

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