Figures
- FIGURE 1
Flow chart depicting recruitment into the Global Asthma Network study.
- FIGURE 2
Time trends in various aspects of asthma including current wheeze, wheeze ever, nocturnal cough, severe asthma and asthma ever through the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I and Phase III, and the Global Asthma Network (GAN) Phase I, in the two age groups of children. #: severe asthma is defined as more than four attacks of wheezing in previous 12 months or wheeze affecting sleep or speech in previous 12 months. *: p<0.05; **: p<0.01; ***: p<0.001 when ISAAC Phase I compared to ISAAC Phase II. ¶¶¶: p<0.001 when ISAAC Phase III compared to GAN Phase I.
Tables
- TABLE 1
Prevalence of symptoms of asthma, severe asthma, asthma ever and doctor-diagnosed asthma in children and adults across both genders
Symptoms 6–7-year age group (n=20 084) 13–14-year age group (n=25 887) Adults (n=81 296)# Male (n=10 441) Female (n=9643) p-value¶ Total n (%) Male (n=12 671) Female (n=13 216) p-value¶ Total n (%) Male (n=40 468) Female (n=40 815) p-value¶ Total n (%) n (%) n (%) n (%) n (%) n (%) n (%) Current wheeze 380 (3.64) 254 (2.63) <0.0001 634 (3.16) 565 (4.46) 375 (2.84) <0.0001 940 (3.63) 1344 (3.32) 1335 (3.27) 0.689 2680 (3.30) Wheeze ever+ 757 (7.25) 498 (5.16) <0.0001 1255 (6.25) 1139 (8.99) 778 (5.89) <0.0001 1917 (7.41) Nocturnal cough in past 12 months+ 1870 (17.91) 1370 (14.21) <0.001 3240 (16.13) 3864 (30.49) 3520 (26.63) <0.0001 7384 (28.52) Asthma severe§ 192 (1.84) 128 (1.33) 0.004 320 (1.59) 258 (2.04) 157 (1.19) <0.0001 415 (1.60) 465 (1.15) 476 (1.17) 0.790 942 (1.16) Asthma ever 174 (1.67) 109 (1.13) 0.0012 283 (1.41) 630 (4.97) 426 (3.22) <0.0001 1056 (4.08) 714 (1.76) 942 (2.31) <0.0001 1656 (2.04) Doctor-diagnosed asthma 138 (1.32) 88 (0.91) 0.0059 226 (1.13) 354 (2.79) 246 (1.86) <0.0001 600 (2.32) 517 (1.28) 659 (1.61) 0.000 1176 (1.45) #: sex not defined for 13 adults. ¶: Chi-squared test. +: questions not included in adult questionnaire. §: severe asthma is defined as more than four attacks of wheezing in previous 12 months or wheeze affecting sleep or speech in previous 12 months.
- TABLE 2
Time trends in known environmental trigger factors through the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III and Global Asthma Network (GAN) in the two age groups of children
6–7-year age group 13–14-year age group GAN (n=20 084) ISAAC Phase III (n=47 166) p-value# GAN (n=25 887) ISAAC Phase III (n=52 289) p-value# Paracetamol use in last 12 months Never 6639 (33.1) 8945 (19.0) 0.000 9838 (38.0) 14 689 (28.1) 0.000 At least once a year 9496 (47.3) 21 499 (45.6) 10 283 (39.7) 18 749 (35.9) At least once per month 2104 (10.5) 5940 (12.6) 4441 (17.2) 9530 (18.2) No response 1845 (9.2) 10 782 (22.8) 1325 (5.1) 9321 (17.8) Farm animals during pregnancy¶ Yes 1307 (6.5) 3357 (7.1) 0.000 No 18 051 (89.9) 34 474 (73.1) No response 726 (3.6) 9335 (19.8) Farm animals during first year of life¶ Yes 1059 (5.3) 4267 (9.0) 0.000 No 18 297 (91.1) 33 585 (71.2) No response 728 (3.6) 9314 (19.8) Trucks pass through the street Never 9999 (49.8) 9451 (20.0) 0.374 11 063 (42.7) 10 978 (21.0) 0.000 Seldom (not often) 8631 (43.0) 13 793 (29.2) 9573 (37.0) 15 354 (29.4) Frequently through the day 1028 (5.1) 8276 (17.6) 2902 (11.2) 9550 (18.3) Almost the whole day 426 (2.1) 5808 (12.3) 1268 (4.9) 2718 (5.2) No response 0 9838 (20.9) 1081 (4.2) 13 689 (26.2) Child ever breastfed¶ Yes 16 569 (82.5) 35 215 (74.7) 0.000 No 2728 (13.6) 2549 (5.4) No response 787 (3.9) 9402 (19.9) Cat in the home during first year of life¶ Yes 991 (4.9) 3756 (8.0) 0.000 No 18 360 (91.4) 34 107 (72.3) No response 733 (3.7) 9303 (19.7) Cat in the home in last 12 months Yes 985 (4.9) 3632 (7.7) 0.000 3221 (12.4) 8491 (16.2) 0.000 No 17 875 (89.0) 34 277 (72.7) 22 041 (85.1) 35 480 (67.9) No response 1224 (6.09) 9257 (19.63) 625 (2.5) 8318 (15.9) Dog in the home during first year of life¶ Yes 1102 (5.5) 4102 (8.7) 0.000 No 18 280 (91.0) 33 836 (71.7) No response 702 (3.5) 9228 (19.6) Dog in the home in last 12 months Yes 1200 (6.0) 3779 (8.0) 0.000 3930 (15.2) 7934 (15.2) 0.000 No 18 150 (90.4) 34 183 (72.5) 21 394 (82.6) 36 000 (68.8) No response 734 (3.6) 9204 (19.5) 563 (2.2) 8355 (16.0) Fast food Never or only occasionally 13 286 (66.2) 10 754 (22.8) 0.000 16 535 (63.9) 12 553 (24.0) 0.000 Once or twice per week 3445 (17.2) 7383 (15.7) 5200 (20.1) 12 018 (23.0) Most or all days 462 (2.3) 9865 (20.9) 1690 (6.5) 10 236 (19.6) No response 2891 (13.3) 19 164 (40.3) 2462 (9.5) 17 482 (33.4) Antibiotic in first year of life¶ Yes 3350 (16.7) 17 706 (37.5) 0.373 No 16 734 (83.3) 17 711 (37.6) No response 0 11 749 (24.9) Fresh fruit Never or only occasionally 4590 (22.9) 11 179 (23.7) 0.000 7698 (29.7) 12 031 (23.0) 0.000 Once or twice per week 6841 (34.1) 12 503 (26.5) 6106 (23.6) 14 409 (27.6) Most or all days 6341 (31.6) 11 511 (24.4) 9255 (35.8) 15 061 (28.8) No response 2312 (11.4) 11 973 (25.4) 2828 (10.9) 10 788 (20.6) Vegetables Never or only occasionally 5565 (27.7) 12 291 (26.1) 0.000 13 150 (50.8) 12 721 (24.3) 0.000 Once or twice per week 5792 (28.8) 9395 (19.9) 4666 (18.0) 11 230 (21.5) Most or all days 5842 (29.1) 13 726 (29.1) 5193 (20.1) 17 681 (33.8) No response 2885 (14.4) 11 754 (24.9) 2878 (11.1) 10 657 (20.4) Mother smoking during first year of life Yes 209 (1.0) 385 (0.8) 0.000 No 19 194 (95.6) 37 637 (79.8) No response 681 (3.4) 9144 (19.4) Data are presented as n (%), unless otherwise stated. #: Chi-squared test. ¶: questions included in the 6–7-year age group questionnaire only.
- TABLE 3
School absenteeism, exercise-induced wheeze and medical assistance required among children and adults with current wheeze with or without doctor-diagnosed asthma, and healthy subjects
In past 12 months 6–7-year age group 13–14-year age group Adults Current wheezers with doctor-diagnosed asthma (n=115) Current wheezers without doctor-diagnosed asthma (n=519) Subjects without current wheeze (n=19 450) p-value# Current wheezers with doctor-diagnosed asthma (n=239) Current wheezers without doctor-diagnosed asthma (n=701) Subjects without current wheeze (n=24 947) p-value# Current wheezers with doctor-diagnosed asthma (n=603) Current wheezers without doctor-diagnosed asthma (n=2077) Subjects without current wheeze (n=78 616) p-value# Missed school due to breathing problem ≥1 day 76 (66.09) 13 (2.50) 53 (0.27) 0.000 126 (52.72) 168 (23.96) 1499 (6.01) 0.000 Wheezy chest with exercise 39 (33.91) 117 (22.54) 399 (2.05) 0.000 103 (43.10) 237 (33.81) 1943 (7.79) 0.000 Urgent visit to doctor due to breathing problem (≥1 time) 81 (70.43) 16 (3.08) 54 (0.28) 0.000 119 (49.79) 208 (29.67) 1606 (6.44) 0.000 391 (64.84) 74 (3.56) 244 (0.31) 0.000 Urgent visit to emergency department due to breathing problem (≥1 time) 42 (36.52) 5 (0.96) 18 (0.09) 0.000 53 (22.17) 73 (10.41) 598 (2.40) 0.000 180 (29.85) 32 (1.54) 106 (0.13) 0.000 Admitted to hospital due to breathing problem (≥1 time) 51 (44.35) 6 (1.16) 22 (0.11) 0.000 61 (25.52) 61 (8.70) 679 (2.72) 0.000 165 (27.36) 32 (1.54) 101 (0.13) 0.000 Limited usual activity (at work or in the home) due to breathing problem 216 (35.82) 366 (17.62) 932 (1.19) 0.000 Data are presented as n (%), unless otherwise stated. #: Chi-squared test.
- TABLE 4
Treatment undertaken for current wheeze and severe asthma in children and adults
Medications used Current wheeze Severe asthma# 6–7-year age group (n=634) 13–14-year age group (n=940) Adults (n=2680) 6–7-year age group (n=320) 13–14-year age group (n=562) Adults (n=1499) n % n % n % n % n % n % Inhaler medicines 97 15.30 270 28.72 487 18.17 72 22.50 208 37.01 389 25.95 Nebuliser 115 18.14 115 12.23 309 11.53 85 26.56 89 15.84 231 15.41 Oral medications 76 11.99 238 25.32 392 14.63 61 19.06 183 32.56 324 21.61 Inhaled β-agonists Only when needed 51 8.04 140 14.89 239 8.92 36 11.25 120 21.35 188 12.54 In short courses 23 3.63 27 2.87 37 1.38 16 5.00 26 4.63 34 2.27 Every day 5 0.79 9 0.96 33 1.23 3 0.94 9 1.60 29 1.93 ICS Only when needed 24 3.79 43 4.57 67 2.50 14 4.38 34 6.05 56 3.74 In short courses 13 2.05 52 5.53 24 0.90 11 3.44 47 8.36 22 1.47 Every day 5 0.79 8 0.85 13 0.49 3 0.94 5 0.89 11 0.73 Combined (ICS+LABA) Only when needed 18 2.84 81 8.62 112 4.18 10 3.13 71 12.63 81 5.40 In short courses 9 1.42 10 1.06 22 0.82 4 1.25 8 1.42 18 1.20 Every day 10 1.58 7 0.74 37 1.38 8 2.50 7 1.25 32 2.13 ICS: inhaled corticosteroid; LABA: long-acting β-agonist. #: severe asthma is defined as current wheeze with more than four attacks per year or wheeze affecting speech or activity.
- TABLE 5
Use of various types of medicines in subjects with current wheeze and severe asthma with or without doctor-diagnosed asthma
Current wheezers with doctor-diagnosed asthma Current wheezers without doctor-diagnosed asthma p-value# Severe asthma with doctor-diagnosed asthma¶ Severe asthma without doctor-diagnosed asthma¶ p-value# 6–7-year age group n=115 n=519 n=95 n=225 Inhaled β-agonists Only when needed 41 (35.65) 10 (1.93) 0.000 33 (34.74) 3 (1.33) 0.000 In short courses 18 (15.65) 5 (0.96) 15 (15.79) 1 (0.44) Every day 5 (4.35) 0 (0.0) 3 (3.16) 0 (0.0) Not using any medicine 51 (44.35) 504 (97.11) 44 (46.31) 221 (98.23) ICS Only when needed 16 (13.91) 8 (1.54) 0.000 11 (11.58) 3 (1.33) 0.000 In short courses 12 (10.43) 1 (0.19) 11 (11.58) 0 (0.0) Every day 4 (3.48) 1 (0.19) 3 (3.16) 0 (0.0) Not using any medicine 83 (72.18) 509 (98.08) 70 (73.68) 222 (98.67) Combined (ICS+LABA) Only when needed 14 (12.17) 4 (0.77) 0.000 9 (9.47) 1 (0.44) 0.000 In short courses 6 (5.22) 3 (0.58) 4 (4.21) 0 (0.0) Every day 9 (7.83) 1 (0.19) 8 (8.42) 0 (0.0) Not using any medicine 86 (74.78) 511 (98.47) 74 (77.90) 224 (99.56) 13–14-year age group n=239 n=701 n=182 n=380 Inhaled β-agonists Only when needed 107 (44.77) 41 (5.85) 0.000 97 (53.30) 26 (6.84) 0.000 In short courses 18 (7.53) 22 (3.14) 17 (9.34) 7 (1.84) Every day 8 (3.35) 1 (0.14) 7 (3.85) 1 (0.26) Not using any medicine 106 (44.35) 637 (90.87) 61 (33.52) 346 (91.06) ICS Only when needed 30 (12.55) 13 (1.85) 0.000 23 (12.64) 11 (2.89) 0.000 In short courses 46 (19.25) 6 (0.86) 42 (23.07) 5 (1.32) Every day 8 (3.35) 0 (0.0) 5 (2.75) 0 (0.0) Not using any medicine 155 (64.85) 682 (97.29) 112 (61.54) 364 (95.79) Combined (ICS+LABA) Only when needed 65 (27.20) 16 (2.28) 0.000 58 (31.86) 13 (3.42) 0.000 In short courses 6 (2.51) 4 (0.57) 0.012 4 (2.20) 4 (1.05) Every day 5 (2.09) 2 (0.29) 0.005 5 (2.75) 2 (0.53) Not using any medicine 163 (68.20) 679 (96.86) 115 (63.19) 361 (95.0) Adults n=603 n=2077 n=467 n=1032 Inhaled β-agonists Only when needed 218 (36.15) 24 (1.16) 0.000 171 (36.62) 16 (1.55) 0.000 In short courses 33 (5.47) 4 (0.19) 31 (6.64) 3 (0.29) Every day 30 (4.98) 3 (0.14) 26 (5.57) 3 (0.29) Not using any medicine 322 (53.40) 2046 (98.51) 239 (51.17) 1010 (97.87) ICS Only when needed 58 (9.62) 9 (0.43) 0.000 49 (10.49) 7 (0.68) 0.000 In short courses 21 (3.48) 3 (0.14) 19 (4.07) 3 (0.29) Every day 13 (2.16) 0 (0.0) 11 (2.36) 0 (0.0) Not using any medicine 511 (84.74) 2065 (99.43) 388 (83.08) 1022 (99.03) Combined (ICS+LABA) Only when needed 101 (16.75) 11 (0.53) 0.000 73 (15.63) 8 (0.78) 0.000 In short courses 18 (2.99) 4 (0.19) 14 (3.00) 4 (0.39) Every day 37 (6.14) 0 (0.0) 32 (6.85) 0 (0.0) Not using any medicine 447 (74.12) 2062 (99.28) 348 (74.52) 1020 (98.83) Data are presented as n (%), unless otherwise stated. ICS: inhaled corticosteroid; LABA: long-acting β-agonist. #: the Chi-squared test is used when all expected cell frequencies are ≥5. If expected cell frequency was <5 the Fisher exact probability test was used. ¶: severe asthma is defined as current wheeze with more than four attacks per year or wheeze affecting speech or activity.
