Clinical Trial

. 2022 Sep 15;60(3):2102866.

doi: 10.1183/13993003.02866-2021. Print 2022 Sep.

The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study

Luis García-Marcos^{1

2}, M Innes Asher³, Neil Pearce⁴, Eamon Ellwood³, Karen Bissell⁵, Chen-Yuan Chiang^{6

7

8}, Asma El Sony⁹, Philippa Ellwood³, Guy B Marks¹⁰, Kevin Mortimer^{11

12}, A Elena Martínez-Torres^{13

14}, Eva Morales¹⁵, Virginia Perez-Fernandez¹⁶, Steven Robertson⁴, Charlotte E Rutter⁴, Richard J Silverwood^{4

17}, David P Strachan¹⁸; Global Asthma Network Phase I Study Group

Affiliations

¹ Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain lgmarcos@um.es.
² ARADyAL Allergy Network, Murcia, Spain.
³ Dept of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁴ Dept of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
⁵ School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁶ International Union Against Tuberculosis and Lung Disease, Paris, France.
⁷ Division of Pulmonary Medicine, Dept of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁸ Division of Pulmonary Medicine, Dept of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan.
¹⁰ Respiratory and Environmental Epidemiology, University of New South Wales, Sydney, Australia.
¹¹ Dept of Medicine, University of Cambridge, Cambridge, UK.
¹² Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
¹³ Paediatric Allergy and Pulmonology Units and Nurse Research Group, Virgen de la Arrixaca University Children's Hospital, Murcia, Spain.
¹⁴ IMIB Bio-health Research Institute, Murcia, Spain.
¹⁵ Dept of Public Health Sciences, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain.
¹⁶ Dept of Biostatistics, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain.
¹⁷ Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.
¹⁸ Population Health Research Institute, St George's, University of London, London, UK.

PMID: 35144987
PMCID: PMC9474895
DOI: 10.1183/13993003.02866-2021

Clinical Trial

The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study

Luis García-Marcos et al. Eur Respir J. 2022.

. 2022 Sep 15;60(3):2102866.

doi: 10.1183/13993003.02866-2021. Print 2022 Sep.

Authors

Affiliations

¹ Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain lgmarcos@um.es.
² ARADyAL Allergy Network, Murcia, Spain.
³ Dept of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁴ Dept of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
⁵ School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁶ International Union Against Tuberculosis and Lung Disease, Paris, France.
⁷ Division of Pulmonary Medicine, Dept of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁸ Division of Pulmonary Medicine, Dept of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan.
¹⁰ Respiratory and Environmental Epidemiology, University of New South Wales, Sydney, Australia.
¹¹ Dept of Medicine, University of Cambridge, Cambridge, UK.
¹² Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
¹³ Paediatric Allergy and Pulmonology Units and Nurse Research Group, Virgen de la Arrixaca University Children's Hospital, Murcia, Spain.
¹⁴ IMIB Bio-health Research Institute, Murcia, Spain.
¹⁵ Dept of Public Health Sciences, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain.
¹⁶ Dept of Biostatistics, University of Murcia and IMIB Bio-health Research Institute, Murcia, Spain.
¹⁷ Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.
¹⁸ Population Health Research Institute, St George's, University of London, London, UK.

PMID: 35144987
PMCID: PMC9474895
DOI: 10.1183/13993003.02866-2021

Abstract

Aims: There have been no worldwide standardised surveys of prevalence and severity of asthma, rhinoconjunctivitis and eczema in school children for 15 years. The present study aims to provide this information.

Methods: Following the exact International Study of Asthma and Allergies in Childhood (ISAAC) methodology (cross-sectional questionnaire-based survey), Global Asthma Network (GAN) Phase I was carried out between 2015 and 2020 in many centres worldwide.

Results: The study included 157 784 adolescents (13-14 years of age) in 63 centres in 25 countries and 101 777 children (6-7 years of age) in 44 centres in 16 countries. The current prevalence of symptoms, respectively, was 11.0% and 9.1% for asthma, 13.3% and 7.7% for rhinoconjunctivitis and 6.4% and 5.9% for eczema. The prevalence of asthma ever was 10.5% and 7.6%, hay fever ever was 15.2% and 11.1% and eczema ever was 10.6% and 13.4%, respectively. Centres in low or lower middle gross national income countries (LICs or LMICs) had significantly lower prevalence of the three disease symptoms and diagnoses (except for hay fever). In children, the prevalence of asthma and rhinoconjunctivitis symptoms was higher in boys, while the reverse occurred among adolescents. For eczema, while the prevalence among female adolescents was double that of males, there was no sex difference among children. Centre accounted for non-negligible variability in all disease symptoms (10-20%).

Conclusion: The burdens of asthma, rhinoconjunctivitis and eczema vary widely among the limited number of countries studied. Although symptom prevalence is lower in LICs and LMICs, it represents a considerable burden everywhere studied.

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Conflict of interest statement

Conflict of interest: C.E. Rutter declares UK Medical Research Council funding for a PhD as part of MRCLID DTP with LSHTM and St Georges, grant number MR/N013638/1, in connection with the present manuscript. All other authors declare no competing interests.

Figures

**FIGURE 1**
Prevalence of a) current wheeze, b) asthma ever, c) hay fever ever and d) eczema ever in adolescents. The symbols indicate prevalence values of <5% (blue squares), 5 to <10% (green circles), 10 to <20% (yellow diamonds) and ≥20% (red stars).

**FIGURE 2**
Prevalence of a) current wheeze, b) asthma ever, c) hay fever ever and d) eczema ever in children. The symbols indicate prevalence values of <5% (blue squares), 5 to <10% (green circles), 10 to <20% (yellow diamonds) and ≥20% (red stars).

**FIGURE 3**
Rank correlation values and scatter plots of the prevalence of asthma ever, hay fever ever and eczema ever at the centre level in adolescents and children. The dashed line is the normality line. Rank correlation coefficient and 95% confidence intervals are shown in each graph.

See this image and copyright information in PMC

Comment in

Planetary respiratory health for asthma, rhinoconjunctivitis and eczema.
Soriano JB. Soriano JB. Eur Respir J. 2022 Sep 15;60(3):2200440. doi: 10.1183/13993003.00440-2022. Print 2022 Sep. Eur Respir J. 2022. PMID: 36109045 No abstract available.

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The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study

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The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study

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