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Prevalence of severe childhood asthma according to the WHO
Björn Nordlund1, Erik Melén2, Erica S Schultz3
1Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Severe asthma is rare in 12-year-olds, affecting 0.23% of the general population and 2.1% of children with asthma in Stockholm. This study used the World Health Organization
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Public Health
Background:
- The World Health Organization (WHO) introduced a new definition for severe asthma to standardize patient characterization and improve prevalence estimations.
- Accurate identification of severe asthma is crucial for resource allocation and targeted therapeutic strategies in pediatric populations.
Purpose of the Study:
- To estimate the prevalence of severe asthma in 12-year-old children residing in Stockholm, Sweden, utilizing the WHO's standardized definition.
- To assess the reliability of combining population-based cohort data with national drug prescription records for severe asthma prevalence studies.
Main Methods:
- Utilized the BAMSE birth cohort, enrolling 4089 children, with data collected from 3015 children at age 12 via parental questionnaires.
- Defined severe asthma based on WHO criteria: presence of asthma plus continuous treatment with inhaled corticosteroids and long-acting beta-2 agonists.
- Validated treatment data using the Swedish prescribed drug register, requiring a minimum daily budesonide dosage equivalent to 800 μg.
Main Results:
- The prevalence of asthma among 12-year-olds was 11% (n=329).
- Seven children met the WHO definition of severe asthma, corresponding to a prevalence of 0.23% (95% CI, 0.06-0.4) in the general population.
- Among children with asthma, the severe asthma prevalence was 2.1% (95% CI, 0.5-3.7); 4/7 had uncontrolled or partly controlled asthma.
Conclusions:
- Severe asthma is uncommon in 12-year-old schoolchildren and the general population, according to the WHO definition.
- The combined approach of using self-reported data from a birth cohort and national drug register information provides a trustworthy method for estimating severe asthma prevalence.
Background:
The World Health Organization (WHO) recently proposed a new definition of severe asthma to facilitate standardized characterization of patients, and enable more accurate estimations of the prevalence of severe asthma. The aim of this study was to estimate the prevalence of severe asthma according to the WHO definition in children aged 12 years, in Stockholm, Sweden.
Methods:
The birth cohort BAMSE enrolled 4089 children during 1994-96. Parental questionnaires provided information on asthma-related symptoms, diagnosis and medication from 3015 enrolled children at the age of 12 years. Severe asthma was defined as the presence of asthma, as well as continuous treatment with inhaled corticosteroids and long-acting beta-2 agonists, based on information from the Swedish prescribed drug register demonstrating prescriptions of at least 800 μg budesonide daily (or equivalent).
Results:
The prevalence of asthma was 11% among 12-year-olds (n = 329). Based on information from the Swedish prescribed drug register, seven children with asthma fulfilled the definition of severe asthma. The estimated prevalence corresponds to 0.23% (95% CI, 0.06-0.4) of the population, or 2.1% (95% CI, 0.5-3.7) of children with asthma. Based on assessed markers of asthma control, 3/7 with severe asthma were considered to have controlled asthma and 4/7 had partly or uncontrolled asthma.
Conclusion:
Severe asthma appears rare both among 12-year-old schoolchildren with asthma and in the general population. Combining self-reported information from a population-based birth cohort with data from a drug register seems trustworthy in estimating severe asthma as defined by the WHO.