Asthma in developing countries in the Asia-Pacific Region (APR)

There is growing interest in the epidemiology of asthma in developing countries, especially in the Asia-Pacific Region (APR). A number of reviews have been published in this field, but a comprehensive synthesis of overall data has not been reported. Here, we summarized the burden, risk factors and challenges of asthma management in developing countries with a specific emphasis on the APR by consolidating evidence from both systematic and narrative reviews published up until February 2023. We found that although asthma prevalence in low and low-middle-income countries (LMICs) is known to be generally lower compared to high-income countries, the burden is substantially greater. Studies conducted in APR LMIC have reported a range of risk factors, including pre- and post-natal factors, environmental considerations, lifestyle measures, individual features and genetics. The low and inequitable distribution of quality preventive and curative health care, a lack of advanced diagnostic measures, non-availability and non-affordability of novel therapeutics, cultural beliefs and practices, and diverse disease phenotypes make it challenging to achieve optimal asthma control in the region. Hence, we call for the development of a region-specific blueprint for action to mitigate this challenging situation, to help reduce the burden of asthma in APR LMIC.     

Asthma Research Performance in Asia-Pacific: A Bibliometric Analysis by Searching PubMed Database

Background and Objective. Countries in the Asia-Pacific region have experienced an increase in the prevalence of asthma, and they have been actively involved in asthma research recently. This study aimed to analyze asthma research from Asia-Pacific in the last decade by bibliometric method. Method. Asthma articles from Asia-Pacific countries published between 1998 and 2007 were retrieved from PubMed by searching MeSH for “asthma.” Results. Most of published asthma articles in Asia-Pacific are from affluent countries in northeast Asia and Oceania. Australia and Japan have been the regional powerhouses since they contributed more than half of regional articles on asthma. Asthma publications from emerging economies in Asia such as South Korea, Taiwan, Hong Kong, and Singapore, have dramatically increased in the last decade in terms of quantity and quality aspects and were considerable sources of basic and translational research in the region. Mainland China and India have significantly increased their research capacity as well, but quality needs to be improved. Asthma publications from New Zealand and Australia, countries with the highest asthma prevalence rates in the world, yielded highest citation counts per articles and were published in journals with high impact factor. Asthma research parameters per million population correlate well with gross domestic product per capita. Almost half (41%) of total articles were produced from only 25 institutions in the region and almost half of them (47%) were published in 20 journals. Conclusions. Asthma research in Asia-Pacific were mainly conducted in countries in Oceania and Northeast Asia and research performance strongly correlated with the nation's wealth. Interesting asthma research projects in the region were recommended.     

Trends in COPD mortality and hospitalizations in countries and regions of Asia-Pacific

Background and objective: The growing burden of COPD in the Asia‐Pacific region supports the need for more intensive research and analysis of the epidemiology of COPD to raise awareness of the disease and its causes, to ensure the development of effective national health policies and to facilitate equitable deployment of finite health‐care resources in the prevention and management of COPD. This study estimated and compared COPD mortality and hospital morbidity rates and trends in these rates over time across countries and regions of Asia‐Pacific. Methods: Data consistent with standard definitions of COPD (ICD‐9/ICD‐10) for the period 1991–2004 were obtained from national health statistics agencies. For countries/regions with complete national mortality and hospitalization data (Australia, Pacific Canada (British Columbia, Hong Kong, South Korea and Taiwan), annual age‐standardized mortality and hospitalization rates were calculated for men and women aged ≥ 40 years. Negative binomial regression modelling was used to estimate rate ratios for country/region, gender and age differences and general trends over time. Results: Mortality rates per 10 000 population ranged 6.4–9.2 in men, 2.1–3.5 in women and 3.7–5.3 overall in 2003. Corresponding ranges for morbidity were 32.6–334.7, 21.2–129 and 28.1–207.3 per 10 000. Trend analysis of data since 1997 produced annual percentage changes in mortality versus hospitalization of ?4.4% versus ?0.7% in Australia, ?3.6% versus 7.5% in Pacific Canada (British Columbia), ?7.15% versus ?5.6% in Hong Kong and ?2.9% versus ?4.2% in Taiwan. Conclusions: In Asia‐Pacific, overall mortality and morbidity rates are high and trends in mortality and morbidity vary between countries/regions. Differences in rates and trends for men and women most likely reflect the different trends in historical and prevalent smoking profiles for COPD in the different countries and regions.     

The Allocation of Family Responsibility for Asthma Management Tasks in African-American Adolescents

The allocation of responsibilities for asthma management within African-American families was examined in 60 adolescents and their primary caretakers. Separate structured interviews were conducted with adolescents and primary caretakers, and perceptions of family management, adherence to asthma treatment regimen, and functional morbidity were assessed. Support for the primary hypothesis that higher levels of nonadherence and functional morbidity would be observed in families where caretakers overestimated the level of adolescent involvement in asthma self-care was found. Implications for family-based asthma management in ethnic minority adolescents are discussed.     

The Allocation of Family Responsibility for Asthma Management Tasks in African-American Adolescents

The allocation of responsibilities for asthma management within African-American families was examined in 60 adolescents and their primary caretakers. Separate structured interviews were conducted with adolescents and primary caretakers, and perceptions of family management, adherence to asthma treatment regimen, and functional morbidity were assessed. Support for the primary hypothesis that higher levels of nonadherence and functional morbidity would be observed in families where caretakers overestimated the level of adolescent involvement in asthma self-care was found. Implications for family-based asthma management in ethnic minority adolescents are discussed.     

Asthma and migration

Abstract The dramatic influx of immigrants from South-East Asian countries into Australia over the past 20 years was associated with an increase in asthma and allergic disease amongst these immigrants. Epidemiological data showed that the prevalence rates of asthma and allergic disease increased with the duration of residence in Australia so that after 10 years in Australia, up to 60% of South-East Asian immigrants developed hayfever while 15% had symptoms of asthma. Many immigrants developed these conditions for the first time after arrival in Australia suggesting that the environment plays an important role in the pathogenesis of asthma and allergy. While sensitization to inhalant allergens such as house dust mite and grass pollen are apparently important in some, other yet undefined local factors are likely to contribute significantly to the overall increase in prevalence. A prospective study designed to follow a group of migrants in areas where asthma and allergic disease are common such as Australia, may reveal the pathogenic role of the environment and provide valuable information that may explain the global distribution and increasing trend of asthma and allergies.     

我国八省市支气管哮喘患者对疾病管理与认知现状调查

目的 调查我国支气管哮喘(以下简称哮喘)患者对疾病管理与认知的现状.方法 对2009年9月-2010年9月全国8个省市哮喘流行病学调查中确诊的2 034例哮喘患者进行哮喘疾病管理与认知的问卷入户调查,主要内容包括:(1)患者一般情况;(2)哮喘患者的控制现状;(3)哮喘患者对疾病的认知程度;(4)哮喘对患者生命质量的影响.结果 2 034例哮喘患者中,462例(22.71％)患者在过去1年中曾进行过肺功能检查,294例(14.45％)患者拥有峰流速仪,仅33例(1.62％)患者每天使用峰流速仪进行病情监测,456例(22.42％)患者能正确认为哮喘是“气道炎症性疾病”,302例(14.85％)患者认识到哮喘治疗目标是“可以长期良好控制或完全控制”.能正确认知疾病本质的患者哮喘控制测试(ACT)评分[(20.60 ±3.92)分]明显高于不能正确认知疾病本质者[(19.95±4.43)分;t=-2.385,P=0.017].1 213例(59.64％)患者表示哮喘影响了其工作、生活和娱乐,181例(8.90％)患者表示需要依靠器具进行日常生活,甚至有93例(4.57％)患者因哮喘而产生过自杀的念头.结论 我国哮喘患者对疾病的管理和认知程度依然不佳,正确认知疾病本质有助于提高哮喘控制水平.     

Intensive Care Unit Admission for Asthma: A Marker for Severe Disease

Background. There appears to be an asthma epidemic in the United States and other developed countries, with increasing prevalence and severity of asthma. Despite these trends, the understanding of severe asthma remains limited. Research has been hampered by the lack of clear methodology for identifying a cohort of adults with severe asthma. We systematically evaluated a method for defining a cohort of adults with severe asthma based on recent intensive care unit admissions for asthma. Methods. We used survey interview and computerized utilization data from a cohort of 400 adults with severe asthma who were enrolled after hospitalization at 17 Northern California Kaiser Permanente hospitals. To assess asthma severity, we used a multifaceted approach that combined structured telephone interview data with computerized utilization data. Using a referent group of adults who were hospitalized without intensive care unit (ICU) admission (n = 282), we examined whether ICU admission is a valid marker for severe disease (n = 118). Results. Adults with asthma who had recent ICU admission had greater severity-of-asthma scores, controlling for sociodemographic factors, smoking, and atopic history (mean score increment 2.3 points; 95% CI 1.3 to 3.2). The ICU subjects also had poorer asthma-specific quality of life (mean score increment 6.6 points; 95% CI 3.5 to 9.8) and were more likely to indicate severe self-perceived asthma (49% vs. 22%, p < 0.0001). Adults with recent ICU admission were more likely to have seen an asthma specialist during the past year (27% vs. 16%). They were also more likely to have had an asthma-related emergency department visit (37% vs. 26%), hospitalization (17% vs. 6%), and ICU admission during the previous year (5% vs. 0.7%) (p < 0.05 in all cases). Among the 311 adults with asthma who had continuous Kaiser Permanente pharmacy benefits for the previous 12 months, a greater proportion of the ICU group received inhaled corticosteroids during the 12 months prior to hospitalization (78% vs. 65%, p = 0.024). Conclusions. Admission to the ICU for asthma identifies a subgroup with severe disease, providing a valid methodology for defining a cohort of adults with severe asthma.     

The Revised Asthma Problem Behavior Checklist: Adaptation for Use in Spanish Asthmatic Patients

Behavioral problems associated with asthma management were examined in a group of 100 adult Spanish outpatients with asthma (57 women, 43 men; 17-69 years of age). All of them completed a Spanish version of the Revised Asthma Problem Behavior Checklist (RAPBC). Data about duration, severity, and self-management of asthma (self-efficacy expectancies and health care utilization), as well as dyspnea and FEVi, were also recorded. The highest-reliability Cronbach a indices were for the criteria related to emotions and behaviors that could precipitate asthma attacks. Concurrent criterion validity was examined first by Pearson correlations between the RAPBC scores and clinical data about asthma (duration, FEVi, and dyspnea), and second, by examining the differences in RAPBC scores (ANOVAs) among three severity groups of patients. Severe patients reported more behavioral problems associated with poor life-styles and self-management of their asthma and showed more psychological and physical negative consequences related to asthma. In conclusion, while the RAPBC could be considered a valid instrument to assess the behavioral problems associated with asthma in Spanish patients, and shows a good concurrent criterion validity, its reliability (internal consistency) with respect to life-style and self-management behaviors related to asthma should be improved, to ensure its utility as a screening instrument for behavior-related problems in asthmatic Spanish patients.     

Effects of regular exercise on asthma control in young adults

Background: According to our systematic literature review, no previous study has assessed potential effects of regular exercise on asthma control among young adults. We hypothesized that regular exercise improves asthma control among young adults. Methods: We studied 162 subjects with current asthma recruited from a population-based cohort study of 1,623 young adults 20–27 years of age. Asthma control was assessed by the occurrence of asthma-related symptoms, including wheezing, shortness of breath, cough, and phlegm production, during the past 12 months. Asthma symptom score was calculated based on reported frequencies of these symptoms (range: 0–12). Exercise was assessed as hours/week. Results: In Poisson regression, adjusting for gender, age, smoking, environmental tobacco smoke exposure, and education, the asthma symptom score reduced by 0.09 points per 1 hour of exercise/week (95% CI: 0.00 to 0.17). Applying the “Low exercise” quartile as the reference, “Medium exercise” reduced the asthma symptom score by 0.66 (?0.39 to 1.72), and “High exercise” reduced it significantly by 1.13 (0.03 to 2.22). The effect was strongest among overweight subjects. Conclusions: Our results provide new evidence that regular exercising among young adults improves their asthma control. Thus, advising about exercise should be included as an important part of asthma self-management in clinical practice.     

Current status on the diagnosis and management of pancreatic cysts in the Asia-Pacific region: role of endoscopic ultrasound

Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) play increasingly prominent roles in the diagnosis and management of pancreatic cysts. The Asian Consortium of Endoscopic Ultrasound was recently formed to conduct collaborative research in this area. This is a review of literature on true pancreatic cysts. Due to the lack of systematic studies, there are no robust data on the true incidence of pancreatic cystic lesions in Asia and any change in over the recent decades. Certain EUS morphological features have been used to predict particular types of pancreatic cysts. Pancreatic cyst fluid viscosity, cytology, pancreatic enzymes, and tumor markers, in particular carcinoembryonic antigen, can aid in the diagnosis of pancreatic cysts. Hemorrhage and infection are the most common complications of EUS-FNA of pancreatic cysts. Pancreatic cysts can either be observed or resected depending on the benign or malignant nature, or malignant potential of the lesions. Guidelines from an international consensus did not require positive cytological findings to be present in their recommendation for resection, which included all mucinous cystic neoplasms, all main-duct intraductal papillary mucinous neoplasms (IPMN), all mixed IPMN, symptomatic side-branch IPMN, and side-branch IPMN larger than 3 cm. In patients with poor surgical risks, EUS-guided cyst ablation of mucinous pancreatic cysts is an alternative. As long-term prospective data on pancreatic cysts are still not available in Asia, management strategies are largely based on risk stratification by surgical risk and malignant potential. Gene expression profiling of pancreatic cyst fluid and confocal laser endomicroscopic examination of pancreatic cysts are novel techniques currently being studied.     

Risk Factors for Asthma Prevalence Among Urban and Nonurban African American Children

Urban residence is a risk factor for asthma. We examined multiple risk factors simultaneously among African American children. We interviewed 2409 African American mothers of newborns who had at least 1 child at home under 18 years of age. Sixteen percent reported at least 1 child with physician-diagnosed asthma. Significantly associated with an asthmatic child were maternal asthma and allergies, maternal cigarette smoking, a humidifying device, and a gas range or oven in the home. Urban residence was related to asthma but became nonsignificant once other factors were controlled for. Asthma associated with urban residence may be explained by identifiable factors.     

Asthma under-recognition and under-treatment in an Australian community

In a study in south-western Sydney, we examined asthma symptoms in a random sample of 4239 schoolchildren aged five-12 years. The prevalence of current wheeze and cough was 17.1% (95% CI 16.0–18.2%). Interviews were conducted with the parents of all 214 symptomatic children from two of the six schools. Only 60% of these children had ever been labelled as asthma, and only 20% were using appropriate asthma treatment. Fewer than 6% had ever had their airway function assessed. There was a socio-economic difference, with better levels of asthma recognition and management in children attending the school in the more aflluent region. The findings suggest that asthma recognition, assessment and management in the Australian community, as in New Zealand and the UK, may need to be improved. (Aust NZ J Med 1992; 22: 36–40.)     

Predictors of Asthma Control in a Random Sample of Asthmatic Patients

The purpose of this study was to identify determinants of asthma control. Questionnaires were completed by a random sample of 570 members of a large managed care organization who were ≥35 years of age with utilization suggestive of active asthma. Asthma control was assessed buy the Asthma Control Test (ACT). Independent relationships were found between lower ACT scores and oral corticosteroid use (p < 0.0001), COPD (p < 0.0001), absence of regular specialist care (p = 0.006), higher BMI (p = 0.01), gastroesophageal reflux (p = 0.02), not being Caucasian (p = 0.04), and low income (p = 0.04).     

Asthma management: how effective is it in the community?

Abstract Background: The National Asthma Campaign (NAC) was launched in Australia in 1989 with the major objective of improving asthma management through the implementation of a six‐step asthma management plan. Aim: The objective of the present study was to analyse the management of asthma in a cohort of adults with self‐reported asthma 10 years after the commencement of the NAC. Methods: The subjects were participants in the laboratory phase of a cross‐sectional epidemiological study conducted in Melbourne in 1999?2000. Participants completed the detailed European Community Respiratory Health Survey, which included specific questions about their asthma management. Participants were included in this analysis if they had a positive response to the question ‘Have you ever had asthma?’. This resulted in a total of 435 subjects. Results: Of the subjects with self‐reported asthma, over half of the participants reported that a doctor had ever measured their breathing (52.9%). However, only 10.1% of participants reported that they owned a peakflow meter (PFM) and only 13.3% reported that they had ever been given a written action plan. In comparison with data reported from 1993, doctor measurement of lung function has decreased significantly (P < 0.0001), as has PFM ownership (P < 0.0001) and, importantly, possession of a written action plan (P = 0.0004). Conclusions: Asthma management among adults still falls well short of NAC guidelines. The decline in some key features over recent years suggests that new management and dissemination strategies are required. (Intern Med J 2002; 32: 451?456)     

Asthma Mortality in Southern Brazil: Is There a Changing Trend?

Background. Mortality from asthma increased during the last decades but is now declining in some countries. Little is known about this trend in Brazil.    Objective. The objective of the study was to determine the trends in asthma mortality in Southern Brazil.    Methods. We reviewed death certificates of 566 people in the state of Rio Grande do Sul, Brazil, between 5 and 39 years of age in whom asthma was reported to be the underlying cause of death during the period of 1981-2003. Population data were available in 5-year age groups. Mortality rates were submitted to linear and quadratic regression procedures.    Results. Among children and teenagers (5-19 years), there were 170 asthma deaths, ranging from 4 to 13 deaths each year with rates of 0.154/100,000 to 0.481/100,000. In young adults (20-39 years), 396 asthma deaths occurred, ranging from 9 to 32 each year, with rates from 0.276/100,000 to 1.034/100,000. There was an initial increase in rates, with later stabilization, and then the start of a decline beginning in the late 1990s and the early part of this decade. This trend occurred in both age subgroups examined but was more evident in males.    Conclusions. Asthma mortality in southern Brazil remains low and appears to be decreasing after reaching a peak in the mid-1990s. The reason for these trends remains unknown.     

Complementary and Alternative Medicine Use among Adults with Work-Related and Non-Work-Related Asthma

Background. The prevalence of complementary and alternative medicine (CAM) use among adults with current asthma has been estimated to be 40%. To our knowledge, there is no information on the prevalence of CAM use among individuals with work-related asthma (WRA). Objectives. To examine the associations between WRA, CAM use, and adverse asthma events. Methods. We analyzed data from the 2006–2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia for ever-employed adults with current asthma. We defined WRA as health-professional-diagnosed WRA. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, health insurance, and geographic region of residence. Results. Of ever-employed adults with current asthma, an estimated 38.1% used CAM and 8.6% had WRA. An estimated 56.6% of individuals with WRA reported using CAM compared with 27.9% of those with non-WRA (PR = 2.0). People with WRA were more likely than those with non-WRA to have adverse asthma events including an asthma attack in the past month (PR = 1.43), urgent treatment for worsening asthma (PR = 1.74), emergency room visit (PR = 1.95), overnight hospital stay (PR = 2.49), and poorly controlled asthma (PR = 1.27). The associations of WRA with adverse asthma events remained after stratifying for CAM use. Conclusions. Compared with non-WRA, individuals with WRA were more likely to use CAM to control their asthma. However, there was no evidence that the use of CAM modified the association of WRA with adverse asthma events.