Prevalence of asthma among schoolchildren in Patras, Greece: three surveys over 20 years

Changing trends in the prevalence of childhood asthma over 40 years in Greece

BACKGROUND

A series of repeated questionnaire surveys among 8- to 9-year-old school children in the city of Patras, Greece, demonstrated a continuous rise in the prevalence of wheeze/asthma from 1978 to 2003, with a plateau between 2003 and 2008. We further investigated wheeze/asthma trends within the same environment over the last decade.

METHODS

Two follow-up surveys were conducted in 2013 (N = 2554) and 2018 (N = 2648). Physician-diagnosed wheeze and asthma were analyzed in relation to their occurrence (recent-onset: within the last 2 years; noncurrent: before 2 years; persistent: both prior and within the last 2 years). In 2018, spirometry was also performed in participants reporting symptoms and in a sample of healthy controls.

RESULTS

The prevalence of current wheeze/asthma declined from 6.9% in 2008% to 5.2% in 2013% and 4.3% in 2018. The persistent and noncurrent wheeze/asthma groups followed this overall trend (P-for-trend <0.001), while the prevalence of recent-onset wheeze/asthma remained unchanged (P-for-trend >0.05). Persistent and noncurrent wheezers were also more frequently diagnosed with asthma, in contrast to those with recent-onset wheeze. The FEV₁ z-score was less than -1 in 32.1% of children with recent-onset and in 22.4% of those with persistent wheeze/asthma; both rates were higher than those of the Noncurrent wheeze/asthma group (7.1%; p < .05) and of healthy controls (3.5%; p < .001).

CONCLUSIONS

The prevalence of childhood wheeze/asthma has declined significantly during the last decade in Greece. The reversing trend may in part be attributed to changing asthma perceptions among physicians and/or parents, especially in the case of younger children with troublesome respiratory symptoms.

Significant rise of the prevalence and clinical features of childhood asthma in Qingdao China: cluster sampling investigation of 10,082 children

Background

Recent investigations suggested that the trend of childhood asthma has been stabilizing or even reversing in some countries. The observation provides contrast to our experience. Thus, the study aimed to investigate the prevalence and clinical features of asthma in children aged 0–14 years in Qingdao China, determine the changes of childhood asthma in China, and discover evidence that can allow better diagnosis and treatment of childhood asthma.

Methods

A cluster sampling method was used. We randomly extracted the investigation clusters from schools, kindergartens, and communities in Qingdao. Subsequently, we interviewed the members of the clusters using a questionnaire from the International Study of Asthma and Allergies in Childhood (ISAAC) to find children with asthmatic symptoms. After determination by the doctors, more details on the asthmatic children were obtained by asking questions from the National Epidemiology Study of Asthma and Allergies in China questionnaire to obtain more details. We intended to survey 10,800 children. However, the actual number of children was 10,082.

Results

The prevalence of asthma in Qingdao children aged 0–14 years was 3.69%. The prevalence among male children was higher than in female (χ2 = 24.53,P < 0.01). Among the asthmatic children, 68.0% had their first attack when they were less than three years old. Moreover, 71.2% once suffered respiratory tract infections. For 95.7% of asthmatic children, the asthma attack was first manifested as cough. Asthmatic children who used inhaled corticosteroids (ICS) only accounted for 46%.

Conclusions

The prevalence of asthma in children aged 0–14 years in Qingdao China increased significantly based on data obtained ten years ago (2000). Respiratory tract infections were the most important precursors of asthma attack. The attack was most commonly manifested as cough. The treatment, especially the use of ICS, was more rational. However, a certain difference was found, which has yet to be contrasted with the Global Initiative for Asthma (GINA) project.

Sex-specific trends in prevalence of childhood asthma over 30 years in Patras, Greece

AIM

 According to four surveys conducted during 1978-2003, the prevalence of childhood asthma and wheezing has risen in the city of Patras, Greece, albeit at a decelerating rate. We examined sex-specific wheeze and asthma prevalence in the same urban environment in 2008.

METHODS

A cross-sectional parental questionnaire survey was performed in 2008 among third and fourth grade schoolchildren (8-9 year old), which was identical to previously conducted surveys in 1978 (n = 3003), 1991 (n = 2417), 1998 (n = 3076) and 2003 (n = 2725).

RESULTS

The prevalence of current wheeze and asthma in 1978, 1991, 1998, 2003 and 2008 (n = 2688) was 1.5%, 4.6%, 6.0%, 6.9% and 6.9%, respectively (p for trend <0.001). Respective values for lifetime (ever had) wheeze and asthma in the 1991-2008 surveys were 8.0%, 9.6%, 12.4% and 12.6% (p for trend <0.001). The male:female ratio of current and lifetime wheeze and asthma increased during the 30-year surveillance period (p for trend <0.001). Irrespective of sex, diagnosed asthma declined among current wheezers by 17% (p < 0.001), but not among non-current ones (6.7%, p = 0.16) during 2003-2008.

CONCLUSIONS

Childhood wheeze and asthma have reached a plateau in an urban environment in Greece, while the male:female ratio increased. Asthma diagnosis declined among schoolage but not preschool wheezers during 2003-2008.

S, DUMITRESCU D, MARSHALL M, MIRESTEAN I, MURESAN M, IACOB D, FARCAU M, ICHIM GE, NANULESCU MV. Epidemiological survey 6 years apart: increased prevalence of asthma and other allergic diseases in schoolchildren aged 13-14 years in cluj-napoca, romania (based on isaac questionnaire)

BACKGROUND

The prevalence of asthma and allergy has increased during recent decades.

OBJECTIVE

We investigate the prevalence of asthma and other allergic diseases in children aged 13-14 years and we evaluate the trend of prevalence after an interval of 6 years.

MATERIAL AND METHODS

We used a core questionnaire designed by the International Study of Asthma and Allergy in Children. In 1991, the questionnaire was administered to 2,866 children from a Romanian city and during 2001 to 1,657 children from the same area.

RESULTS

The prevalence of asthma increased from 3.3% in 1995 to 5.5% in 2001 (p<0.001). In 1995, 4.3% of children reported asthma-related symptoms, significantly fewer than the percentage 6 years later (13.6%; p<0.00001). Similar results were obtained with regard to allergic rhinitis (13.6% versus 20%; p<0.00001) and eczema (11.5% versus 16.2%; p=0.00015). As far as gender differences are concerned, in the first stage of study all three allergic disorders were found to occur more frequently in females. In the study undertaken in 2001, females proved to have a higher prevalence of asthma (p=0.226), but a lower prevalence for allergic rhinitis (p=0.121) and eczema (p=0.064).

CONCLUSIONS

The prevalence of asthma and allergy increased significantly during the past 6 years.

Acute respiratory admissions in Thessaloniki, Greece: 14-year follow-up

BACKGROUND

Acute exacerbations of respiratory diseases are a common cause of hospitalization among infants and children.

AIM

To assess the epidemiological characteristics of asthma, bronchiolitis and croup among hospitalized children in Thessaloniki, from 1990 to 2003 included.

METHODS

Data from the patient registry with discharge diagnosis "asthma", "bronchiolitis" and "croup" were analyzed retrospectively, in five Paediatric Departments of Thessaloniki. Age and sex of the patients, as well as the month of admission were taken into consideration.

RESULTS

A total of 8762 admissions of children (aged 3 months-14 years) with the diagnosis of asthma, "bronchiolitis" and "croup", were identified. Sex distribution was 65.86% males (64.86% bronchiolitis, 65.26% asthma and 70.31% croup). Asthma admissions decreased by 53.65%, croup admissions decreased by 4.73%, while bronchiolitis admissions increased by 25.03%, during the study period. A clear seasonal variation was found in all the three diseases, with the lowest incidence during summer months. Moreover there were two peaks for asthma (one during spring and a second during autumn), one peak for bronchiolitis (during winter early spring) and one peak for croup (during autumn).

CONCLUSIONS

Paediatric asthma and croup admissions have declined during the last 14 years, in contrast with bronchiolitis admissions, which showed an increased tendency. More frequent use of inhaled steroids and induction of asthma education programs may have contributed to decreasing asthma admission rates.

Increase in chronic or recurrent rhinitis, rhinoconjunctivitis and eczema among schoolchildren in Greece: three surveys during 1991-2003

The prevalence of allergic rhinitis, hay fever and eczema has risen worldwide during the last four decades but may have reached a plateau in some westernized societies. We examined time trends in the prevalence of childhood chronic or recurrent rhinitis, rhinoconjunctivitis and eczema in urban Greece. Using identical methodology, three population-based cross-sectional parental questionnaire surveys on current (last two years) and lifetime allergic symptoms of the nose, eyes and skin were performed among 8-10-yr-old children in 1991, 1998 and 2003 in Patras, Greece. Exactly 2417, 3006 and 2725 questionnaires were completed in 1991, 1998 and 2003, respectively. Prevalence rates of current (lifetime) symptoms of chronic or recurrent rhinitis were 5.1% (6.0%) for 1991, 6.5% (8.0%) for 1998 and 8.0% (9.8%) for 2003. Respective values for rhinoconjunctivitis were 1.8% (2.1%), 2.7% (3.4%) and 3.6% (4.6%) and for eczema 2.5% (4.5%), 3.4% (6.3%) and 5.0% (9.5%) (p for trend <0.001). Among current asthmatics there was an increase in lifetime rhinitis (p = 0.038), current (p = 0.025) and lifetime rhinoconjunctivitis (p = 0.007) and current (p = 0.001) and lifetime eczema (p < 0.001); male predominance increased throughout the study. The proportion of atopic asthma (current asthma with chronic or recurrent rhinitis and/or rhinoconjunctivitis and/or eczema) increased during the same period (p < 0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations among preadolescent children in Patras, Greece during the period 1991-2003. In our population, boys have contributed to this increase more than girls and the increase of atopy is, at least partially, responsible for the increase of asthma.

Asthma, lung function and sensitization in school children with a history of bronchiolitis

BACKGROUND

The purpose of the present retrospective study was to investigate the association of school-age asthma with acute-bronchiolitis and examine the influence of potential risk factors.

METHODS

One hundred and eighty-nine children aged 7.5 +/- 2.2 years consecutively hospitalized for respiratory syncytial virus (RSV)-positive acute bronchiolitis during infancy were evaluated by clinical examination and measurement of peak expiratory flow (PEFR), spirometry, IgE and skin-prick testing. Their pulmonary function was compared with that of 60 non-asthmatic matched controls.

RESULTS

Of the entire cohort 57.1% were diagnosed as asthmatic. PEFR, the 1-second forced expiratory volume and forced expiratory flow of 50% vital capacity of children with a history of acute bronchiolitis were statistically significantly lower than in the control group (all P < 0.001). All the aforementioned measurements of children with/without asthma were also significantly lower than controls, while values of asthmatics were significantly lower than those of non-asthmatics. The incidence of asthma in childhood was independently associated with breast-feeding <3 months (adjusted odds ratio [aOR], 8.4; 95% confidence interval [CI]: 3.1-22.4), at least one positive skin prick test (aOR, 7.1; 95%CI: 2.8-18.1), male gender (aOR, 5.0; 95%CI: 2.2-11.5), evidence of moisture in the home environment (aOR, 2.9; 95%CI: 1.3-6.3) and presence of more than one house-resident smoking indoors (aOR, 4.9; 95%CI: 1.8-9.2).

CONCLUSION

Children with a history of RSV-bronchiolitis during infancy have an increased risk for developing asthma in childhood, which was independently associated with male gender, breast-feeding <3 months, living in a home environment with moisture damage and/or tobacco smoke by two or more residents and sensitization to at least one aeroallergen. Children with a history of RSV bronchiolitis in infancy had lower spirometry in comparison to matched control group. The difference was more marked for asthmatic ones but remained significant even for non-asthmatic children.

[Prevalence of childhood asthma in Baranya County, Hungary, between 2003 and 2006]

INTRODUCTION

The prevalence of bronchial asthma, allergic rhinitis and atopic dermatitis (AD) in children has constantly and significantly increased worldwide in the past decades. Recent publications, however, reported a moderate decrease or levelling off in this parameter. The authors estimated the prevalence of bronchial asthma and asthmatic complaints among schoolchildren in Baranya county in the years 2003 and 2006 in order to register the possible changes.

MATERIALS AND METHODS

Both surveys were carried out by means of identical questionnaires which were consistent with the ISAAC Phase III. protocol. The data were collected in 16 primary schools (6 in a city, 10 in small settlements and villages) in February 2006. Finally 2404 questionnaires (1124 boys, 1280 girls) in two age groups, among 6-7 and 13-14-year-old children were processed and compared to the data derived from the survey done in 2003.

RESULTS

The prevalence of the "wheezing-ever" and "physician diagnosed asthma" did not change during the observation period (2006: 20.2% and 6.7%; 2003: 19.8% and 8.2%) but there was a significant increase in the frequency of "wheezing in the last 12 months" (2006: 9.6%; 2003: 6.8%). As expected, significantly higher prevalence rates were detected among boys and in the 6-7-year-old age group than among girls and in the 13-14-year-old age group in both surveys. There was no significant difference in the two surveys in the prevalence of bronchial asthma and asthmatic signs between children from a city and from small settlements.

CONCLUSION

During the observation period of three years there was a significant increase "wheezing in the last 12 months", but the prevalence of "wheezing-ever" as well as the "physician-diagnosed asthma" remained unchanged.

The challenge of asthma in adolescence

The adolescents with asthma are a distinct group of patients with different problems and needs compared to children and adults. Specific issues of asthma in adolescence are the variability of the clinical spectrum, the presence of particular risk factors for the persistence of symptoms, underdiagnosis and undertreatment of the disease. Refusal of the sick role, denial of symptoms, carelessness about dangerous inhalation exposure, erratic self-medication, overexertion without taking precautions against exercise-induced asthma, and a poor relationship between patients, their families, and often doctors are the main obstacles to successful management of asthma in this critical age. There are also major problems of compliance for these patients. The goal of optimal quality of life will be achieved only if the physician thoroughly understands the adolescent's needs and provides optimal care.

Prevalence of asthma among schoolchildren in Patras, Greece: four questionnaire surveys during 1978-2003

BACKGROUND

The prevalence of asthma and wheezing has risen during the past four decades. Recent reports suggest that the "asthma epidemic" has reached a plateau.

OBJECTIVE

To examine further trends in the prevalence of childhood diagnosed asthma and wheezing in an urban environment in Greece.

METHODS

A population-based cross-sectional parental questionnaire survey was repeated among third-grade and fourth-grade school children (8-10 years) of public primary schools in 2003 in the city of Patras, Greece, by using methods identical to that of surveys conducted in 1978 (completed questionnaires, n = 3003), 1991 (n = 2417) and 1998 (n = 3076).

RESULTS

2725 questionnaires were completed in the 2003 survey. The prevalence rates of current asthma and/or wheezing in 1978, 1991, 1998 and 2003 were 1.5%, 4.6%, 6% and 6.9%, respectively (p for trend <0.001). The lifetime prevalence of asthma and/or wheezing in the three more recent surveys was 8%, 9.6% and 12.4%, respectively (p for trend <0.001). The male:female ratios of current asthma and/or wheezing in the four surveys were 1.14:1, 1.15:1, 1.16:1 and 1.22:1, respectively. The proportion of those with wheezing diagnosed with asthma has increased during the study period, more so among non-current children with asthma.

CONCLUSIONS

Our findings show a continuous increase in the prevalence of asthma and wheezing among preadolescent children in Patras, Greece, over 25 years, albeit at a decelerating rate. There seems to be a true increase in wheezing, despite some diagnostic transfer, particularly among younger children. The male predominance of the disease has persisted in the population of this study.

Different effects of urban and rural environments in the respiratory status of Greek schoolchildren

We hypothesized that asthma symptoms and lung function of schoolchildren living in Athens urban area are adversely affected as compared to others living in a rural environment, over a period of 8 years. We recruited 478 and 342 children aged 8-10 years living within a short radius around the urban and rural area monitoring stations, respectively. Respiratory health was assessed by a parent-completed questionnaire in three phases: 1995-1996 (phase-1), 1999-2000 (phase-2), 2003-2004 (phase-3) and by spirometry in phases-1 and 2. Reported asthma and wheeze did not differ in the two areas, whereas cough was more prevalent in the urban area in phase-1. Children from the rural environment had lower levels of percent-predicted forced vital capacity (FVC%) in phase-1 and higher of percent-predicted-forced expiratory flow at mid-FVC (FEF(50)%) in both phases. Independent associations were detected between FVC% as-well-as FEF(50)% and residential area. High FVC% was associated with outdoor systemic athletic activities; there was lower FVC% growth in the urban versus the rural area. Nitrogen dioxide and sulfur dioxide were higher in the urban area, whereas ozone concentrations differed less between the two areas. These results suggest that long-term exposure to urban environment is associated with sub-clinical airway narrowing and slower rate of FVC growth.

Trends in prevalence of asthma, allergic rhinitis and atopic dermatitis in 5-7-year old Swiss children from 1992 to 2001

BACKGROUND

Changing occurrence rates of asthma, allergic rhinitis and atopic dermatitis are of public health concern and require surveillance. Changes in prevalence rates of these atopic diseases were monitored during 10 years and their trend with time was determined taking into account the influence of personal and environmental risk factors.

METHODS

Four cross-sectional surveys in 5-7-year old children were performed in seven different communities in Switzerland between 1992 and 2001. Prevalence of respiratory and allergic symptoms and of affecting risk factors including parental environmental concern were assessed using a standardized parental questionnaire.

RESULTS

A total of 988 (74.1%), 1778 (79.0%), 1406 (82.6%) and 1274 (78.9%) children participated, respectively, in the 1992, 1995, 1998 and 2001 surveys. Prevalence rates of asthma and hay fever symptoms remained quite stable over time (wheeze/past year: 8.8%, 7.8%, 6.4% and 7.4%, sneezing attack during pollen season: 5.0%, 5.6%, 5.4% and 4.6%). Rates of reported atopic dermatitis symptoms (specific skin rash/past year: 4.6%, 6.5%,7.4% and 7.6%) showed an increase over time, but those of diagnosis of eczema did not show a clear pattern (18.4%, 15.7%, 14.0% and 15.2%). Stratified analysis by parental environmental concern and by parental atopy showed similar trends. Rates of atopic dermatitis symptoms showed significant increase in girls but stayed stable in boys.

CONCLUSION

Results of these four consecutive surveys suggest that the increase in prevalence of asthma and hay fever in 5-7-year old children living in Switzerland may have ceased. However, symptoms of atopic dermatitis may still be on the rise, especially among girls.

Prevalence of asthma, eczema and allergic rhinitis: two surveys, 6 years apart, in Kota Bharu, Malaysia

OBJECTIVE

This study was undertaken to determine the prevalence of asthma, eczema, and allergic rhinitis in school children in Kota Bharu, Malaysia, and in so doing to determine the differences in symptom prevalence rates of asthma, and atopic diseases in Kota Bharu school children between 1995 and 2001.

METHODOLOGY

In two studies (1995 and 2001), year one primary school (PS) pupils (6-7 years old) and secondary school (SS) year two pupils (13-14 years old) were randomly selected from the district of Kota Bharu, Kelantan, Malaysia. In 1995, 3939 PS children and 3116 SS children participated, and in 2001 3157 PS children and 3004 SS children participated. The Phase I International Study of Asthma and Allergies in Childhood prevalence written questionnaire and video questionnaire (only shown to SS children) were used in both studies.

RESULTS

The written questionnaire showed no significant changes in the prevalence (1995, 2001) of ever wheeze (8.3%, 6.9%P = 0.06), current wheeze (5.4%, 4.3%P = 0.08), exercise-induced wheeze (EIW; 3.9%, 3.7%P = 0.63), and rhinoconjunctivitis (4.6%, 5%P = 0.42) among PS children. The prevalence of flexural itchy rash increased from 14% to 17.6% (P = 0.004) and night cough decreased from 20.4% to 17.5% (P = 0.005). There were also no significant changes in these symptoms among SS children (1995, 2001): ever wheeze (10.7%, 12%P = 0.37), current wheeze (6.8%, 5.7%P = 0.20), EIW (9.9%, 11.6%P = 0.28), night cough (21.6%, 24%P = 0.39), rhinoconjunctivitis (11%, 15%P = 0.11), and flexural itchy rash (12%, 13%P = 0.11). The video questionnaire showed no significant changes in the prevalence of symptoms in the previous 12 months (1995 vs 2001) for wheeze at rest (3.8%, 2.8%P = 0.12), EIW (6.9%, 8.8%P = 0.32), waking with wheeze (1.7%, 1.7%P = 1.0), and severe wheeze (2.1%, 3%P = 0.12). Night cough in the previous 12 months increased significantly from 5.1% to 8.3% (P = 0.007).

CONCLUSION

Although asthma and atopic disorders are common in this country, the results revealed no major changes in the prevalence rates of these diseases over a period of 6 years.

Signs of reversing trends in prevalence of asthma

Several recent reports have provided evidence that the burden of asthma may have levelled off, after increasing for decades. Implementation of the national and global asthma prevention and management guidelines that have led to earlier detection and improved treatment of asthmatics, is considered to be involved in this apparent change for the better. In addition, environmental influences associated with the modern life may have reached the maximum in inducing symptoms and disease in genetically susceptible individuals in some areas. Available data obtained from Canada and non-English-speaking countries in Europe show that the peak in asthma prevalence has been reached at the level of 8-12%. This review outlines the most recent literature on time trends in asthma prevalence and considers the possible causes of the current trends. Problems and pitfalls in appraising studies on time trends are also discussed.

Hospitalizations for childhood asthma in Athens, Greece, from 1978 to 2000

Trends in rates of asthma admissions among children have shown a variety of patterns in different countries in the last decades. We undertook the present study to determine the time trends in asthma admissions and readmissions of children in Athens, Greece. Data were obtained retrospectively from hospital registries of the three main children's hospitals in Athens from 1978 to 2000. Children admitted with the diagnoses of asthma, asthmatic bronchitis or wheezy bronchitis were included. Hospital admission rate for asthma among children 0-14 yr from 1978 to 2000 rose by 271% (p <0.001). The rise in rates among those aged 0-4 and 5-15 yr were 250% and 276%, respectively. The mean annual increase in admission rate was 12.2% for 1978-1987, 4.7% for 1988-1993 and 0.6% for 1994-2000. The readmission rate among children 0-14 yr was increased from 15.3% to 23.3%. A positive correlation between admission and readmission rates in all age groups was observed. In conclusion, our findings show an increase in the childhood asthma admission rate in Athens in late 1970's and during the 1980's, which has decelerated in the 1990's, particularly in the second-half of the decade. The readmission rate paralleled that of admissions over the entire study period.

Prevalence and risk factors for allergic rhinitis and atopic eczema among schoolchildren in Israel: results from a national study

BACKGROUND

There is growing evidence that the prevalence rates of asthma and allergic diseases are increasing, especially among children. Several risk factors are under investigation.

OBJECTIVE

To evaluate the prevalence and risk factors for allergic diseases, including allergic rhinitis (AR) and atopic eczema (AE), among 13- to 14-year-old schoolchildren in Israel.

METHODS

A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of schoolchildren 13 to 14 years old in Israel. The questionnaire was completed by the schoolchildren themselves.

RESULTS

There were 10,057 complete questionnaires available for analysis. The prevalence of AR symptoms ever and current AR were 41.6% and 9.4%, respectively. Allergic rhinoconjunctivitis symptoms ever were reported by 15.8% of the children. The prevalence rates of 6 months of itchy rash ever and AE were 5.9% and 7.8%, respectively. After adjustment for demographic and environmental factors, current asthma, parental history of asthma, and population group were the most significant risk factors for current AR (odds ratio [OR], 4.47; 95% confidence interval [CI], 3.70-5.40; OR, 1.30; 95% CI, 1.02-1.66; and OR, 1.75; 95% CI 1.45-2.13; respectively) and AE (OR, 2.30; 95% CI, 1.80-2.90; OR, 1.80; 95% CI, 1.40-2.30; and OR, 1.70; 95% CI, 1.40-2.00; respectively).

CONCLUSIONS

Israeli children have a low prevalence rate of current AR and a midrange rate of AE. Arabs have lower prevalence rates of allergic diseases than Jews, and the prominent risk factors for those diseases are current asthma and parental history of asthma.

Wheeze and urban variation in South Asia

Typically, urban South Asia is characterised by narrow streets, heavy traffic, visible haze, unplanned city architecture and the use of kerosene or wood-burning stoves at home. However, some urban areas in South Asia are clean and modern, with concrete housing, vehicle emission regulations and use of smoke-free household fuel. The purpose of this study was to compare wheeze prevalence in 13-14-year-olds between two South Asian cities (Galle, Chandigarh), representing each of the above two archetypes. The validated one-page International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire for 13-14-year-olds was used for the study. Of 1814 distributed questionnaires, 1737 (95.8%) were completed correctly and returned (Galle: n=1162; Chandigarh: n=575). Crude prevalence rates, and prevalence odds ratios (with 95% two-sided confidence intervals (CI) for comparison of prevalence rates), were calculated. The prevalence rate for wheezing in Galle (28.7%) was higher than in Chandigarh (12.5%). The prevalence odds ratios (Galle versus Chandigarh) for lifetime wheezing (2.3; 1.8-2.9), wheezing in the previous year (2.1; 1.6-2.7), exercise-related wheeze (4.8; 3.5-6.7) and physician-diagnosed wheeze (1.7; 1.2-2.3) demonstrated significant differences in wheeze prevalence between the two cities ( P<0.05). The numbers of 13-14-year-olds experiencing less than 12 wheezing episodes per year or sleep disturbance due to wheeze of less than 1 night per week were also significantly higher for Galle than Chandigarh. There is a higher prevalence of wheeze in 13-14-year-old children living in an old-fashioned, congested city than in a clean and modern city in South Asia.

Geographical variations of asthma and asthma symptoms among schoolchildren aged 5 to 8 years and 12 to 15 years in Palestine: the International Study of Asthma and Allergies in Childhood (ISAAC)

BACKGROUND

Many studies demonstrated the existence of geographic differences, within and between countries, in the prevalence of asthma, rhinitis, and eczema. However, in Palestine, there are no comprehensive Palestinian data to compare with those from other regional and international centers.

OBJECTIVE

To describe the prevalence of asthma and asthma symptoms in schoolchildren in two districts (Ramallah and North Gaza) in Palestine.

METHODS

After a two-stage stratified systematic sampling, approximately 14,500 schoolchildren, from the first and second grades of elementary school (ages 5 to 8 years) and eighth and ninth school grades (ages 12 to 15 years), were invited to participate in a survey using International Study of Asthma and Allergies in Childhood phase III questionnaires and protocols.

RESULTS

In general, younger children were reported to have a higher 12-month wheezing prevalence rate than older children (9.6 and 7.2%, respectively), and more physician-diagnosed asthma (8.4 and 5.9%, respectively). However, nocturnal cough and exercise-related wheezing were higher in the older age group compared with younger children. Younger children living in North Gaza district showed slightly higher prevalence rates for asthma and asthma symptoms, but older children had higher rates in Ramallah district. After adjustment using logistic regression analysis, male sex, living in inland areas, and younger age were shown to predict 12-month wheezing and physician-diagnosed asthma.

CONCLUSIONS

Palestinian children have asthma symptoms rates that are similar to several countries in the Mediterranean region such as Spain and Turkey, but still lower than other Middle East countries such as Saudi Arabia and Israel.