Operational definitions of asthma in recent epidemiological studies are inconsistent

Clinical and Translational Allergy

João Almeida Fonseca¹  Jean Bousquet⁶  António Bugalho-Almeida⁸  Carlos Robalo-Cordeiro²  Mário Morais-Almeida⁴  Luís Filipe Azevedo³  Tiago Jacinto⁵  Ana Sá-Sousa⁷ 

[1] Faculdade de Medicina da Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal;Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal;Health Information and Decision Sciences Department – CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal;Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal;Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal;Centre de recherche en Epidémiologie et Santé des Populations, CESP Inserm U1018, Villejuif, France;Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal;Clínica Universitária de Pneumologia-Faculdade de Medicina de Lisboa, Lisboa, Portugal

关键词: Review;    Prevalence;    Epidemiology;    Definition;    Asthma;   

Others  :  1092781
DOI  :  10.1186/2045-7022-4-24

 received in 2014-04-24, accepted in 2014-07-15,  发布年份 2014

【 摘 要 】

Objective

The best combination of questions to define asthma in epidemiological asthma studies is not known. We summarized the operational definitions of asthma used in prevalence studies and empirically assess how asthma prevalence estimates vary depending on the definition used.

Methods

We searched the Thomson Reuters ISI Web of knowledge and included (1) cross-sectional studies (2) on asthma prevalence (3) conducted in the general population and (4) containing an explicit definition of asthma. The search was limited to the 100 most-cited papers or published since January 2010. For each paper, we recorded the asthma definition used and other variables. Then we applied the definitions to the data of the Portuguese National Asthma survey (INAsma) and of the 2005–2006 National Health and Nutrition Examination Survey (NHANES) computing asthma prevalence estimates for the different definitions.

Results

Of 1738 papers retrieved, 117 were included for analysis. Lifetime asthma, diagnosed asthma and current asthma were defined in 8, 12 and 29 different ways, respectively. By applying definitions of current asthma on INAsma and NHANES data, the prevalence ranged between 5.3%-24.4% and 1.1%-17.2%, respectively.

Conclusions

There is considerable heterogeneity in the definitions of asthma used in epidemiological studies leading to highly variable estimates of asthma prevalence. Studies to inform a standardized operational definition are needed. Meanwhile, we propose a set of questions to be reported when defining asthma in epidemiological studies.

【 授权许可】

   
2014 Sá-Sousa et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Bousquet J, Khaltaev , Cruz AA: Global surveillance, prevention and control of Chronic Respiratory Diseases: A comprehensive approach. Switzerland: World Health Organization; 2007.
• [2]Burney P, Chinn C, Luczynska C, Jarvis D, Vermeire P, Bousquet J, Nowak D, Prichard J, Marco de R, Rijcken B, Anto J, Alves J, Boman G, Kesteloot H, Nielsen N, Paoletti P: Variations in the prevalence of respiratory symptoms, selfreported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS). Eur Respir J 1996, 9:687-695.
• [3]Asher MI, Anderson HR, Stewart AW, Crane J, Ait-Khaled N, Anabwani G, Anderson HR, Beasley R, Bjorksten B, Burr ML, Clayton TO, Ellwood P, Keil U, Lai CKW, Mallol J, Martinez FD, Mitchell EA, Montefort S, Pearce N, Robertson CF, Shah JR, Sibbald B, Strachan DP, von Mutius E, Weiland SK, Williams HC, Comm IS: Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998, 12:315-335.
• [4]Bousquet J, Burney PG, Zuberbier T, Cauwenberge PV, Akdis CA, Bindslev-Jensen C, Bonini S, Fokkens WJ, Kauffmann F, Kowalski ML, Lodrup-Carlsen K, Mullol J, Nizankowska-Mogilnicka E, Papadopoulos N, Toskala E, Wickman M, Anto J, Auvergne N, Bachert C, Bousquet PJ, Brunekreef B, Canonica GW, Carlsen KH, Gjomarkaj M, Haahtela T, Howarth P, Lenzen G, Lotvall J, Radon K, Ring J, et al.: GA2LEN (Global Allergy and Asthma European Network) addresses the allergy and asthma 'epidemic’. Allergy 2009, 64:969-977.
• [5]Van Wonderen KE, Van Der Mark LB, Mohrs J, Bindels PJ, Van Aalderen WM, Ter Riet G: Different definitions in childhood asthma: how dependable is the dependent variable? Eur Respir J 2010, 36:48-56.
• [6]Pekkanen J, Pearce N: Defining asthma in epidemiological studies. Eur Respir J 1999, 14:951-957.
• [7]Pekkanen J, Sunyer J, Anto JM, Burney P: Operational definitions of asthma in studies on its aetiology. Eur Respir J 2005, 26:28-35.
• [8]Toren K, Brisman J, Jarvholm B: Asthma and asthma-like symptoms in adults assessed by questionnaires. A literature review Chest 1993, 104:600-608.
• [9]Sa-Sousa A, Morais-Almeida M, Azevedo LF, Carvalho R, Jacinto T, Todo-Bom A, Loureiro C, Bugalho-Almeida A, Bousquet J, Fonseca JA: Prevalence of asthma in Portugal - The Portuguese National Asthma Survey. Clin Transl Allergy 2012, 2:15-15.
• [10]National Health and Nutrition Examination Survey 2005–2006 [http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/nhanes05_06.htm webcite]
• [11]von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008, 61:344-349.
• [12]Gergen PJ, Arbes SJ, Calatroni A, Mitchell HE, Zeldin DC: Total IgE and Asthma Prevalence in the U.S. Population: Results from the National Health and Nutrition Examination Survey (NHANES) 2005–2006. J Allergy Clin Immunol 2009, 124:447-453.
• [13]Burr ML, Butland BK, King S, Vaughan-Williams E: Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child 1989, 64:1452-1456.
• [14]Fukutomi Y, Nakamura H, Kobayashi F, Taniguchi M, Konno S, Nishimura M, Kawagishi Y, Watanabe J, Komase Y, Akamatsu Y, Okada C, Tanimoto Y, Takahashi K, Kimura T, Eboshida A, Hirota R, Ikei J, Odajima H, Nakagawa T, Akasawa A, Akiyama K: Nationwide Cross-Sectional Population-Based Study on the Prevalences of Asthma and Asthma Symptoms among Japanese Adults. Int Arch Allergy Immunol 2010, 153:280-287.
• [15]Weitzman M, Gortmaker SL, Sobol AM, Perrin JM: Recent trends in the prevalence and severity of childhood asthma. JAMA 1992, 268:2673-2677.
• [16]Crain EF, Weiss KB, Bijur PE, Hersh M, Westbrook L, Stein REK: An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics 1994, 94:356-362.
• [17]Dell SD, Foty RG, Gilbert NL, Jerret M, To T, Walter SD, Stieb DM: Asthma and allergic disease prevalence in a diverse sample of Toronto school children: results from the Toronto Child Health Evaluation Questionnaire (T-CHEQ) Study. Can Respir J 2010, 17:e1-6.
• [18]Chittleborough CR, Taylor AW, Dal Grande E, Gill TK, Grant JF, Adams RJ, Wilson DH, Ruffin RE, Team NWAHS: Gender differences in asthma prevalence: Variations with socioeconomic disadvantage. Respirology 2010, 15:107-114.
• [19]Ekici A, Ekici M, Kocyigit P, Karlidag A: Prevalence of Self-Reported Asthma in Urban and Rural Areas of Turkey. J Asthma 2012, 49:522-526.
• [20]Broms K, Norback D, Eriksson M, Sundelin C, Svardsudd K: Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children. BMC Public Health 2013, 13:764.
• [21]Kwon J-W, Kim B-J, Song Y, Seo J-H, Kim T-H, Yu J, Kim HB, Lee SY, Kim W-K, Kim K-W, Ji H-M, Kim K-E, Kim H, Hong S-J: Changes in the Prevalence of Childhood Asthma in Seoul from 1995 to 2008 and Its Risk Factors. Allergy Asthma Immunol Res 2011, 3:27-33.
• [22]Clifford RD, Radford M, Howell JB, Holgate ST: Prevalence of respiratory symptoms among 7-year-old and 11-year-old schoolchildren and association with asthma. Arch Dis Child 1989, 64:1118-1125.
• [23]Haby MM, Peat JK, Marks GB, Woolcock AJ, Leeder SR: Asthma in preschool children: prevalence and risk factors. Thorax 2001, 56:589-595.
• [24]Ekerljung L, Andersson A, Sundblad BM, Ronmark E, Larsson K, Ahlstedt S, Dahlen SE, Lundback B: Has the increase in the prevalence of asthma and respiratory symptoms reached a plateau in Stockholm, Sweden? Int J Tuberc Lung Dis 2010, 14:764-771.
• [25]Arif AA, Delclos GL, Lee ES, Tortolero SR, Whitehead LW: Prevalence and risk factors of asthma and wheezing among US adults: an analysis of the NHANES III data. Eur Respir J 2003, 21:827-833.
• [26]Barry AC, Mannino DM, Hopenhayn C, Bush H: Exposure to Indoor Biomass Fuel Pollutants and Asthma Prevalence in Southeastern Kentucky: Results From the Burden of Lung Disease (BOLD) Study. J Asthma 2010, 47:735-741.
• [27]Oraka E, King ME, Callahan DB: Asthma and Serious Psychological Distress Prevalence and Risk Factors Among US Adults, 2001–2007. Chest 2010, 137:609-616.
• [28]Oraka E, Elizabeth HJ, King ME, Callahan DB: Asthma Prevalence among US Elderly by Age Groups: Age Still Matters. J Asthma 2012, 49:593-599.
• [29]Rodriguez MA, Winkleby MA, Ahn D, Sundquist J, Kraemer HC: Identification of population subgroups of children and adolescents with high asthma prevalence - Findings from the Third National Health and Nutrition Examination Survey. Arch Pediatr Adolesc Med 2002, 156:269-275.
• [30]Ma J, Xiao L, Knowles SB: Obesity, insulin resistance and the prevalence of atopy and asthma in US adults. Allergy 2010, 65:1455-1463.
• [31]Akinbami LJ, Lynch CD, Parker JD, Woodruff TJ: The association between childhood asthma prevalence and monitored air pollutants in metropolitan areas, United States, 2001–2004. Environ Res 2010, 110:294-301.
• [32]Akinbami LJ, Moorman JE, Liu X: Asthma prevalence, health care use, and mortality: United States. Natl Health Stat Report 2005–2009, 2011:1-14.
• [33]Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, Liu X: Trends in asthma prevalence, health care use, and mortality in the United States. NCHS data brief 2001–2010, 2012:1-8.
• [34]Zahran HS, Bailey C, Garbe P: Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education-United States, 2001–2009 (Reprinted from MMWR, vol 60, pg 547–552, 2011). JAMA 2011, 305:2514-2516.
• [35]Moorman JE, Zahran H, Truman BI, Molla MT, Centers for Disease C, Prevention: Current asthma prevalence - United States, 2006–2008. Morbidity and mortality weekly report Surveillance summaries (Washington, DC: 2002) 2011, 60((Suppl)):84-86.
• [36]Frazier JC, Loveland KM, Zimmerman HJ, Helgerson SD, Harwell TS: Prevalence of Asthma Among Adults in Metropolitan Versus Nonmetropolitan Areas in Montana, 2008. Prev Chronic Dis 2012, 9:E09.
• [37]Coker TR, Kaplan RM, Chung PJ: The Association of Health Insurance and Disease Impairment with Reported Asthma Prevalence in U.S. Children. Health Serv Res 2012, 47:431-445.
• [38]Fukutomi Y, Taniguchi M, Watanabe J, Nakamura H, Komase Y, Ohta K, Akasawa A, Nakagawa T, Miyamoto T, Akiyama K: Time trend in the prevalence of adult asthma in Japan: findings from population-based surveys in Fujieda City in 1985, 1999, and 2006. Allergol Int 2011, 60:443-448.
• [39]Anthracopoulos MB, Pandiora A, Fouzas S, Panagiotopoulou E, Liolios E, Priftis KN: Sex-specific trends in prevalence of childhood asthma over 30 years in Patras, Greece. Acta Paediatr 2011, 100:1000-1005.
• [40]Anthracopoulos MB, Fouzas S, Pandiora A, Panagiotopoulou E, Liolios E, Priftis KN: Prevalence trends of rhinoconjunctivitis, eczema, and atopic asthma in Greek schoolchildren: four surveys during 1991–2008. Allergy Asthma Proc 2011, 32:56-62.
• [41]Musafiri S, van Meerbeeck J, Musango L, Brusselle G, Joos G, Seminega B, Rutayisire C: Prevalence of atopy, asthma and COPD in an urban and a rural area of an African country. Respir Med 2011, 105:1596-1605.
• [42]Rodriguez A, Vaca M, Oviedo G, Erazo S, Chico ME, Teles C, Barreto ML, Rodrigues LC, Cooper PJ: Urbanisation is associated with prevalence of childhood asthma in diverse, small rural communities in Ecuador. Thorax 2011, 66:1043-1050.
• [43]Duggan EM, Sturley J, Fitzgerald AP, Perry IJ, Hourihane JOB: The 2002–2007 trends of prevalence of asthma, allergic rhinitis and eczema in Irish schoolchildren. Pediatr Allergy Immunol 2012, 23:464-471.
• [44]Anderson HR, Butland BK, Strachan DP: Trends in prevalence and severity of childhood asthma. Br Med J 1994, 308:1600-1604.
• [45]Jain A, Bhat HV, Acharya D: Prevalence of Bronchial Asthma in Rural Indian Children: A Cross Sectional Study from South India. Indian J Pediatr 2010, 77:31-35.
• [46]Sanchez-Lerma B: High Prevalence of Asthma and Allergic Diseases in Children Aged 6 and 7 Years From the Canary Islands: The International Study of Asthma and Allergies in Childhood (vol 19, pg 383, 2009). J Investig Allergol Clin Immunol 2012, 22:79-79.
• [47]Hong S, Son DK, Lim WR, Kim SH, Kim H, Yum HY, Kwon H: The prevalence of atopic dermatitis, asthma, and allergic rhinitis and the comorbidity of allergic diseases in children. Environ Health Toxicol 2012, 27:e2012006-e2012006.
• [48]Luna MFG, Almeida PC, Silva MGC: Asthma and rhinitis prevalence and co-morbidity in 13-14-year-old schoolchildren in the city of Fortaleza, Ceara State, Brazil. Cad Saude Publica 2011, 27:103-112.
• [49]de Luna MFG, Fischer GB, de Luna JRG, da Silva MGC, de Almeida PC, Chiesa D: Prevalences of asthma and rhinitis among adolescents in the city of Fortaleza, Brazil: temporal changes. J Bras Pneumol 2013, 39:128-137.
• [50]Matos Povoas Juca SCB, Takano OA, Lacerda Moraes LS, Guimaraes LV: Asthma prevalence and risk factors in adolescents 13 to 14 years of age in Cuiaba, Mato Grosso State. Brazil Cad Saude Publica 2012, 28:689-697.
• [51]de Farias MRC, Rosa AM, Hacon SS, de Castro HA, Ignotti E: Prevalence of asthma in schoolchildren in Alta Floresta- a municipality in the southeast of the Brazilian Amazon. Rev Bras Epidemiol 2010, 13:49-57.
• [52]Bennoor KS, Hassan MR, Hossain MA, Mahmud AM, Ahmad MM, Habib GM: Trends of asthma in Bangladesh: findings of the national asthma prevalence study -1999 and 2010. Respirology 2011, 16:212-212.
• [53]Gudelj I, Mrkic Kobal I, Munivrana Skvorc H, Mise K, Vrbica Z, Plavec D, Tudoric N: Intraregional differences in asthma prevalence and risk factors for asthma among adolescents in Split-Dalmatia County, Croatia. Med Sci Monit 2012, 18:PH43-50.
• [54]Toledo MF, Rozov T, Leone C: Prevalence of asthma and allergies in 13-to 14-year-old adolescents and the frequency of risk factors in carriers of current asthma in Taubate, Sao Paulo, Brazil. Allergol Immunopathol (Madr) 2011, 39:284-290.
• [55]Robinson CL, Baumann LM, Gilman RH, Romero K, Manuel Combe J, Cabrera L, Hansel NN, Barnes K, Gonzalvez G, Wise RA, Breysse PN, Checkley W: The Peru Urban versus Rural Asthma (PURA) Study: methods and baseline quality control data from a cross-sectional investigation into the prevalence, severity, genetics, immunology and environmental factors affecting asthma in adolescence in Peru. Bmj Open 2012, 2:e000421.
• [56]Delmas MC, Guignon N, Leynaert B, Annesi-Maesano I, Com-Ruelle L, Gonzalez L, Fuhrman C: Prevalence and control of asthma in young children in France. Rev Mal Respir 2012, 29:688-696.
• [57]Julia-Serda G, Cabrera-Navarro P, Acosta-Fernandez O, Martin-Perez P, Losada-Cabrera P, Garcia-Bello MA, Carrillo-Diaz T, Anto-Boque J: High prevalence of asthma and atopy in the Canary Islands, Spain. Int J Tuberc Lung Dis 2011, 15:536-541.
• [58]Mahboub BH, Al-Hammadi S, Rafique M, Sulaiman N, Pawankar R, Al Redha AI, Mehta AC: Population prevalence of asthma and its determinants based on European Community Respiratory Health Survey in the United Arab Emirates. BMC Pulm Med 2012, 12:4.
• [59]Alves GC, Santos DN, Feitosa CA, Barreto ML: Community violence and childhood asthma prevalence in peripheral neighborhoods in Salvador, Bahia State. Brazil Cad Saude Publica 2012, 28:86-94.
• [60]Akinbami LJ, Schoendorf KC: Trends in childhood asthma: Prevalence, health care utilization, and mortality. Pediatrics 2002, 110:315-322.
• [61]Agrawal S: Effect of Indoor Air Pollution from Biomass and Solid Fuel Combustion on Prevalence of Self-Reported Asthma among Adult Men and Women in India: Findings from a Nationwide Large-Scale Cross-Sectional Survey. J Asthma 2012, 49:355-365.
• [62]Agrawal S, Pearce N, Ebrahim S: Prevalence and risk factors for self-reported asthma in an adult Indian population: a cross-sectional survey. Int J Tuberc Lung Dis 2013, 17:275-282.
• [63]Burney PGJ, Chinn S, Rona RJ: Has the prevalence of asthma increased in children - evidence from the national study of health and growth 1973–86. Br Med J 1990, 300:1306-1310.
• [64]Krstic G: Asthma Prevalence Associated with Geographical Latitude and Regional Insolation in the United States of America and Australia. PloS One 2011, 6:e18492.
• [65]Sousa CA, Cesar CLG, Barros MBA, Carandina L, Goldbaum M, Pereira JCR: Prevalence of asthma and risk factors associated: population based study in Sao Paulo, Southeastern Brazil, 2008–2009. Rev Saude Publica 2012, 46:825-833.
• [66]Fiori NS, Goncalves H, Dumith SC, Dropa Chrestani Cesar MA, Menezes AMB, Cardozo Macedo SE: Ten-year trends in prevalence of asthma in adults in southern Brazil: comparison of two population-based studies. Cad Saude Publica 2012, 28:135-144.
• [67]Mak H, Johnston P, Abbey H, Talamo RC: Prevalence of athma and health-service utilization of asthmatic-children in an inner-city. J Allergy Clin Immunol 1982, 70:367-372.
• [68]Moreira SM, Ribeiro ACG, Fonseca M, Lourenco O, Taborda-Barata L: Comparative study of the prevalence, clinical features, sensitisation profiles and risk factors for Bronchial Asthma between elderly and young adults in Cova da Beira Portugal. Eur J Med Res 2010, 15:216-216.
• [69]Parasuramalu BG, Huliraj N, Rudraprasad BM, Prashanth Kumar SP, Ramesh Masthi NR, Gangaboraiah : Prevalence of bronchial asthma and its association with smoking habits among adult population in rural area. Indian J Public Health 2010, 54:165-168.
• [70]Woolcock AJ, Peat JK, Salome CM, Yan K, Anderson SD, Schoeffel RE, McCowage G, Killalea T: Prevalence of bronchial hyperresponsiveness and asthma in a rural adult-population. Thorax 1987, 42:361-368.
• [71]Cornell AG, Mellins RB, Acosta LM, Rundle AG, Miller RL, Kinney PL, Yan B, Perera FP, Jacobson JS, Goldstein IF, Chillrud SN, Perzanowski MS: Exhaled No Is Elevated With Exposure To Black Carbon And Dust Mite Allergen Among 7 And 8-Year-Old Children Living In High And Low Asthma Prevalence Neighborhoods In New York City. Am J Respir Crit Care Med 2011, 183:A4473.
• [72]Studnicka M, Hackl E, Pischinger J, Fangmeyer C, Haschke N, Kuhr J, Urbanek R, Neumann M, Frischer T: Traffic-related NO2 and the prevalence of asthma and respiratory symptoms in seven year olds. Eur Respir J 1997, 10:2275-2278.
• [73]Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE: Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis. Br J Dermatol 2001, 144:523-532.
• [74]Kolokotroni O, Middleton N, Nicolaou N, Pipis S, Priftis KN, Milton DK, Yiallouros PK: Temporal changes in the prevalence of childhood asthma and allergies in urban and rural areas of Cyprus: results from two cross sectional studies. BMC Public Health 2011, 11:858.
• [75]Pearce N, Aiet-Khaled N, Beasley R, Mallol J, Keil U, Mitchell E, Robertson C, Grp IPTS: Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2007, 62:758-766.
• [76]Upton MN, McConnachie A, McSharry C, Hart CL, Smith GD, Gillis CR, Watt GCM: Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. Br Med J 2000, 321:88-92.
• [77]Bjorksten B, Dumitrascu D, Foucard T, Khetsuriani N, Khaitov R, Leja M, Lis G, Pekkanen J, Priftanji A, Riikjarv MA: Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe. Eur Respir J 1998, 12:432-437.
• [78]Galassi C, De Sario M, Biggeri A, Bisanti L, Chellini E, Ciccone G, Petronio MG, Piffer S, Sestini P, Rusconi F, Viegi G, Forastiere F: Changes in prevalence of asthma and allergies among children and adolescents in Italy: 1994–2002. Pediatrics 2006, 117:34-42.
• [79]Leung R, Wong G, Lau J, Ho A, Chan JKW, Choy D, Douglass C, Lai CKW: Prevalence of asthma and allergy in Hong Kong schoolchildren: An ISAAC study. Eur Respir J 1997, 10:354-360.
• [80]Robertson CF, Heycock E, Bishop J, Nolan T, Olinsky A, Phelan PD: Prevalence of asthma in melbourne schoolchildren - changes over 26 years. Br Med J 1991, 302:1116-1118.
• [81]Pegas PN, Alves CA, Scotto MG, Evtyugina MG, Pio CA, Freitas MC: Risk factors and prevalence of asthma and rhinitis among primary school children in Lisbon. Rev Port Pneumol 2011, 17:109-116.
• [82]Lopez-Silvarrey-Varela A, Pertega-Diaz S, Rueda-Esteban S, Manuel Sanchez-Lastres J, Angel San-Jose-Gonzalez M, Sampedro-Campos M, Perez-Castro T, Garnelo-Suarez L, Bamonde-Rodriguez L, Lopez-Silvarrey-Varela J, Gonzalez-Barcala J: Prevalence and Geographic Variations in Asthma Symptoms in Children and Adolescents in Galicia (Spain). Arch Bronconeumol 2011, 47:274-282.
• [83]Pearce N, Sunyer J, Cheng S, Chinn S, Bjorksten B, Burr M, Keil U, Anderson HR, Burney P, Com ISCE: Comparison of asthma prevalence in the ISAAC and the ECRHS. Eur Respir J 2000, 16:420-426.
• [84]Kaur B, Anderson HR, Austin J, Burr M, Harkins LS, Strachan DP, Warner JO: 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). Br Med J 1998, 316:118-124.
• [85]Ekerljung L, Sundblad B-M, Ronmark E, Larsson K, Lundback B: Incidence and prevalence of adult asthma is associated with low socio-economic status. Clin Respir J 2010, 4:147-156.
• [86]Lam HT, Ronmark E, Tu'o'ng NV, Ekerljung L, Chuc NTK, Lundback B: Increase in asthma and a high prevalence of bronchitis: results from a population study among adults in urban and rural Vietnam. Respir Med 2011, 105:177-185.
• [87]James AL, Knuiman MW, Divitini ML, Hui J, Hunter M, Palmer LJ, Maier G, Musk AW: Changes in the prevalence of asthma in adults since 1966: the Busseltion health study. Eur Respir J 2010, 35:273-278.
• [88]Wennergren G, Ekerljung L, Alm B, Eriksson J, Lotvall J, Lundback B: Asthma in late adolescence - farm childhood is protective and the prevalence increase has levelled off. Pediatr Allergy Immunol 2010, 21:806-813.
• [89]Arnedo-Pena A, Garcia-Marcos L, Fuertes Fernandez-Espinar J, Bercedo-Sanz A, Aguinaga-Ontoso I, Gonzalez-Diaz C, Carvajal-Uruena I, Busquet-Monge R, Morales Suarez-Varela M, Garcia de Andoin N, Batlles-Garrido J, Blanco-Quiros A, Lopez-Silvarrey Varela A, Garcia-Hernandez G: Sunny hours and variations in the prevalence of asthma in schoolchildren according to the International Study of Asthma and Allergies (ISAAC) Phase III in Spain. Int J Biometeorol 2011, 55:423-434.
• [90]Alsowaidi S, Abdulle A, Bernsen R: Prevalence and Risk Factors of Asthma among Adolescents and Their Parents in Al-Ain (United Arab Emirates). Respiration 2010, 79:105-111.
• [91]Guo YLL, Lin YC, Sung FC, Huang SL, Ko YC, Lai JS, Su HJ, Shaw CK, Lin RS, Dockery DW: Climate, traffic-related air pollutants, and asthma prevalence in middle-school children in Taiwan. Environ Health Perspect 1999, 107:1001-1006.
• [92]Hwang G-S, Choi J-W, Yoo Y, Choung J-T, Yoon C-S: Residential Environmental Risk Factors for Childhood Asthma Prevalence in Metropolitan and Semirural Cities in Korea. Asia Pac J Public Health 2012, 24:58-67.
• [93]Sousa SIV, Ferraz C, Alvim-Ferraz MCM, Martins FG, Vaz LG, Pereira MC: Spirometric tests to assess the prevalence of childhood asthma at Portuguese rural areas: Influence of exposure to high ozone levels. Environ Int 2011, 37:474-478.
• [94]Koshy G, Delpisheh A, Brabin BJ: Trends in prevalence of childhood and parental asthma in Merseyside, 1991–2006. J Public Health 2010, 32:488-495.
• [95]Hansen TE, Evjenth B, Holt J: Increasing prevalence of asthma, allergic rhinoconjunctivitis and eczema among schoolchildren: three surveys during the period 1985–2008. Acta Paediatr 2013, 102:47-52.
• [96]Zollner IK, Weiland SK, Piechotowski I, Gabrio T, von Mutius E, Link B, Pfaff G, Kouros B, Wuthe J: No increase in the prevalence of asthma, allergies, and atopic sensitisation among children in Germany: 1992–2001. Thorax 2005, 60:545-548.
• [97]Kim SY, Jung JY, Park MS, Kang YA, Kim EY, Kim SK, Chang J, Kim YS: Increased Prevalence of Self-Reported Asthma Among Korean Adults: An Analysis of KNHANES I and IV Data. Lung 2013, 191:281-288.
• [98]Bjerg A, Sandstrom T, Lundback B, Ronmark E: Time trends in asthma and wheeze in Swedish children 1996–2006: prevalence and risk factors by sex. Allergy 2010, 65:48-55.
• [99]Bai J, Zhao J, Shen K-L, Xiang L, Chen A-H, Huang S, Huang Y, Wang J-S, Ye R-W: Current Trends of the Prevalence of Childhood Asthma in Three Chinese Cities : A Multicenter Epidemiological Survey. Biomed Environ Sci 2010, 23:453-457.
• [100]Peat JK, Haby M, Spijker J, Berry G, Woolcock AJ: Prevalence of asthma in adults in Busselton, Western-Australia. Br Med J 1992, 305:1326-1329.
• [101]Kainu A, Pallasaho P, Piirila P, Lindqvist A, Sovijarvi A, Pietinalho A: Increase in prevalence of physician-diagnosed asthma in Helsinki during the Finnish Asthma Programme: improved recognition of asthma in primary care? A cross-sectional cohort study. Prim Care Respir J 2013, 22:64-71.
• [102]Al Ghobain MO, Al-Hajjaj MS, Al Moamary MS: Asthma prevalence among 16-to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire. BMC Public Health 2012, 12:239.
• [103]To T, Stanojevic S, Moores G, Gershon AS, Bateman ED, Cruz AA, Boulet LP: Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 2012, 12:204.
• [104]Wehrmeister FC, de Anselmo Peres KG: Regional inequalities in the prevalence of asthma diagnosis in children: an analysis of the Brazilian National Household Sample Survey, 2003. Cad Saude Publica 2010, 26:1839-1852.
• [105]Strachan DP, Anderson HR, Limb ES, Oneill A, Wells N: A national survey of asthma prevalence, severity, and treatment in Great-Britain. Arch Dis Child 1994, 70:174-178.
• [106]Andrea Rodriguez L, Jose Rey J, Berena Herrera A, Castro H, Niederbacher J, Maria Vera L, Libia Cala L, Bolivar F: Respiratory symptoms associated with asthma prevalence and air pollution in preschool children. Biomedica 2010, 30:15-22.
• [107]Goh DYT, Chew FT, Quek SC, Lee BW: Prevalence and severity of asthma, rhinitis, and eczema in Singapore schoolchildren. Arch Dis Child 1996, 74:131-135.
• [108]Shakurnia AH, Assar S, Afra M, Latifi M: Prevalence of asthma among schoolchildren in Ahvaz, Islamic Republic of Iran. East Mediterr Health J 2010, 16:651-656.
• [109]Fedortsiv O, Brozek GM, Luchyshyn N, Kubey I, Lawson JA, Rennie DC, Zejda JE: Prevalence of childhood asthma, rhinitis, and eczema in the Ternopil region of Ukraine - results of BUPAS study. Adv Med Sci 2012, 57:282-289.
• [110]Vonmutius E, Fritzsch C, Weiland SK, Roll G, Magnussen H: Prevalence of asthma and allergic disorders among children in United Germany - a descriptive comparison. Br Med J 1992, 305:1395-1399.
• [111]Litonjua AA, Carey VJ, Weiss ST, Gold DR: Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr Pulmonol 1999, 28:394-401.
• [112]Nriagu J, Martin J, Smith P, Socier D: Residential hazards, high asthma prevalence and multimorbidity among children in Saginaw, Michigan. Sci Total Environ 2012, 416:53-61.
• [113]Downs SH, Marks GB, Sporik R, Belosouva EG, Car NG, Peat JK: Continued increase in the prevalence of asthma and atopy. Arch Dis Child 2001, 84:20-23.
• [114]Lukrafka JL, Fuchs SC, Moreira LB, Picon RV, Fischer GB, Fuchs FD: Performance of the ISAAC Questionnaire to Establish the Prevalence of Asthma in Adolescents: A Population-Based Study. J Asthma 2010, 47:166-169.
• [115]Miller JE: The effects of race/ethnicity and income on early childhood asthma prevalence and health care use. Am J Public Health 2000, 90:428-430.
• [116]Zobeiri M: Prevalence, risk factors and severity of asthma symptoms in children of Kermanshah, IRAN: ISAAC phase I, II. Acta Med Iran 2011, 49:184-188.
• [117]Yeh K-W, Ou L-S, Yao T-C, Chen L-C, Lee W-I, Huang J-L, Grp PS: Prevalence and risk factors for early presentation of asthma among preschool children in Taiwan. Asian Pac J Allergy Immunol 2011, 29:120-126.
• [118]Joseph CLM, Foxman B, Leickly FE, Peterson E, Ownby D: Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren. J Pediatr 1996, 129:735-742.
• [119]Gergen PJ, Mullally DI, Evans R: National survey of prevalence of asthma among children in United-States, 1976 to 1980. Pediatrics 1988, 81:1-7.
• [120]Jie Y, Isa ZM, Jie X, Ismail NH: Asthma and Asthma-Related Symptoms among Adults of an Acid Rain-Plagued City in Southwest China: Prevalence and Risk Factors. Pol J Environ Stud 2013, 22:717-726.
• [121]Rerksuppaphol S, Rerksuppaphol L: Carotenoid intake and asthma prevalence in Thai children. Pediatr Rep 2012, 4:e12-e12.
• [122]de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, Casali L, Ferrari M, Nicolini G, Panico MG, Pirina P, Zanolin ME, Cerveri I, Verlato G: The Coexistence of Asthma and Chronic Obstructive Pulmonary Disease (COPD): Prevalence and Risk Factors in Young. Middle-aged and Elderly People from the General Population. PloS One 2013, 8:e62985.
• [123]Bryant-Stephens T, West C, Dirl C, Banks T, Briggs V, Rosenthal M: Asthma Prevalence in Philadelphia: Description of Two Community-Based Methodologies to Assess Asthma Prevalence in an Inner-City Population. J Asthma 2012, 49:581-585.
• [124]Waite DA, Eyles EF, Tonkin SL, Odonnell TV: Asthma prevalence in Tokelauan children in 2 environments. Clin Allergy 1980, 10:71-75.
• [125]de Sousa JC, Santo ME, Colaco T, Almada-Lobo F, Yaphe J: Asthma in an Urban Population in Portugal: A prevalence study. BMC Public Health 2011, 11:347.
• [126]Zivkovic Z, Vukasinovic Z, Cerovic S, Radulovic S, Zivanovic S: Prevalence of childhood asthma and allergies in Serbia and Montenegro. World J Pediatr 2010, 6:331-336.
• [127]Burney PG, Laitinen LA, Perdrizet S, Huckauf H, Tattersfield AE, Chinn S, Poisson N, Heeren A, Britton JR, Jones T: Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison. Eur Respir J 1989, 2:940-945.
• [128]de Marco R, Cerveri I, Bugiani M, Ferrari M, Verlato G: An undetected burden of asthma in Italy: the relationship between clinical and epidemiological diagnosis of asthma. Eur Respir J 1998, 11:599-605.
• [129]Skytt N, Bønnelykke K, Bisgaard H: “To wheeze or not to wheeze”: That is not the question. J Allergy Clin Immunol 2012, 130:403-407.
• [130]Wright AL: Epidemiology of asthma and recurrent wheeze in childhood. Clin Rev Allergy Immunol 2002, 22:33-44.
• [131]Discussion document of symptom outcomes [http://www.ecrhs.org/Publications/symptomoutcomes.pdf webcite]