The Global Asthma Report 2018

References

1. Global Asthma Network

Asher I, Haahtela T, Selroos O, et al. Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma.Allergol Immunopathol (Madr) 2017; 45(2):105-114.

Bissell K, Perrin C. Access to quality-assured, affordable asthma medicines. Chapter 10 in the Global Asthma Report 2014. Auckland, New Zealand: Global Asthma Network. Website www.globalasthmareport.org

Ellwood P, Asher I. Bissell K, et al. Asthma Management Guidelines. Chapter 9 in the Global Asthma Report 2014. Auckland, New Zealand: Global Asthma Network. Website www.globalasthmareport.org

Ellwood P, Asher MI, Billo NE, et al. The Global Asthma Network rationale and methods for Phase I global surveillance: prevalence, severity, management and risk factors.Eur Respir J 2017;49:1601605.

Global Asthma Network website www.globalasthmanetwork.org

Figure. Map of Participating Global Asthma Network Centres.Global Asthma Network. 2018 June.

2. What is Asthma?

Holgate ST. A brief history of asthma and its mechanisms to modern concepts of disease and pathogenesis. Allergy Asthma Immunol Res 2010 July;2(3):165-171.

Global Initiative for Asthma. Global strategy for asthma management and prevention, 2017. Available from www.ginasthma.org.

Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases.Lancet 2018;391(10118):350-400.

3. Global Burden of Disease due to Asthma

Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1211-59.

Hay SI, Abajobir AA, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1260-1344.

Naghavi M, Abajobir AA, Abbafati C, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1151-1210.

Agusti A, Bel E, Thomas M, et al. Treatable traits: toward precision medicine of chronic airway diseases.Eur Respir J 2016;47(2):410-9.

Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases.Lancet 2018; 391(10118):350-400.

Figures 1 and 2. Prevalence of asthma symptoms among 13-14 year olds (ISAAC); Prevalence of severe asthma among 13-14 year olds (ISAAC).From: Lai CKW, Beasley R, Crane J, et al. Global variation in the prevalence and severity of asthma symptoms: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009;64(6):476-483.

Figure 3. Prevalence of “attacks of wheezing or whistling breath” (symptoms of asthma) in the last 12 months among persons aged 18 to 45, 70 countries, World Health Survey 2002-2003. From: To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 2012;12:204.

Figure 4. Burden of disease, measured by disability adjusted life years (DALYs, see explanation p20) per 100,000 population attributed to asthma by age group and sex. Global population, 2010. From: Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease (GBD) Cause Patterns. Seattle, WA: University of Washington; 2013 [8th May 2014]>. Available from: www.healthmetricsandevaluation.org/gbd/visualizations/gbd-cause-patterns.

4. Hospital Admissions for Asthma

Anderson HR, Gupta R, Kapetanakis V, et al. International correlations between indicators of prevalence, hospital admissions and mortality for asthma in children. Int J Epidemiol 2008;37:573-582.

Anderson HR, Gupta R, Strachan DP, Limb ES. 50 years of asthma: UK trends from 1955 to 2004. Thorax 2007;62:85-90.

Chawla J, Seear M, Zhang T, et al. Fifty years of pediatric asthma in developed countries: how reliable are the basic data sources? Pediatric Pulmonology 2012;47:211-219.

Gupta R, Anderson HR, Strachan DP, et al. International trends in admissions and drug sales for asthma. Int J Tuberc Lung Dis 2006;10:138-145.

Hasegawa K, Tsugawa Y, Brown DFM, Camargo CA. Childhood asthma hospitalizations in the United States, 2000-2009. J Pediatr 2013;163:1127-1133.

Figure 1. Age-standardised admission rates for asthma (all ages) in 30 European countries, 2001-2005 and 2011-2015, ranked by age-standardised admission rate in 2011-2015. From: Eurostat database http://ec.europa.eu/eurostat/web/health/health-care/data/database, November 2017 download.

Figure 2. Relative changes in age-standardised rates of hospitalisation for asthma, 2011-2015 vs. 2001-2005, for adults (age 20+) and children & adolescents (age 0-19) in 25 European countries. Eurostat database http://ec.europa.eu/eurostat/web/health/health-care/data/database, November 2017 download.

Figure 3. Schematic representation of long-term time trends in self-reported asthma prevalence, hospital admission rates and mortality rates for asthma among children in high-income countries (some European countries, USA, Canada, Australia, New Zealand, Hong Kong and Singapore). Reproduced from: Chawla J, Seear M, Zhang T, et al. Fifty years of pediatric asthma in developed countries: how reliable are the basic data sources? Pediatric Pulmonology 2012;47:211-219.

Figure 4. Annual change in hospital admission rates for childhood asthma (ages 5-14) in countries with one or more ISAAC centres providing prevalence data for both ISAAC Phase One (1993-5) and ISAAC Phase Three (2001-3), by change in prevalence of nocturnal wheezing among 13-14-year-olds. Adapted from: Anderson HR, Gupta R, Kapetanakis V, et al. International correlations between indicators of prevalence, hospital admissions and mortality for asthma in children. International Journal of Epidemiology 2008;37(3):573-82. (National admissions data updated from WHO Hospital Morbidity Database November 2013) and Pearce N, Aït-Khaled N, Beasley R, et al. Worldwide trends in the prevalence of asthama symptoms: Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2007;62(9):758-66. (Prevalence data)

5. Asthma Mortality

Anderson HR, Gupta R, Kapetanakis V, et al. International correlations between indicators of prevalence, hospital admissions and mortality for asthma in children. Int J Epidemiol 2008;37:573-582.

Chatenoud L, Malvezzi M, Pitrelli A, et al. Asthma mortality and long-acting beta2-agonists in five major European countries, 1994-2004. J Asthma 2009;46:546-551.

Chawla J, Seear M, Zhang T, et al. Fifty years of pediatric asthma in developed countries: how reliable are the basic data sources? Pediatric Pulmonology 2012;47:211-219.

Royal College of Physicians (UK). Why asthma still kills. The National Review of Asthma Deaths Confidential Enquiry Report, May 2014. London: RCP, 2014.

Ebmeier S, Thayabaran D, Braithwaite I, et al. Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993-2012). Lancet 2017;390:935-945.

Figure 1. Age-standardised asthma mortality rates for all ages, 2001-2005 and 2011-2015, by country, ordered by mortality rate and income group. Source: WHO Mortality Database updated from http://www.who.int/healthinfo/statistics/mortality_rawdata/en/ [version dated 1 October 2017]. Population denominators from UN World Population Prospects, June 2017 revision http://data.un.org/Data.aspx?d=POP&f=tableCode%3A22 [Accessed 8 January 2018]. Income groups based on the World Bank 2014 definitions https://blogs.worldbank.org/opendata/new-country-classifications [Accessed 11 January 2018].

Figure 2. Age-standardised asthma mortality rates for ages 5-34 years only, 2001-2005 and 2011-2015, by country, ordered by mortality rate and income group. Source: WHO Mortality Database updated from http://www.who.int/healthinfo/statistics/mortality_rawdata/en/ [version dated 1 October 2017]. Population denominators from UN World Population Prospects, June 2017 revision http://data.un.org/Data.aspx?d=POP&f=tableCode%3A22 [Accessed 8 January 2018]. Income groups based on the World Bank 2014 definitions https://blogs.worldbank.org/opendata/new-country-classifications [Accessed 11 January 2018].

Figure 3. Relative changes in age-standardised mortality and hospitalisation rates for asthma (all ages) in 24 European countries, 2011-2015 vs 2001-2005. Sources: WHO Mortality Database updated from http://www.who.int/healthinfo/statistics/mortality_rawdata/en/ [version dated 1 October 2017].Eurostat: http://ec.europa.eu/eurostat/web/health/health-care/data/database [version dated 16 November 2017].

6. The Economic Burden of Asthma

Soriano JB, Abajobir AA, Abate KH, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017;390:1211–59.

Ehteshami-Afshar S, FitzGerald JM, Doyle-Waters MM, Sadatsafavi M. The global economic burden of asthma and chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2016; 20(1):11–23.

Sadatsafavi M, Rousseau R, Chen W, et al. The preventable burden of productivity loss due to suboptimal asthma control: a population-based study. Chest 2013;12;145(4):787–93.

Haahtela T, Herse F, Karjalainen J, et al. The Finnish experience to save asthma costs by improving care in 1987-2013. J Allergy Clin Immunol 2017;139(2):408–414.e2.

Jang J, Gary Chan KC, Huang H, Sullivan SD. Trends in cost and outcomes among adult and pediatric patients with asthma: 2000-2009. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol 2013;111(6):516–22.

Figure. Success of a national asthma strategy: overall annual costs of asthma care at the societal level in Finland from 1987 to 2013; the national asthma program began in 1994. Monetary values are in euros (€). From: Haahtela T, Herse F, Karjalainen J, et al. The Finnish experience to save asthma costs by improving care in 1987-2013. J Allergy Clin Immunol 2017;139(2):408–414.e2.

7. Factors Affecting Asthma

Asher MI. Recent perspectives on global epidemiology of asthma in childhood. Allergol Immunopathol (Madr ) 2010;38:83-87.

Beghe B, Fabbri LM, Contoli M et al. Update in Asthma 2016. Am J Respir Crit Care Med 2017;196:548-557.

Silverwood RJ, Rutter CE, Mitchell EA et al. Risk factors for asthma symptoms in Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC): combined analyses at the individual-level and school-level. (Under review) 2018.

Weinmayr G, Weiland SK, Bjorksten B et al. Atopic sensitization and the international variation of asthma symptom prevalence in children. Am J Respir Crit Care Med 2007;176:565-574.

Weinmayr G, Gehring U, Genuneit J et al. Dampness and moulds in relation to respiratory and allergic symptoms in children: results from Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC Phase Two). Clin Exp Allergy 2013;43:762-774.

Figure. Effects of individual-level exposures on wheeze in the last 12 months Mixed logistic regression models with random intercepts at the school, centre and country levels. ISAAC Phase Three Dataset. International Study of Asthma and Allergies in Childhood 2017.

8. Cost-effectiveness of Asthma Management using Inhaled Corticosteroids

Allen LN, Pullar J, Wickramasinghe KK, et al. Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower middle-income countries: a systematic review from 1990 to 2015. BMJ Global Health 2018; 3:e000535 doi:10.1136/bmjgh-2017-000535

Stanciole AE, Ortegon M, Chisholm D, Lauer JA. Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344:e608 doi:10.1136/bmj.e608

World Economic Forum and World Health Organiztion. From Burden to “Best Buys”. Geneva, 2011.

World Health Organization. Tackling NCDs: ‘Best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. WHO/NMH NVI/17.9 Geneva, 2017.

World Health Organization. Technical Briefing. Asthma and COPD interventions for the Appendix 3 of the Global Action Plan for Non Communicable Disease. Geneva, 2017.

9. Spacers for Asthma and Wheezing in Children

Zar HJ, Brown G, Donson H, et al. Home-made spacers for bronchodilator therapy in children with acute asthma: a randomised trial. Lancet 1999;354:979-82.

Zar HJ, Streun S, Levin M, et al. Randomised controlled trial of the efficacy of a metered dose inhaler with bottle spacer for bronchodilator treatment in acute lower airway obstruction. Arch Dis Child 2007;92:142–6.

Zar HJ, Green C, Mann MD, Weinberg EG. A novel method for constructing an alternative spacer for patients with asthma. S Afr Med J 1999;89(1):1-4.

Rodriguez C, Sossa M, Lozano JM. Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children. Cochrane Database Syst Rev 2008;2(CD005536).

10. Achieving Access to

Affordable, Quality-Assured, Essential Asthma Medicines

World Health Organization. Action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva, Switzerland: World Health Organization, 2013.

World Health Organization. The selection and use of essential medicines: report of the WHO Expert Committee, 2017 (including the 20th WHO Model List of Essential Medicines and the 6th WHO Model List of Essential Medicines for Children). Geneva: World Health Organization; 2017 (WHO technical report series; no. 1006).

Babar ZU, Lessing C, Mace C, Bissell K. The availability, pricing and affordability of three essential asthma medicines in 52 low- and middle-income countries. Pharmacoeconomics 2013;31:1063-82.

Asher I, Bissell K, Ellwood P, et al. Global asthma network identifies gaps in essential asthma medicines. European Respiratory Journal 2016 48: PA4186; DOI: 10.1183/13993003.congress-2016.PA4186

11. Asthma Management in Low-Income Countries

Adé G, Gninafon M,Tawo L, et al. Management of asthma in Benin: the challenge of loss to follow-up. Public Health Action 2013;3(1):76-80.

El Sony A , Chiang C-Y, Malik E, et al. Standard Case Management of asthma in Sudan: a pilot project. Public Health Action 2013;3(3):247–252.

Aït-Khaled N, Enarson DA, Chiang C-Y, et al. Management of Asthma: a guide to essentials of good clinical practice. Paris, France. The International Union Against Tuberculosis and Lung Disease, Third Edition 2008.

Chiang C-Y, Aït-Khaled N, Bissell K, Enarson DA. Management of asthma in resource-limited settings: role of low cost corticosteroid/β-agonist combination inhaler. Int J Tuberc Lung Dis 2015;19(2):129–136.

Kan XH, Chiang C-Y, Enarson DA, et al. Asthma as a hidden disease in rural China: opportunities and challenges of Standard Case Management. Public Health Action 2012;2(3):87–91.

12. Asthma in regions: Country reports from Africa

Benin:

Agodokpessi G, Aït-Khaled N, Gninafon M, et al. Assessment of a revolving drug fund for essential asthma medicines in Benin. J Pharm Policy Pract 2015;8:12.

Ghana:

Bosu WK. A comprehensive review of the policy and programmatic response to chronic non-communicable disease in Ghana. Ghana Med J 2012;46(2):10.

Kenya:

Subramanian S, Gakunga R, Kibachio J, et al. Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors. PLoS One 2018;13(1): e0190113.

Nigeria:

Onyedum CC, Ukwaja KN, Desalu OO, Ezeudo C. Challenges in the management of bronchial asthma among adults in Nigeria: A systematic review. Ann Med Health Sci Res 2013;3:324-9.

South Africa:

Zar HJ, Ehrlich RI, Workman L, Weinberg EG. The changing prevalence of asthma from 1995 to 2002. Pediatr Allergy Immunol 2007;18:560-565.

Table: Prevalence of current symptoms of asthma (12 month prevalence rate of wheeze) by centre in South Africa in 6 – 7 year and 13 – 14 year age groups as measured on the International Study of Asthma and Allergies in Childhood (ISAAC) Phases 1 and 3. From: Zar HJ, Ehrlich RI, Workman L, Weinberg EG. The changing prevalence of asthma from 1995 to 2002. Pediatr Allergy Immunol 2007;18:560-565.

Sudan:

Musa O, Magzoub A, Elsony A, Eltigani M, Elmahi G, Elawad A, Dawoud O. Prevalence and Risk Factors of Asthma Symptoms in Adult Sudanese Using a Modified ISAAC Questionnaire. Int J Sci Res 2016;5(2):1153 – 1156.

El Sony AI, Chiang CY, Malik E, et al. Standard case management of asthma in Sudan: a pilot project. Public Health Action 2013;3(3):247-52.

Africa-tailored spirometry training course:

Petty TL. Spirometry for All. RT magazine. 1997;10(3);18.

13. Asthma in regions: Country reports from Asia and India

China:

Zhu W-J, Ma H-X, Cui H-Y, et al. Prevalence and Treatment of Children’s Asthma in Rural Areas Compared with Urban Areas in Beijing. Chinese Medical Journal 2015;128(17):2273-7.

National Cooperative Group on Childhood Asthma; Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention; Chinese Center for Disease Control and Prevention. Third nationwide survey of childhood asthma in urban areas of China. Zhonghua Er Ke Za Zhi (Chinese Journal of Pediatrics) 2013;51(10):729-735.

Figure: Prevalence of asthma (asthma symptoms in the past 2 years) in children under 14 years from 43 major cities across China in 2010.

India:

Singh S, Sharma BB, Sharma SK, et al. Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: associations with parental smoking and traffic pollution. J Asthma 2016;53(3):238-44.

Indonesia:

Sundaru H. Epidemiology of asthma. Acta Medica Indonesiana 2005;37(1):1-2.

Pedoman Nasional Asma Anak (National Guideline of Paediatric Asthma) 2 ed. Jakarta 2016.

Malaysia:

Cates, CJ, Welsh, EJ and Rowe, BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2013 Sep 13;(9):CD000052.

Thailand:

Thanaviratananich S, Cho SH, Ghoshal AG, et al. Burden of respiratory disease in Thailand: Results from the APBORD observational study. Medicine 2016;95(28):e4090.

14. Asthma in regions: Country reports from Latin America

Argentina:

Arias SJ, Neffen H, Bosio JC, et al. Prevalence and Features of Asthma in Young Adults in Urban Areas of Argentina. Arch Bronconeumol 2018;54(3):134–139.

Figure. Trends in asthma mortality in Argentina (1980-2015)Age- and sex-adjusted rates, crude rate and number of deaths. From Departmento Programas de Salud. Instituto Nacional de enfermedades Respiratorias Emilio Coni Administración Nacional de Laboratorios e institutos de Salud. Database from the Dirección Nacional de Estadisticas de Salud. Argentina 2017.

Brazil:

Barreto ML, Ribeiro-Silva RdC, Malta DC, et al. Prevalence of asthma symptoms among adolescents in Brazil: National Adolescent School-based Health Survey (PeNSE 2012). Revista Brasileira de Epidemiologia 2014;17:106-15.

Colombia:

Dennis RJ, Caraballo L, Garcia E, et al. Prevalence of asthma and other allergic conditions in Colombia 2009–2010: a cross-sectional study. BMC Pulmon Med 2012;12:17.

Colombian Ministry of Health and Social Protection. National strategy for the prevention and control of chronic respiratory diseases. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ENT/estrategia-enfermedades-respiratorias-cronicas-2017.pdf. [last accessed 07 February 2018].

16. Asthma as an NCD Priority

Pearce N, Asher MI, Billo N, et al. Asthma in the global NCD agenda: a neglected epidemic. Lancet Respiratory Medicine 2013;1:96-97.

Pearce N, Ebrahim S, McKee M, et al. The road to 25x25: how can the five-target strategy reach its destination? Lancet Global Health 2014;2:e126.

World Health Organization. Action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva, Switzerland: World Health Organization, 2013.

http://www.un.org/en/ga/ncdmeeting2011/

http://www.who.int/mediacentre/factsheets/fs355/en/

17. Asthma and the UN’s Sustainable Development Goals 2030

United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. New York, NY, USA: United Nations, 2015. https://sustainabledevelopment.un.org/post2015/transformingourworld

High-Level Political Forum (HLPF). 2017 HLPF Thematic Review of SDG3: Ensure healthy lives and promote well-being for all at all ages. 2017. https://sustainabledevelopment.un.org/content/documents/14367SDG3format-rev_MD_OD.pdf

United Nations. The Sustainable Development Goals Report 2017. New York, NY, USA: United Nations, 2017. https://unstats.un.org/sdgs/files/report/2017/TheSustainableDevelopmentGoalsReport2017.pdf

United Nations Statistical Commission. Report of the inter-agency and expert group on Sustainable Development Goal Indicators. New York, NY, USA: UN Statistical Commission, 2017. https://undocs.org/A/RES/71/313

Chiang C-Y, Aït-Khaled N, Bissell K, Enarson DA. Management of asthma in resource-limited settings: role of low cost corticosteroid/β-agonist combination inhaler. Int J Tuberc Lung Dis 2015;19(2):129–136.

GBD 2016 SDG Collaborators. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017;390:1423–59.

Tables and Figures in Appendices

Table. Prevalence of current symptoms of asthma by world region in 6 – 7 year and 13 – 14 year age groups as measured in the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Lai CKW, Beasley R, Crane J, et al. Global variation in the prevalence and severity of asthma symptoms: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009; 64: 476–483.

All tables, figures and graphs have been reproduced with permission from their respective sources.

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The global epidemic of NCDs is a major and growing challenge to development.