Heterogeneity of asthma in society

There has been an increased interest in studying other factors that affect asthma pathogenesis and cause heterogeneity in prevalence and incidence of asthma. The reason there are such varied expression patterns of disease in asthmatics is because of multiple variables that affect the pathogenesis of asthma. As an exemplar of an epidemiologic variable, we will discuss geographical location, obesity and vitamin D status of the individual, and their effects on asthma burden in humans. There is varying data regarding the prevalence or severity of asthma in urban versus rural setting which is likely related to the difference of the populations studied, complexity of causal variables involved, and local geographic factors. In addition to cross-sectional and cohort studies in humans, animal models and studies have established a link between asthma and obesity by investigating the mechanisms affecting both disease processes. The complicated interrelationship between obesity and asthma is an active area of epidemiological and experimental research with new insights being discovered at a rapid pace. Finally, vitamin D, an important immunomodulator thought to be important in pathogenesis of asthma, has both mechanistic and therapeutic implications in treatment of asthma. The influences of these factors on the clinical expression of asthma are discussed below.