Background

Asthma is the most common chronic disease in children globally. The Global Asthma Network (GAN) Phase I study aimed to determine if the worldwide burden of asthma symptoms is changing.

Methods

This updated cross-sectional study used the same methods as the International study of Asthma and Allergies in Childhood (ISAAC) Phase III. Asthma symptoms were assessed from centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both. We included individuals from two age groups (children aged 6–7 years and adolescents aged 13–14 years) who self-completed written questionnaires at school. We estimated the 10-year rate of change in prevalence of current wheeze, severe asthma symptoms, ever having asthma, exercise wheeze, and night cough (defined by core questions in the questionnaire) for each centre, and we estimated trends across world regions and income levels using mixed-effects linear regression models with region and country income level as confounders.

Findings

Overall, 119 795 participants from 27 centres in 14 countries were included: 74 361 adolescents (response rate 90%) and 45 434 children (response rate 79%). About one in ten individuals of both age groups had wheeze in the preceding year, of whom almost half had severe symptoms. Most centres showed a change in prevalence of 2 SE or more between ISAAC Phase III to GAN Phase I. Over the 27-year period (1993–2020), adolescents showed a significant decrease in percentage point prevalence per decade in severe asthma symptoms (–0·37, 95% CI –0·69 to –0·04) and an increase in ever having asthma (1·25, 0·67 to 1·83) and night cough (4·25, 3·06 to 5·44), which was also found in children (3·21, 1·80 to 4·62). The prevalence of current wheeze decreased in low-income countries (–1·37, –2·47 to –0·27], in children and –1·67, –2·70 to –0·64, in adolescents) and increased in lower-middle-income countries (1·99, 0·33 to 3·66, in children and 1·69, 0·13 to 3·25, in adolescents), but it was stable in upper-middle-income and high-income countries.

Interpretation

Trends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma.

Funding

International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca Educational Grant, National Institute for Health Research, UK Medical Research Council, European Research Council, and Instituto de Salud Carlos III.

中文翻译：

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学龄儿童哮喘症状负担的全球趋势：全球哮喘网络 I 期横断面研究

 背景

哮喘是全球儿童中最常见的慢性疾病。全球哮喘网络 (GAN) 第一阶段研究旨在确定全球哮喘症状负担是否正在发生变化。

 方法

这项更新的横断面研究使用了与国际儿童哮喘和过敏研究 (ISAAC) III 期研究相同的方法。哮喘症状是在完成 GAN 第一阶段和 ISAAC 第一阶段 (1993-95)、ISAAC 第三阶段 (2001-03) 或两者的中心进行评估的。我们纳入了来自两个年龄组（6-7 岁的儿童和 13-14 岁的青少年）的个人，他们在学校自行填写了书面问卷。我们估计了每个中心当前喘息、严重哮喘症状、曾经患有哮喘、运动喘息和夜间咳嗽（由调查问卷中的核心问题定义）患病率的 10 年变化率，并且我们估计了世界各地区和地区的趋势使用混合效应线性回归模型计算收入水平，以地区和国家收入水平作为混杂因素。

 发现

总体而言，包括来自 14 个国家 27 个中心的 119 795 名参与者：74 361 名青少年（答复率为 90%）和 45 434 名儿童（答复率为 79%）。这两个年龄段中大约十分之一的人在前一年出现过喘息，其中近一半有严重症状。大多数中心显示，从 ISAAC III 期到 GAN I 期，患病率发生了 2 SE 或更多的变化。在 27 年期间（1993 年至 2020 年），青少年每十年严重哮喘症状的患病率显着下降（- 0·37, 95% CI –0·69 至 –0·04) 以及曾经患有哮喘 (1·25, 0·67 至 1·83) 和夜间咳嗽 (4·25, 3·06 至 5) 的增加·44)，在儿童中也发现了这种情况（3·21、1·80 至 4·62）。当前喘息的患病率在低收入国家有所下降（儿童为 –1·37、–2·47 至 –0·27]，青少年为 –1·67、–2·70 至 –0·64）中低收入国家有所增加（儿童为 1·99、0·33 至 3·66，青少年为 1·69、0·13 至 3·25），但中高收入国家保持稳定和高收入国家。

 解释

过去三十年来，哮喘症状的患病率和严重程度的趋势因年龄组、国家收入、地区和中心而异。通过提供有效的哮喘治疗方法，可以减轻全球范围内严重哮喘症状的沉重负担。

 资金

国际抗结核和肺病联盟、新西兰勃林格殷格翰、阿斯利康教育补助金、国家健康研究所、英国医学研究委员会、欧洲研究委员会和卡洛斯三世健康研究所。