Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study

Background: Asthma is the most common chronic disease in children globally. The Global Asthma Network (GAN) Phase I study aimed to determine if the worldwide burden of asthma symptoms is changing. Methods: This updated cross-sectional study used the same methods as the International study of Asthma and Allergies in Childhood (ISAAC) Phase III. Asthma symptoms were assessed from centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both. We included individuals from two age groups (children aged 6–7 years and adolescents aged 13–14 years) who self-completed written questionnaires at school. We estimated the 10-year rate of change in prevalence of current wheeze, severe asthma symptoms, ever having asthma, exercise wheeze, and night cough (defined by core questions in the questionnaire) for each centre, and we estimated trends across world regions and income levels using mixed-effects linear regression models with region and country income level as confounders. Findings: Overall, 119 795 participants from 27 centres in 14 countries were included: 74 361 adolescents (response rate 90%) and 45 434 children (response rate 79%). About one in ten individuals of both age groups had wheeze in the preceding year, of whom almost half had severe symptoms. Most centres showed a change in prevalence of 2 SE or more between ISAAC Phase III to GAN Phase I. Over the 27-year period (1993–2020), adolescents showed a significant decrease in percentage point prevalence per decade in severe asthma symptoms (–0·37, 95% CI –0·69 to –0·04) and an increase in ever having asthma (1·25, 0·67 to 1·83) and night cough (4·25, 3·06 to 5·44), which was also found in children (3·21, 1·80 to 4·62). The prevalence of current wheeze decreased in low-income countries (–1·37, –2·47 to –0·27], in children and –1·67, –2·70 to –0·64, in adolescents) and increased in lower-middle-income countries (1·99, 0·33 to 3·66, in children and 1·69, 0·13 to 3·25, in adolescents), but it was stable in upper-middle-income and high-income countries. Interpretation: Trends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma. Funding: International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca Educational Grant, National Institute for Health Research, UK Medical Research Council, European Research Council, and Instituto de Salud Carlos III

Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study

Background: Eczema (atopic dermatitis) is a major global public health issue with high prevalence and morbidity. Our goal was to evaluate eczema prevalence over time, using standardized methodology. Methods: The Global Asthma Network (GAN) Phase I study is an international collaborative study arising from the International Study of Asthma and Allergies in Children (ISAAC). Using surveys, we assessed eczema prevalence, severity, and lifetime prevalence, in global centres participating in GAN Phase I (2015–2020) and one/ both of ISAAC Phase I (1993–1995) and Phase III (2001–2003). We fitted linear mixed models to estimate 10-yearly prevalence trends, by age group, income, and region. Results: We analysed GAN Phase I data from 27 centres in 14 countries involving 74,361 adolescents aged 13–14 and 47,907 children aged 6–7 (response rate 90%, 79%). A median of 6% of children and adolescents had symptoms of current eczema, with 1.1% and 0.6% in adolescents and children, respectively, reporting symptoms of severe eczema. Over 27 years, after adjusting for world region and income, we estimated small overall 10-year increases in current eczema prevalence (adolescents: 0.98%, 95% CI 0.04%–1.92%; children: 1.21%, 95% CI 0.18%–2.24%), and severe eczema (adolescents: 0.26%, 95% CI 0.06%–0.46%; children: 0.23%, 95% CI 0.02%–0.45%) with larger increases in lifetime prevalence (adolescents: 2.71%, 95% CI 1.10%–4.32%; children: 3.91%, 95% CI 2.07%–5.75%). There was substantial heterogeneity in 10-year change between centres (standard deviations 2.40%, 0.58%, and 3.04%), and strong evidence that some of this heterogeneity was explained by region and income level, with increases in some outcomes in high-income children and middle-income adolescents. Conclusions: There is substantial variation in changes in eczema prevalence over time by income and region. Understanding reasons for increases in some regions and decreases in others will help inform prevention strategies

Clinical standards for the diagnosis and management of asthma in low- and middle-income countries

BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs). METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards. RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94–98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3–5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0–3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6–11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12–18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS. The following standards (14–18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual’s lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available. CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings

Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study

Funder: International Union Against Tuberculosis and Lung Disease; Id: http://dx.doi.org/10.13039/501100005850Funder: Boehringer Ingelheim New ZealandFunder: Astra Zeneca Educational GrantFunder: UK National Institute of Health ResearchBackground: Eczema (atopic dermatitis) is a major global public health issue with high prevalence and morbidity. Our goal was to evaluate eczema prevalence over time, using standardized methodology. Methods: The Global Asthma Network (GAN) Phase I study is an international collaborative study arising from the International Study of Asthma and Allergies in Children (ISAAC). Using surveys, we assessed eczema prevalence, severity, and lifetime prevalence, in global centres participating in GAN Phase I (2015–2020) and one/ both of ISAAC Phase I (1993–1995) and Phase III (2001–2003). We fitted linear mixed models to estimate 10‐yearly prevalence trends, by age group, income, and region. Results: We analysed GAN Phase I data from 27 centres in 14 countries involving 74,361 adolescents aged 13–14 and 47,907 children aged 6–7 (response rate 90%, 79%). A median of 6% of children and adolescents had symptoms of current eczema, with 1.1% and 0.6% in adolescents and children, respectively, reporting symptoms of severe eczema. Over 27 years, after adjusting for world region and income, we estimated small overall 10‐year increases in current eczema prevalence (adolescents: 0.98%, 95% CI 0.04%–1.92%; children: 1.21%, 95% CI 0.18%–2.24%), and severe eczema (adolescents: 0.26%, 95% CI 0.06%–0.46%; children: 0.23%, 95% CI 0.02%–0.45%) with larger increases in lifetime prevalence (adolescents: 2.71%, 95% CI 1.10%–4.32%; children: 3.91%, 95% CI 2.07%–5.75%). There was substantial heterogeneity in 10‐year change between centres (standard deviations 2.40%, 0.58%, and 3.04%), and strong evidence that some of this heterogeneity was explained by region and income level, with increases in some outcomes in high‐income children and middle‐income adolescents. Conclusions: There is substantial variation in changes in eczema prevalence over time by income and region. Understanding reasons for increases in some regions and decreases in others will help inform prevention strategies

Anales de Edafología y Agrobiología Tomo 46 Número 7-12

l. Suelos.-Biología La lombriz de tierra (E. Foetida sav. y L. Rubellus Hoff). Biología y usos más importantes. Por M. T. Flores y P. Alvira.-- Composición qufmico-bromatológica y proporción de aminoácidos de la harina de la lombriz de tierra (E. Foetida sav. y L. Rubellus Hoff.). Por M. T. Flores y P. Alvira.-- Génesis, Clasificación y Cartografía Estudio edáfico de la Sierra de Cazorla. (Jaén). (III). Características de suelos con epipedón mollico. Por J. González Parra, C. González Huecas y A . López Lafuente.-- Suelos de la Rioja Alavesa: l. Entisoles y Aridisoles. Por A. J. Ocio, A. Guerra, R. Jiménez Ballesta y J. Batllé.-- Suelos de la rioja Alavesa: II. Inceptisoles. Por A. J. Ocio, R. Jiménez Ballesta, J. Batllé y A. Guerra.-- Caracterización de una toposecuencia en las naves (Dunas estabilizadas) del Parque Nacional de Doñana. Por P. Siljestrom Ribed y L. Clemente Salas.-- Evolución edafo-geomorfológica de las lagunas temporales del Parque Nacional de Doñana. Por P. Siljeström Ribed y L. Clemente Salas.-- Ordenación agronómica de un área de montaña de Galicia. l. Datos del medio fÍsico Por R. Blázquez, R. Calvo y F. Macías.-- Ordenación agronómica de un área de montaña en Galicia. II. Una alternativa de planificación. Por R. Calvo, R. Blázquez y F. Macías.-- Suelos de la Sierra del Maigmo (Alicante). II. Descripción de perfiles. Datos analíticos, clasificación y distribución. Por L. J. Alfas y A. de la Torre.--II. Biología Vegetal-Nutrición Estudio del poder fertilizante de un complejo de turba. l. Ensayo de fertilidad sobre suelo arcilloso. Por F. l. Pugnaire y C. García Izquierdo.-- Efecto de la relación N03 /NJtt en la composición mineral de plantas de tomate y pimiento cultivadas en ambiente controlado. Por J. Caselles, P. Zornoza y O. Carpena.-- Influencia de la fertilización nitrogenada en la evolución foliar de algunos nutrientes, ácidos y azúcares de la V. Vinifera "Pedro Ximénez". Por C. Aceituno, J. Mérida, J. L. González y M. Medina.-- Fisiología Effect of Sesbania mosaic virus on photosynthetic production of Dhaincha leaves. Por G.P. Rao, D. N. Shukla and K. Shukla.-- Influencia de almacenamiento en frío y tratamiento hormonal sobre el reposo de estaquillas de castaño. Por E. González, l. Iglesias, T. Díaz y J. L. G. Mantilla.-- Agrobiología. Viñedos Canarios. Zona de Acentejo. l. Climatologra. Por Ma E. Figueruelo O jeda, F. Gutiérrez Jérez y Mª I. Trujillo Jacinto del Castillo.-- Viñedos Canarios. Zona de Acentejo. II. Caracteristicas fÍsicas del suelo. Por F. Gutiérrez Jérez, l. Trujillo Jacinto del Castillo, E. Figueruelo Ojeda y C. Curbelo Mújica.-- III. Trabajos recapitulativos. El cobre como nutriente de la planta. Por O. Lastra, A. Chueca. C. González, M. Lachica y J. López Gorge. l. Suelos-Química. Problemas de caracterización del complejo de cambio en suelos de Galicia. Por R. M. Calvo de Anta y E. Alvarez Rodríguez.—Biología. Uso del violeta de Genciana en un medio de cultivo sintético que permite el desarrollo de bacterias aerobias Gram negativas del suelo. Por M. T. Pérez, M. A . Gómez y M. A. Sagardoy.-- Efecto de la temperatura sobre el comportamiento cinético de la actividad fj-D-Giucosidasa en una turba del Valle del Ebro (Burgos, España). Por S. González Carcedo, M. A . Arconada Varas y M. D. Luera.-- Génesis, Clasificación y Cartografía Suelos de la Rioja Alavesa: III. Mollisoles, Alfisoles y síntesis final. Por A. J. Ocio, R. Jiménez Ballesta, J. L. Martín de Vidales y A. Guerra.-- Morfología y evolución de Jos suelos de las lagunas permanentes del Parque Nacional de Doñana. Por P. Siljeström Ribed y L. Clemente Salas.-- Evolución edáfica en la vera arcillosa del Parque Nacional de Doñana. Por P. Siljeström Ribed y L. Clemente Salas.-- Suelos con horizontes arg!licos en el macizo de Ayllón y Sierra del Alto Rey (Sistema Central): Pautas de distribución en el paisaje. Por J. J. lbáñez, J. Gallardo y R. Jiménez Ballesta.—Fertilidad. Quelación por EDDHA de micronutrientes en suelos calizos: Ecuación modificada de Freundlich. Por J. Sánchez-Andréu, M. Juárez, L. Play J. Mataix .-- Estudio de la fertilidad de los suelos y nutrición mineral de la fresa en la Isla de Tenerife. Por A. Arévalo Morales, C. Martínez Barroso y C. E. Alvarez González.-- II. Biología Vegetal.-Nutrición Producción y contenido protéico de tallo y hoja de Cynodon dactylon en clima mediterráneo. Por M. C. Bergareche, M. J. López y E. Simón.-- Factores externos y nutrición mineral del trigo. Por L. Sánchez de la Puente y R. M.3 Belda Navarro.-- Balance de N. P, K y S en trigo de la región semiárida de la provincia de Buenos Aires, Argentina. Por R. A. Rosell, M. R. Landriscini, K. Ch. Sommer y A . Glave.-- Agrobiología Cinética del proceso de adsorción de TMTD sobre carbón activo y sepiolita. Por M. Socias Viciana, A. Valverde García, M. Villafranca Sánchez y E. González Pradas.-- Viñedos Canarios. Zona de Acentejo. III. Características químicas de los suelos. Por I. Trujillo Jacinto del Castillo, E. Figueruelo Ojeda, F. Gutiérrez Jérez y D. del Castillo Rodríguez.-- Relaciones suelo-pasto en superficies de tipo raña. Por A. García, J. J. lbáñez y J. Pastor.-- Estructura y distribución de bosques caducifolios sobre distintos sustratos en el Valle del V aldeón. Cordillera Cantábrica. Por A. García.-- III. Trabajos reacapitulativos. Interacción entre micorrizas VA y organismos patógenos de plantas. Por J. M. García-Garrido y J. A. Ocampo.-- Interaction of humic substances with microbes and enzymes in soil and possible implications for soil fertility. By Richard G. Burns.-- l. Suelos.Física. Osmo-Regulación en cultivares contrastantes de trigo y su relación con la etapa del desarrollo. Por N. L. García Girou y N. R. Curvetto.-- Estudio comparativo sobre diferentes métodos de valoración de la erosión hídrica en unas áreas piloto representativas de la provincia de Valencia. España. Por V. Bordas Valls y J. Sánchez Díaz.—Química. Adsorción de Malathion sobre sepiolita natural. Por E. González Paradas, M. Villafranca Sánchez, R. J. Plaza Capel, A. Valverde García, F. del Rey Bueno y A. García Rodríguez.-- Fertilidad- Nivel de fertilidad de los vertisoles de la provincia de Badajoz (España). l. Características generales de la capa arable. Por A García Navarro y A. López Piñeiro.-- Wheat soil Management and N fertilization in semiarid Argentina. Por R. A. Rosell, R. M. Martínez and K. Chr. Sommer.-- Modelos de comportamiento de la fertilidad de suelos calizos. Por l. Gómez, F. Burlo. B. Gómez y J. Mataix.-- Dinámica del fósforo en un suelo calizo. 11. Comparación de dos ritmos de abonado fosfórico y su incidencia en un cultivo de tomate. Por R. M. Cuesta, A. M. Ramón, J. J. Lucena y A. Gárate.-- Cantidades y formas de fósforo en suelos naturales de Galicia (Nw Spain). Por M.3 C. Trasar Cepeda, F. Gil Sotres y F. Guitián Ojea..-- II. Biología Vegetal. Nutrición Efectos del riego por goteo en la nutrición nitrogenada de la berenjena (Solanum melongena L.) cultivada en invernadero. Por S. Jaime, M. Casado y A. Aguilar.-- Nutrición mineral del níspero del Japón (Eriobotrya japonica L.) evolución anual de los macroelementos N, P, K, Ca y Mg. 8 años de observaciones. Por S. Jaime, J. M. Farré, J. M. Hermoso y A. Aguilar.-- Influencia de la fertilización nitrogenada en condiciones salinas en el cultivo de plantas de tomate y pepino. l. Rendimientos y calidad de fruto. Por V. Martínez y A. Cerdá.-- Influencia de la fertilización nitrogenada en condiciones salinas en el cultivo de plantas de tomate y pepino. ll. Composición mineral. Por V. Martínez y A. Cerdá.-- Distribución e interrelaciones de componentes metálicos en segmentos ecológicos. Por F. Romero, C. Elejalde y G. Gómez.-- Fisiología Germinación de semillas de Phaseolus vulgaris, L. var. Eagle. l. Papel del ácido gilberélico sobre la producción de etileno. Por l . M. Sánchez-Calle y A. J. Matilla.-- Influencia del pH del suelo sobre el desarrollo y producción de la piña tropical. II. Desarrollo vegetativo y medidas; acidez y producción del fruto. Por C. E. Alvarez González, A E. Carracedo Torres, C. García Corujo y M. Fernández Falcón.—Agro biología. Viñedos canarios. Zona de Acentejo. IV. Estudio estadístico de regresión y contraste de hipótesis de las propiedades físicas y Qufmicas de los suelos. Por l. Trujillo Jacinto del Castillo, E. Figueruelo Ojeda, F. Gutiérrez Jérez y J. Trujillo Jacinto del Castillo.-- Trabajos recapitulativos. El cloroplasto: composición, función y estructura. Por J. Val, L. Heras y E. Monge.-- IV. Bibliografía. Estudio de la producción científica española en el área de Geología. Por A. de Irazazabal Nerpell, S. Alvarez Borge, C. Ortiz González y J. Zarco Weidner.Peer reviewe

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma

Background Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. Methods The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013–2014. One of the questions was: “Has a national asthma strategy been developed in your country for the next five years? For children? For adults?”. Results Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p < 0.001). Interpretation In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. © 2017 SEICA

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma

Background Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. Methods The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013–2014. One of the questions was: “Has a national asthma strategy been developed in your country for the next five years? For children? For adults?”. Results Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p < 0.001). Interpretation In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. © 2017 SEICA