Asthma, Rhinitis, Other Respiratory Diseases
Incidence and remission of asthma: A retrospective study on the natural history of asthma in Italy,☆☆,

https://doi.org/10.1067/mai.2002.125600Get rights and content

Abstract

Background: The knowledge of the natural history of asthma from birth to adulthood could provide important clues for its cause and for the understanding of epidemiologic findings. Objective: This study is aimed at assessing the incidence and remission of asthma from birth to the age of 44 years by using data from 18,873 subjects involved in a large, nationally representative, cross-sectional study carried out in Italy from 1998 through 2000. Methods: The onset of asthma was defined as the age at the first attack, and remission was considered present when a subject was neither under treatment nor had experienced an asthma attack in the last 24 months. Person-years and survival techniques were used for the analysis. Results: The average annual incidence rate for the 1953 to 2000 period was 2.56/1000 persons per year. Incidence peaked in boys less than 10 years of age (4.38/1000 persons per year) and in women 30 years of age or older (3.1/1000 persons per year) and showed a generational increase (incident rate ratio = 2.63 and 95% CI = 2.20-3.12 for 1974-1979 vs 1953-1958 birth cohort). The overall remission rate was 45.8% (41.6% in women and 49.5% in men, P < .001). Asthmatic patients in remission had an earlier age at onset (7.8 vs 15.9 years, P < .001) and a shorter duration of the disease (5.6 vs 16.1 years, P < .001) than patients with current asthma. The probability of remission was strongly (P < .001) and inversely related to the age at onset (62.8% and 15.0% in the <10- and ≥20-years age-at-onset groups, respectively). Conclusion: With respect to its natural history, asthma presents 2 different forms: early-onset asthma, which occurs early in childhood, affects mainly boys, and has a good prognosis, and late-onset asthma, which generally occurs during or after puberty, mainly affects women, and has a poor prognosis. The minority of patients with early-onset asthma who do not remit represents more than 35% of patients with current asthma in the general young adult population. (J Allergy Clin Immunol 2002;110:228-35.)

Section snippets

Study design

The Italian Study on Asthma in Young Adults is a multicenter, cross-sectional survey on the young general adult population specifically aimed at assessing the prevalence and current management of asthma in Italy.

The survey was carried out between 1998 and 2000 in 9 Italian centers belonging to 2 different climatic regions: subcontinental (Northern Italy) and Mediterranean (Central/Southern Italy). Each center identified an up-to-date sampling frame of the residents of the target area, from

Asthma incidence

Of 25,969 eligible subjects in 9 centers, 18,873 filled in the questionnaire, with an overall response rate of 72.7%. All the centers but one had a response rate greater than 70%. The age and sex distribution of responders was similar to that of nonresponders. One thousand five hundred twenty-six subjects (8.1%) reported ever having had asthma during their life, of which 91.3% were given a diagnosis by a doctor, and the total person-years amounted to 589,716.

The overall crude incidence (Table

Discussion

The main findings of the analysis of the incidence and remission of asthma in Italy are as follows:

  • The average incidence rate of asthma in the 0- to 44-year age group during the period from 1953 to 2000 was 2.6/1000 persons per year, with strong variation by age, sex, and generation.

  • In the presence of a generational increase, the incidence of asthma shows a constant age-specific U-shaped pattern, implying 2 different forms of the disease: early-onset asthma, mainly affecting boys (3.8/1000

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    Principal participants in the Italian Study on Asthma in Young Adults are listed in the Appendix.

    ☆☆

    Supported by Italian Ministry of University and Scientific Research; University of Verona; Glaxo Wellcome Italia; National Health Service, AUSL Ferrara; National Health Service, AUSL Pavia; National Health Service, ASL 4 Turin; IRCCS San Matteo; Udine Municipality; Councillorship for Health, Modena Province; Pavia Province; Siracusa Province; and Veneto Region.

    Reprint requests: Roberto de Marco, PhD, Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134 Verona, Italy.

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