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Global Asthma Network Phase I Syria asthma surveillance and the impact of the war
Yousser Mohammad1,2, Shaaban Rafea3, Youssef Latifeh4,5
1Al-Sham Private University, Faculty of Medicine and Pharmacy, Damascus and Latakia, Syria.
Insights
Childhood asthma prevalence and severity significantly increased in Syria during wartime, linked to pollution and stress. This study highlights the devastating impact of conflict on children's respiratory health.
Area of Science:
- Pediatric Respiratory Medicine
- Epidemiology
- Environmental Health
Background:
- Asthma is a leading chronic respiratory disease in children globally, causing significant morbidity and mortality.
- Standardized worldwide surveys of childhood asthma prevalence and severity have been lacking since the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III (2001-3).
- The Global Asthma Network (GAN) Phase I was initiated to address this data gap.
Purpose of the Study:
- To track changes in asthma prevalence and severity in Syrian school children.
- To compare current data with historical ISAAC Phase III findings.
- To investigate the impact of war-related pollutants and stress on childhood asthma.
Main Methods:
- A cross-sectional study employing the ISAAC methodology and questionnaire, translated into Arabic.
- Inclusion of additional questions on home displacement, war pollutants, and the Depression, Anxiety and Stress Scale (DASS).
- Survey of 1,100 adolescents in Damascus and 1,215 in Latakia, focusing on core asthma indicators.
Main Results:
- Wheeze prevalence in Syrian adolescents rose from 5.2% (ISAAC III, pre-war) to 19.28% (GAN, during war).
- Prevalence of severe asthma symptoms increased from 2.5% to 12.8% during the same periods.
- A statistically significant increase (p=0.0001) in wheezing was observed, associated with war pollutants and higher DASS scores.
Conclusions:
- Childhood asthma prevalence and severity have paradoxically increased in Syria during wartime.
- War-related environmental factors, including pollutants and psychological stress, appear positively associated with increased asthma symptoms.
- Urgent attention is needed to address the respiratory health crisis in children affected by conflict.
Background:
Asthma is the most prevalent chronic respiratory disease (CRD) in children. It causes extensive morbidity and mortality worldwide. Since the International Study of Asthma and Allergies in Childhood (ISAAC Phase III 2001-3), there have been no worldwide standardised surveys of prevalence and severity of asthma in school children. The Global Asthma Network (GAN) Phase I aims to provide this information. We participated in GAN with the aim of tracking changes in Syria and comparing the results to those of ISAAC Phase III. We also aimed to track the impact of war pollutants and stress.
Methods:
GAN Phase I, following the same methodology of ISAAC in a cross-sectional study. The same ISAAC questionnaire translated into Arabic was repeated. We added questions about displacement from home, and the impact of war pollutants. We also added the Depression, Anxiety and Stress Scale (DASS Score). In this article, we focused on the prevalence of 5 core asthma indicators (wheezing in the past 12 months, wheezing ever, severe wheeze, exercise wheeze and night cough) in adolescents from two centres in Syria: Damascus and Latakia. Additionally, we investigated the impact of the war on our two centres, while the DASS score was investigated only in Damascus. We surveyed 1,100 adolescents from 11 schools in Damascus and 1,215 adolescents from 10 schools in Latakia.
Results:
In Syria, which is a low-income country, wheeze prevalence before the war in ISAAC III was 5.2% for 13-14-year-old, whilst it was 19.28% in GAN during the war. Prevalence of severe asthma symptoms was 2.5% in ISAAC III and 12.8% in GAN. Wheezing appearing after the war or becoming more severe was statistically significant p=0.0001. War is associated with higher exposure to new environmental chemicals and pollutants and higher anxiety and depression scores.
Conclusions:
It is paradoxical to note that in Syria, current wheeze and severity are much higher in GAN (19.8%) than in ISAAC III (5.2%), which seems positively associated with war pollution and stress.
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