CHILDREN ALLERGY CENTER

Asthma Prevalence and Statistics 1980-2010

Asthma is an airway disorder that causes respiratory hypersensitivity, inflammation, and intermittent obstruction. Asthma commonly causes constriction of the smooth muscles in the airway, wheezing, and dyspnea.  Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial responsiveness to a variety of stimuli. Reversibility of airflow limitation may be incomplete in some patients with asthma.

Asthma Prevalence and Statistics

• Asthma is common in industrialized nations such as Canada, England, Australia, Germany, and New Zealand, where much of the asthma data have been collected. The prevalence rate of severe asthma in industrialized countries ranges from 2-10% and is estimated to affect 300 million persons worldwide. Trends suggest an increase in both the prevalence and morbidity of asthma, especially in children younger than 6 years. Factors that have been implicated include urbanization, air pollution, passive smoking, and change in exposure to environmental allergens.
• Asthma affects an estimated 300 million individuals worldwide. Evidence shows that the prevalence of asthma is increasing, especially in children. Annually, the World Health Organization (WHO) has estimated that 15 million disability-adjusted life-years are lost and 250,000 asthma deaths are reported worldwide. Approximately 500,000 annual hospitalizations (34.6% in individuals aged 18 y or younger) are due to asthma. The cost of illness related to asthma is around $6.2 billion. Each year, an estimated 1.81 million people (47.8% in individuals aged 18 y or younger) require treatment in the emergency department. Among children and adolescents aged 5-17 years, asthma accounts for a loss of 10 million school days and costs caretakers $726.1 million because of work absence.
• Worldwide, 130 million people have asthma. The prevalence is 8-10 times higher in developed countries (eg, United States, Great Britain, Australia, New Zealand) than in the developing countries. In developed countries, the prevalence is higher in low income groups in urban areas and inner cities than in other groups.
• Asthma prevalence varies from 1-30% across nations; the prevalence increases with increased urbanization and affluence. Over the past decade, asthma mortality has been stable in many countries, including Australia, Israel, New Zealand, and the United Kingdom
• Asthma is a common chronic disease worldwide and affects 22 million persons in the United States. Asthma is the most common chronic disease in childhood, affecting an estimated 6 million children, and it is a common cause of hospitalization for children in the United States. The overall prevalence rate of exercise-induced bronchospasm is 3-10% of the general population if persons who do not have asthma or allergy are excluded, but the rate increases to 12-15% of the general population if patients with underlying asthma are included. The rate of exercise-induced symptoms in persons with asthma has been reported to vary from 40-90%
• Approximately 34.1 million Americans have been diagnosed with asthma in their lifetime. The prevalence of asthma in the general population is 5%, and it has increased 40% in the past decade. Asthma accounts for more school absences and more hospitalizations than any other chronic illness. In most children’s hospitals in the United States, it is the most common diagnosis at admission. The current asthma prevalence is estimated to be 6.7% in adults and 8.5% in children.  According to the most recent US Centers for Disease Control and Prevention (CDC) Asthma Surveillance Survey, the burden of asthma has increased more than 75% from 1980-1999
• Most centres showed a change in prevalence of 1 or more SE for at least one disorder, with increases being twice as common as decreases, and increases being more common in the 6–7 year age-group than in the 13–14 year age-group, and at most levels of mean prevalence. An exception was asthma symptoms in the older age-group, in which decreases were more common at high prevalence. For both age-groups, more centres showed increases in all three disorders more often than showing decreases, but most centres had mixed changes. The rise in prevalence of symptoms in many centres is concerning, but the absence of increases in prevalence of asthma symptoms for centres with existing high prevalence in the older age-group is reassuring. The divergent trends in prevalence of symptoms of allergic diseases form the basis for further research into the causes of such disorders.
• The prevalence of asthma increased 75% from 1980-1994.
• Asthma rates in children under the age of five have increased more than 160% from 1980-1994.
• It is estimated that the number of people with asthma will grow by more than 100 million by 2025.
• Asthma accounts for approximately 500,000 hospitalizations each year.
• 13 million school days are missed each year due to asthma.
• Approximately 34.1 million Americans have been diagnosed with asthma by a health professional during their  lifetime.
• An estimated 300 million people worldwide suffer from asthma, with 250,000 annual deaths attributed to the disease
• Workplace conditions, such as exposure to fumes, gases or dust, are responsible for 11% of asthma cases worldwide.
• About 70% of asthmatics also have allergies.
• A study of UK schoolchildren has revealed that Black Africans, Indians and Bangladeshis have a similar or lower prevalence of asthma than White children, while Black Caribbean and Mixed Black Caribbean/White boys are more likely to have asthma. Researchers writing in the open access journal BMC Pediatrics studied the occurrence of asthma, investigating ethnic differences in risk factors. Melissa Whitrow and Seeromanie Harding from the Social and Public Health Sciences Unit of the Medical Research Council, UK, used data taken from 51 London schools to investigate a random selection of 11-13 year old pupils. The final sample for analysis included 1219 children who identified themselves as ‘White UK’, 933 ‘Black Caribbean’, 1095 ‘Black African’, 459 ‘Indian’, Globally, morbidity and mortality associated with asthma have increased over the last 2 decades. This increase is attributed to increasing urbanization. Despite advancements in our understanding of asthma and the development of new therapeutic strategies, the morbidity and mortality rates due to asthma definitely increased from 1980-1995.
• The prevalence of asthma is higher in minority groups (eg, blacks, Hispanics) than in other groups; however, findings from one study suggest that much of the recent increase in the prevalence is attributed to asthma in white children. Approximately 5-8% of all black children have asthma at some time. The prevalence in Hispanic children is reported to be as high as 15%. In blacks, the death rate is consistently higher than in whites
• In the United States, the mortality rate due to asthma has increased in all age, race, and sex strata. In the United States, the mortality rate due to asthma is more than 17 deaths per 1 million people (ie, 5000 deaths per year). From 1975-1993, the number of deaths nearly doubled in people aged 5-14 years. In the northeastern and midwestern United States, the highest mortality rate has been among persons aged 5-34 years. According to the most recent report from the CDC and the National Center for Health Statistics, 187 children aged 0-17 years died from asthma, or 0.3 deaths per 100,000 children compared with 1.9 deaths per 100,000 adults aged 18 or older in the year 2002.¹³  Non-Hispanic blacks were the most likely to die from asthma and had an asthma death rate more than 200% higher than non-Hispanic whites and 160% higher than Hispanics.215 ‘Pakistani’, 392 ‘Bangladeshi’ and 299 ‘Mixed White UK and Black Caribbean’
• Community influences of living in a low-educational area are associated with asthma, independently of subjects’ own educational level and social class.
• Asthma accounts for about 10.1 million missed work days for adults annually.
• Asthma was responsible for 3,384 deaths in the United States in 2005
• The annual economic cost of asthma is $19.7 billion. Direct costs make up $14.7 billion of that total, and indirect costs such as lost productivity add another $5 billion.
• Prescription drugs represented the largest single direct medical expenditure related to asthma, over $6 billion.
• Children from refugee camps appear to be at higher risk of asthma than children from neighbouring villages or cities. The prevalence of asthma and asthma symptoms in Palestine appears to be close to that of Jordan, but it is much lower than Israel, and lower than some other countries in the region, such as Kuwait and Saudi Arabia, and more developed countries. This initial study is a baseline for a study on lifestyle and environmental determinants for asthma among Palestinian children.
• In 2006, asthma prevalence was 20.1% higher in African Americans than in whites.
• The prevalence of asthma in adult females was 23% greater than the rate in males, in 2006.
• Approximately 40% of children who have asthmatic parents will develop asthma.
• In 2005, 8.9% of children in the United States currently had asthma.
• Nine million U.S. children under 18 have been diagnosed with asthma at some point in their lifetime.
• Nearly 4 million children have had an asthma attack in the previous year.
• More than 12 million people in the United States report having an asthma attack in the past year.
• In most children, asthma develops before age 5 years, and, in more than half, asthma develops before they age 3 years.
• Among infants, 20% have wheezing with only upper respiratory tract infections (URTIs), and 60% no longer have wheezing by age 6 years. Many of these children were called “transient wheezers” by Martinez et al. They tend to have no allergies, although their lung function is often abnormal. These findings have led to the idea that they have small lungs. Children in whom wheezing begins early, in conjunction with allergies, are more likely to have wheezing when they are aged 6-11 years. Similarly, children in whom wheezing begins after age 6 years often have allergies, and the wheezing is more likely to continue when they are aged 11 years
• Asthma accounts for 217,000 emergency room visits and 10.5 million physician office visits every year.
• The estimate of lost work and school time from asthma is approximately 100 million days of restricted activity. More than 1.8 million emergency department evaluations for asthma occur annually. The figures from the 1997 National Institutes of Health report¹ an estimated 500,000 hospitalizations and 5,000 deaths from asthma annually. International asthma mortality is reported as high as 0.86 deaths per 100,000 persons in some countries. US asthma mortality rates in 2002 were reported at 1.5 deaths per 100,000 persons. Mortality is primarily related to lung function, with an 8-fold increase in patients in the lowest quartile, but mortality has also been linked with asthma management failure, especially in young persons. Other factors that impact mortality include age older than 40 years, cigarette smoking more than 20-pack years, blood eosinophilia, forced expiratory volume in one second (FEV₁) of 40-69% predicted, and greater reversibility
• In 2006, almost 2.5 million people over the age of 65 had asthma, and more than 1 million had an asthma attack or episode.
• In a survey of U.S. homes, approximately one-quarter had levels of dust mite allergens present in a bed at a level high enough to trigger asthma symptoms.
• In 2007, 29% of children who had a food allergy also had asthma.
• Asthma increases the odds of healthcare use in obese people by 33%.
• About 23 million people, including almost 7 million children, have asthma.
• Approximately 2 million Hispanics in the U.S. have asthma.
• Asthma is the third-ranking cause of hospitalization among children under 15.
• Asthma is a common disorder that accounts for almost 2 million ED visits each year in the United States. In 2005, 1.8 million ED visits were for acute asthma. On average, this represents approximately 2% of all ED visits. In urban centers, however, acute asthma may comprise up to 10% of all ED visits.
• Incidence of acute asthma, defined as the number of persons who develop asthma within a specific time period, is approximately 0.2-0.4% annually. Childhood asthma persists into adulthood in approximately 50% of cases. Those with symptoms persisting into the second decade of life usually have asthma throughout adulthood. Asthma prevalence is 6-10% (ie, 20-25 million persons); one half of these cases are children (ie, 8-20% of all children). Overall, acute asthma represents about 2% of all ED visits with the national rate rising from 1993-1998 but stable from 1998-2005. The asthma epidemic seems to be plateauing.
• Children : 9-11%  children less than 18 years (9.5%) currently have asthma. 11.3% of male children currently have asthma. 7.7% of female children currently have asthma. This is not a statistically significant difference.
• Adults (≥ 18 Years): 9 -11%  adults 18 years and older  currently have asthma. The asthma prevalence for adults (9.5%) is higher than that for the United States (8.2%). The asthma prevalence in Michigan is significantly higher for adult females (11.0%) than adult males (7.9%).  The asthma prevalence is significantly higher for non-Hispanic black adults (12.9%) than non-Hispanic white adults. (8.7%).  Asthma prevalence for adults decreases with increasing household income.
• Asthma occurs in persons of all races worldwide. In the United States, asthma prevalence, especially morbidity and mortality, is higher in blacks than in whites.
• In children younger than 10 years, the male-to-female ratio is 2:1. Between the ages of 18 and 54 years, the ratio is reversed, with women being affected twice as often as men. Women visit the ED and are hospitalized for acute asthma twice as often as men. Previous data suggested that 40% of these hospitalizations occur during the premenstrual phase of the cycle; more recent data from larger studies have not borne out these initial findings. Indeed, some studies suggest a peak in asthma exacerbations shortly before ovulation, when estrogen levels are rising (and not falling).
• Although genetic factors are of major importance in determining a predisposition to the development of asthma, environmental factors play a greater role than racial factors in asthma onset. A national concern is that some of the increased morbidity is due to differences in asthma treatment afforded certain minority groups.
• The prevalence for those earning less than $20,000 is significantly higher than those earning $75,000 or more. 
• Among adults reporting a disability, 15.0 8.1% of non-Hispanic white children currently have asthma. 11.6% of non-Hispanic black children currently have asthma.  This is not a statistically significant difference.  An average of one out of every 10 school-aged child has asthma.
• Annual expenditures for health and lost productivity due to asthma are estimated at over $20 billion, according to the National Heart, Lung and Blood Institute.
• Over 92% of the 402 asthma deaths in 2006 were among people aged 45 years and over. Asthma in older Australians is distinct in many ways. The presence of comorbid conditions makes the management of asthma in older people more complex. The disease itself is also more persistent and severe than in the younger ages.
• Asthma predominantly occurs in boys in childhood, with a male-to-female ratio of 2:1 until puberty, when the male-to-female ratio becomes 1:1.
• Asthma prevalence is greater in females after puberty, and the majority of adult-onset cases diagnosed in persons older than 40 years occur in females.
• Boys are more likely than girls to experience a decrease in symptoms by late adolescence.
• Some 75% of asthmatic patients had associated rhinitis and this association was more frequent in atopic subjects. There is a positive correlation between the severity of rhinitis and asthma and between the number of asthma exacerbations and the presence of rhinitis. These results support the main message of ARIA and GEMA recommendations regarding the integral management of airways to improve the control of asthma.
• Before puberty, the prevalence is 3 times higher in boys than in girls. During adolescence, the prevalence is equal among males and females. Adult-onset asthma is more common in women than in men
• Asthma symptoms usually begin in early childhood (eg, 80-90% experience symptoms by age 6 y); however, asthma can present at any age, including elderly persons. Children younger than 10 years constitute approximately 50% of all cases.
• In 2003 asthma was the leading cause of burden of disease in Australian children, contributing 17.4% of total DALYs and the eleventh-leading contributor to the overall burden of disease in Australia, accounting for 2.4% of the total number of DALYs.
• Asthma and chronic obstructive pulmonary disease (COPD) can together be described as obstructive lung disease. This report examines recent data on deaths and hospitalisations among people aged 55 years and over when asthma or COPD are recorded as one of multiple causes of death or hospital diagnoses.
• The questionnaire demonstrated a greater prevalence of GER symptoms, RARS, and reflux-associated inhaler use in asthmatics. This excessive inhaler use may explain how GER indirectly causes asthma to worsen.
• Chronic respiratory diseases, such as asthma and emphysema, are very prevalent in the world. This report brings together data from a variety of sources to highlight the prevalence and impact of chronic respiratory diseases
• Asthma prevalence is increased in very young persons and very old persons because of airway responsiveness and lower levels of lung function.  Two thirds of all asthma cases are diagnosed before the patient is aged 18 years. Approximately half of all children diagnosed with asthma have a decrease or disappearance of symptoms by early adulthood.
• The assessment and diagnosis of exercise-induced bronchospasm is made more often in children and young adults than in older adults and is related to high levels of physical activity. Exercise-induced bronchospasm can be observed in persons of any age based on the level of underlying airway reactivity and the level of physical exertion.
• Parents of 5472 children aged 5-17 years from 3209 families were interviewed in a nationwide household survey. In the past year, 15.0% of children had wheezed, 2.2% had more than 12 attacks, and 2.3% had experienced a speech limiting attack. Altogether 4.3% were woken more than once a week by wheezing, 13.1% had doctor diagnosed asthma, and 13.6% had been prescribed antiasthmatic drugs in the past year. With increasing age, morbidity related to wheezing declined to a greater extent than annual period prevalence. The prevalence of wheeze varied little by socioeconomic group, but there were marked trends in all three indices of severity towards increased morbidity in poorer families. Diagnostic labelling and drug treatment of wheezy children did not differ substantially with socioeconomic status. Thus, a degree of socioeconomic equality exists in the process of medical care for childhood asthma in Britain. This does not appear to have resulted in equality of outcome
• 15 Years Prevalence. In 1973 a survey was conducted among 12 year old children living in a defined area of South Wales. In 1988 the survey was repeated in the same area, again among 12 year old children. Questionnaires were completed for all 965 children in the population sample; peak expiratory flow rates were performed on them all, and repeated (except for five children) after an exercise provocation test. The prevalence of a history of wheeze at any time had increased from 17% to 22%, while that of a history of asthma at any time had increased from 6% to 12%. Current asthma had increased from 4% to 9%, but wheezing in the past year not attributed to asthma had remained at 6%. The exercise provocation tests suggested that both mild and severe asthma had become more common. Increases had also occurred in the frequencies of a history of eczema (from 5% to 16%) and of hay fever (from 9% to 15%). It seems that the prevalence of asthma has risen, and that this cannot be wholly explained by a greater readiness to diagnose the disease.
• Prevalence of asthma in the general population is 4-5%. In pregnancy, the prevalence ranges from 1-4%.
• Morbidity and mortality rates of pregnant women with asthma are comparable to the general population.
• The mortality rate from asthma in the United States is currently 2.1 per 100,000. Death rates in the United States have been increasing from 0.8 per 100,000 in the general population in the late 1970s to 2.1 per 100,000 in 1994.
• Prevalence and mortality rates are significantly higher in African Americans and Hispanics when compared with whites.

source :

• World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, 2007.
• American Lung Association. Epidemiology & Statistics Unit, Research and Program Services. Trends in Asthma Morbidity and Mortality, November 2007.
• Asthma Statistic http://www.aaaai.org/media/statistics/asthma-statistics.asp
• Centers for Disease Control. Surveillance for Asthma – United States, 1960-1995, MMWR, 1998; 47 (SS-1).

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