Asthma may affect as many as 334 million people.

The Global Asthma Report 2014

REFERENCES

1. Global Asthma Network

The International Union Against Tuberculosis and Lung disease, The International Study of Asthma and Allergies in Childhood (ISAAC), editors. The Global Asthma Report 2011. Paris, France: The International Union Against Tuberculosis and Lung Disease; 2011.

Douwes J, Pearce N. Epidemiology of Respiratory Allergies and Asthma. In: Ahrens W, Pigeot I, (eds). Handbook of Epidemiology. 2nd ed. New York: Springer Science+Business Media; 2014.

Ellwood P, Asher MI, Beasley R, et al. The International Study of Asthma and Allergies in Childhood (ISAAC): Phase Three rationale and methods. International Journal of Tuberculosis and Lung Disease. 2005;9(1):10-6.

Enarson DA. Fostering a spirit of critical thinking: the ISAAC story. International Journal of Tuberculosis and Lung Disease. 2005;9(1):1.

Global Asthma Network Steering Group. The Global Asthma Network Website: The Global Asthma Network; 2012. Available from: www.globalasthmanetwork.org.

Horton R. GBD 2010: understanding disease, injury, and risk. Lancet. 2012;380(9859):2053-4.

ISAAC Steering Committee. The ISAAC Story: The International Study of Asthma and Allergies in Childhood. Asher M, Strachan D, Pearce N, et al., editors. Auckland, New Zealand: The International Study of Asthma and Allergies in Childhood; 2011.

2. Global Burden of Disease due to Asthma

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.

Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease (GBD) Compare. Seattle, WA: University of Washington; 2013 [8th May 2014]. Available from: viz.healthmetricsandevaluation.org/gbd-compare/.

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):476-83.

Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2197-223.

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.

3. Hospital Admissions

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.

Anderson HR, Gupta R, Strachan DP, et al. 50 years of asthma: UK trends from 1955 to 2004. Thorax. 2007;62(1):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(3):211-9.

Gupta R, Anderson HR, Strachan DP, et al. International trends in admissions and drug sales for asthma. International Journal of Tuberculosis and Lung Disease. 2006;10(2):138-45.

Hasegawa K, Tsugawa Y, Brown DF, et al. Childhood asthma hospitalisations in the United States, 2000-2009. The Journal of Pediatrics. 2013;163(4):1127-33 e3.

4. Asthma Mortality

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.

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(3):211-9.

Chatenoud L, Malvezzi M, Pitrelli A, et al. Asthma Mortality and Long-Acting Beta2-Agonists in Five Major European Countries, 1994–2004. Journal of Asthma. 2009;46(6):546-51.

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

Wijesinghe M, Weatherall M, Perrin K, et al. International trends in asthma mortality rates in the 5- to 34-year age group: a call for closer surveillance. Chest. 2009;135(4):1045-9.

5.  Wheezing in Infants

Guidelines for the diagnosis and management of asthma (August 2007). National Asthma Education and Prevention Program (NAEPP), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH). 2007.

Busse WW, Lemanske RF, Jr., Gern JE. Role of viral respiratory infections in asthma and asthma exacerbations. Lancet. 2010;376(9743):826-34.

García-Marcos L, Mallol J, Solé D, et al. International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life. Pediatric Allergy and Immunology. 2010;21(5):878-88.

Mallol J, García-Marcos L, Solé D, et al. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65(11):1004-9.

Schultz A, Brand PL. Episodic viral wheeze and multiple trigger wheeze in preschool children: a useful distinction for clinicians? Paediatric Respiratory Reviews. 2011;12(3):160-4.

Ducharme FM, Tse SM, Chauhan B. Diagnosis, management, and prognosis of preschool wheeze. Lancet. 2014;383(9928):1593-604.

6: The Economic Burden of Asthma

Accordini S, Corsico AG, Braggion M, et al. The cost of persistent asthma in Europe: an international population-based study in adults. Int ernational Archives of Allergy and Immunology. 2013;160(1):93-101.

Bahadori K, Doyle-Waters MM, Marra C, et al. Economic burden of asthma: a systematic review. BMC Pulmonary  Medicine. 2009;9:24.

Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. Journal of Allergy and Clinical Immunology. 2011;127(1):145-52.

Bender B, Boulet L, Chaustre L, et al. Adherence to long-term therapies: evidence for action [Internet]. Geneva: World Health Organzation; 2003 [cited 2013 Aug 11]. Available from: www.who.int/chp/knowledge/publications/adherence_report/en/.

Lai CKW, Kim Y-Y, Kuo S-H, et al. Cost of asthma in the Asia-Pacific region. European Respiratory Review. 2006;15(98):10-6.

Sadatsafavi M, Rousseau R, Chen W, et al. The preventable burden of productivity loss due to suboptimal asthma control: a population-based study. Chest. 2014;145(4):787-93.

Zafari Z, Lynd LD, FitzGerald JM, et al. Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: A simulation study. Journal of Allergy and Clinical Immunology. 2014; Epub ahead of print.

7. Factors Affecting Asthma

Asher MI, Stewart AW, Mallol J, et al. Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One. Respiratory Research. 2010;11:8.

Douwes J, Boezen M, Pearce N. Chronic obstructive pulmonary disease and asthma. In: Detels R, Beaglehole R, Lansang MA, et al., (eds). Oxford textbook of public health. Vol.3. 5th ed. Oxford: Oxford University Press; 2009. p. 1021-45.

Pearce N, Douwes J, Beasley R. Asthma. In: Detels R, McEwen J, Beaglehole R, et al., (eds). Oxford textbook of public health. Vol.3. 4th ed. Oxford: Oxford University Press; 2002. p. 1255-77.

Strachan DP. The role of environmental factors in asthma. British Medical Bulletin. 2000;56(4):865-82.

U.S. Dept of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

8. National Asthma Strategies

Ade 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.

Ellwood P, Ellwood E, Asher MI, et al. Asthma Management Guidelines and Strategies - who has them? (Abstract).  ATS Conference; San Diego 2014.

Haahtela T, Tuomisto LE, Pietinalho A, et al. A 10 year asthma programme in Finland: major change for the better. Thorax. 2006;61(8):663-70.

Haahtela T, von Hertzen L, Makela M, et al. Finnish Allergy Programme 2008-2018--time to act and change the course. Allergy. 2008;63(6):634-45.

Hanski I, von Hertzen L, Fyhrquist N, et al. Environmental biodiversity, human microbiota, and allergy are interrelated. Proceedings of the National Academy of Sciences of the United States of America. 2012;109(21):8334-9.

Kupczyk M, Haahtela T, Cruz AA, et al. Reduction of asthma burden is possible through National Asthma Plans. Allergy. 2010;65(4):415-9.

Lalloo UG, Walters RD, Adachi M, et al. Asthma programmes in diverse regions of the world: challenges, successes and lessons learnt. International Journal of Tuberculosis and Lung Disease. 2011;15(12):1574-87.

Reissel E, Herse F, Väänänen J, et al. Asthma costs in Finland 1987–2005 (in Finnish, Abstract in English). Finnish Medical  Journal. 2010;65:811-6.

9. Asthma Management Guidelines

FitzGerald JM, Quon BS. The impact of asthma guidelines. Lancet. 2010;376(9743):751-3.

Rabe KF, Decramer M, Siafakas N. The year of the lung. Lancet. 2010;376(9743):753-4.

The International Union Against Tuberculosis and Lung disease, The International Study of Asthma and Allergies in Childhood (ISAAC), editors. The Global Asthma Report 2011. Paris, France: The International Union Against Tuberculosis and Lung Disease; 2011.

World Health Organization. Prevention and Control of Noncommunicable Diseases: Guidelines for primary health care in low resource settings. Geneva, Switzerland: World Health Organization; 2012.

10. Access to Quality-Assured, Affordable Asthma Medicines

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.

Cameron A, Ewen M, Ross-Degnan D, et al. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009 Jan 17;373(9659):240-9.

WHO. Medicines prices, availability and affordability. The World Medicines Situation 2011. Geneva, Switzerland: World Health Organization, 2011  WHO/EMP/MIE/2011.2.1.

Chiang C-Y, Bissell K, Perrin C.  Are national asthma programmes needed in resource-limited settings?  International Journal of Tuberculosis and Lung Disease 2012; 16: 572.

Hogerzeil HV. The concept of essential medicines: lessons for rich countries. British Medical Journal 2004; 329(7475):1169-1172.

11. Quality of Inhalers

Azatyan S. Roles of National Medicines Regulatory Authorities.  WHO/Global Fund joint meeting on Quality Assurance of Essential Medicines; 30-31 August Geneva2011.

Committee for medicinal products for human use. Guideline on the requirements for clinical documentation for orally inhaled products (OIP) including the requirements for demonstration of therapeutic equivalence between two inhaled products for use in the treatment of asthma and chronic obstructive pulmonary disease (COPD) in adults and for use in the treatment of asthma in children and adolescents. London: European Medicines Agency, 2009.

WHO. WHO Prequalification Programme: progress report June 2013. Geneva, Switzerland: World Health Organization, 2013.

12. Asthma Management in Low-Income Countries

Ade 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.

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

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

Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention (Updated 2014). Global Initiative for Asthma (GINA) 2014.

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.

World Health Organization. Prevention and Control of Noncommunicable Diseases: Guidelines for primary health care in low resource settings. Geneva, Switzerland: World Health Organization; 2012.

14. Asthma as a Lung Health Priority in LMICs

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

Asthmasms Sudan: An asthma follow up system using rapidsms: UNICEF; 2013 [updated 10 September; cited 2014]. Available from: unicefstories.org/2013/09/10/asthmasms-sudan-an-asthma-follow-up-system-using-rapidsms/.

The Impact of Involving Informal Health Providers for Tuberculosis Control in Sudan (Triage-Plus): National Institutes of Health; 2013 [cited 2014]. Available from: clinicaltrials.gov/show/NCT01841541.

Brooks C, Pearce N, Douwes J. The hygiene hypothesis in allergy and asthma: an update. Current Opinion in Allergy and Clinical Immunology. 2013;13(1):70-7.

Pearce N, Asher I, Billo N, et al. Asthma in the global NCD agenda: A neglected epidemic. Lancet Respiratory Medicine. 2013;1(2):96-8.

Seita A, Harries AD. All you need to know in public health we can learn from tuberculosis care: lessons for non-communicable disease. International Journal of Tuberculosis and Lung Disease, 2013, 17:429–430

Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96.

15. Asthma as a NCD priority

Mallol J, García-Marcos L, Sole D, et al. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65(11):1004-9.

Pearce N, Asher I, Billo N, et al. Asthma in the global NCD agenda: A neglected epidemic. Lancet Respiratory Medicine. 2013;1(2):96-8.

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.


Tables and Figures

2. Global Burden of Disease

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.

Figure 5. Components of disability adjusted life years (DALYs), Years lived with disability (YLD) and Years of life lost (YLL) per 100,000 population attributed to asthma by age group. Global population, 2010 (see DALY explanation on p20). 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. 

Figure 6. Disability adjusted life years (DALYs) per 100,000 population attributed to asthma by country, both sexes, 2010. From: Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease (GBD) Compare. Seattle, WA: University of Washington; 2013 [8th May 2014]. Available from: viz.healthmetricsandevaluation.org/gbd-compare/

3. Hospital Admissions

Figure 1. Age-standardised admission rates for asthma for earliest and latest available year in European countries ordered by latest admission rate. From: WHO Hospital Morbidity Database, November 2013 download, plus Eurostat (for some earlier data).

Figure 2. Asthma admission rates for European countries, age 5-14 v 20-44 years. From: WHO Hospital Morbidity Database, November 2013 download.

Figure 3. Long-term time trends in self-reported asthma prevalence, hospital admission rates and mortality rates for asthma among children in high income countries. 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 (around 1995) and ISAAC Phase Three (around 2002), 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 from updated by WHO Hospital Morbidity Database) and Pearce N, Aït-Khaled N, Beasley R, et al. Worldwide trends in the prevalence of asthma symptoms: Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2007; 62(9): 758-66. (Prevalence data)

4. Mortality

Figure 1. Age-standardised asthma mortality rates for all ages 2001-2010 from countries where asthma is separately coded as a cause of death, ordered by mortality rate and country income group. Calculated from the average number of deaths and average population for each 5-year age-group over the period 2001-2010, using all available data for each country (the number of available years over this period ranged from 1 to 10). Source: WHO Detailed Mortality Database, February 2014 update.

Figure 2. Age-standardised asthma mortality rates for ages 5-34 years only, 2001-2010 from countries where asthma is separately coded as a cause of death, ordered by mortality rate and country income group. Data standardised to the World Standard Population. Calculated from the average number of deaths and average population for each 5-year age-group over the period 2001-2010, using all available data for each country (the number of available years over this period ranged from 1 to 10). Source: WHO Detailed Mortality Database, February 2014 update.

Figure 3. Age-standardised asthma mortality rates and age-standardised hospital admission rates for asthma, in European countries providing recent data for both (2001-2010). Sources: WHO Detailed Mortality Database, February 2014 update, WHO Hospital Morbidity Database, November 2013 download.

5.  Wheezing in Infants

Figure 1. Prevalence of recurrent wheezing in infants during the first year of life

in European and Latin American centres.   From: Mallol J, García-Marcos L, Sole D, et al. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65(11):1004-9.

Figure 2. Reported severity, medications and other variables in infants with Recurrent Wheezing during the first year of life. Source: Mallol J, García-Marcos L, Sole D, et al. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65(11):1004-9.

8. National Asthma Strategies

Figure 1. Generic template for a local action plan. Adapted from: Haahtela T. Evidence for asthma control – zero tolerance to asthma with the Finnish Programmes. In:  Global Atlas of Asthma. Eds.C.A. Akdis, I. Agache. EAACI 2013.

Figure 2. Strategic flow for an asthma plan Adapted from: Haahtela T, von Hertzen L, Makela M, et al. Finnish Allergy Programme 2008-2018--time to act and change the course. Allergy. 2008;63(6):634-45.

Figure 3. National asthma strategies for children and adults in countries responding to the Global Asthma Network survey, 2013. Global Asthma Network survey; 2013.

9. Asthma Management Guidelines Update

Figure 1. Asthma management guidelines in countries responding to the Global Asthma Network survey, 2013. Global Asthma Network survey; 2013.

Figure 2. Pharmaceutical sponsorship in asthma management guidelines in countries responding to the Global Asthma Network survey, 2013. Global Asthma Network survey; 2013.

Table: Comparison of 2011 and 2013 asthma guideline usage for those 72 countries participating in both surveys. Global Asthma Network surveys 2011 and 2013.

10. Access to Quality-Assured, Affordable Asthma Medicines

Figure 1. Essential asthma medicines survey 2014, Global Asthma Network countries. Global Asthma Network survey; 2014.

Table 1. Inclusion of inhalers on the WHO Essential Medicines List (EML) in National EML and National Reimbursement Lists (NRL), by country, in 99 Global Asthma Network countries, 2014. Global Asthma Network survey; 2014.

11. Quality of Inhalers

Figure 1. Schematic diagram of a pressurised metered dose inhaler.

14. Asthma as a lung health priority in LMICs

Figure1. The reduction in emergency room visits from one year of enrolment in the asthma standard case management project in Sudan 2007-2008. From: El Sony AI, Chiang C-Y, Malik E, et al. Standard case management of asthma in Sudan: a pilot project. Public Health Action. 2013;3(3):247-52.

Figure 2. Number of emergency visits and hospitalisations in Benin:initial at enrolment versus one year 2007-2008. From: Ade 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.

Tables and Figures in appendices

Table 1. ISAAC world map data, symptoms of asthma. Adapted from: ISAAC Steering Committee. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). European Respiratory Journal 1998; 12(2): 315-35. And: 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.

Table 2. National asthma management guidelines in countries participating in the Global Asthma Network, 2013. Global Asthma Network survey; 2013.

Figures 1-3. Scatter plots of national admission rates for asthma among children (aged 5-14) and adults (aged 20-44 and 45+) in European countries, latest available data (around 2010). From: WHO Hospital Morbidity Database, November 2013 download.

Figure 4. National asthma strategies for children in countries responding to the Global Asthma Network survey, 2013. Global Asthma Network survey; 2013.

Figure 5. National asthma strategies for adults in countries responding to the Global Asthma Network survey, 2013. Global Asthma Network survey; 2013.

Figure 6. Questions asked in the Global Asthma Network asthma guidelines survey 2013.

Figure 4. Pharmaceutical involvement in national asthma management guidelines in countries responding to the Global Asthma Network survey, 2013. Global Asthma Network survey; 2013.

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

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