International patterns of the prevalence of pediatric asthma: The ISAAC program
Section snippets
The ISAAC program
The International Study of Asthma and Allergies in Childhood (ISAAC) program arose from the realization that systematic international comparisons of the prevalence of asthma were needed to understand the global epidemiology of asthma better and to provide a framework for etiologic research into the role of different causative and protective factors [6], [7], [8]. This unique project has attracted worldwide interest and unprecedented large-scale participation. The program has evolved as a series
ISAAC phase one
The aims of phase one were to describe the prevalence and severity of the symptoms of asthma, rhinitis, and eczema in children living in different geographic centers and to make comparisons within and between countries, to obtain baseline measures for assessment of future prevalence trends and to provide a framework for future etiologic research into the causation of these diseases. The emphasis was on simple, validated methods that could be used in a standardized way, at minimal cost, in as
Phase one ecological studies
An extensive series of ecological studies have been undertaken throughout the world where standardized risk factor data have been available to evaluate the strength of associations between the recorded symptom prevalence of childhood asthma and risk factors in different centers. Such ecological analyses need to be interpreted with caution, because a correlation between variables based on group (ecological) characteristics may not necessarily be caused by an association between the variables
ISAAC phase two
Although such ecological analyses are useful for generating rather than proving hypotheses, they do provide the basis for further research. In the ISAAC program, these ecological analyses have led to the second phase in which detailed clinical and environmental data are being obtained in children in 48 centers from 20 countries. Populations that were considered to be potentially informative, such as those with contrasting prevalence of disease or environmental exposures, were chosen for
ISAAC phase three
Divergent international time trends in the prevalence of asthma are of particular interest in exploring the role of different environmental factors. The third phase of the ISAAC program aims to examine time trends in the prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema in centers and countries that participated in phase one [7]. Phase three also provides the opportunity to describe the prevalence and severity of asthma in centers and countries that are of interest but did
Summary
Like so much research, the findings from the ISAAC program have raised more questions than they have answered. Despite their limitations, the ISAAC findings provide the basis for further studies to investigate factors that potentially contribute to these international patterns and may lead to novel public health and pharmacologic intervention strategies that reduce the prevalence and severity of asthma worldwide.
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