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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Anderson HR et al; "50 Years of Asthma: UK Trends From 1955 to 2004." Thorax; V.62; 2007; p85
      STUDY DESIGN: The aim of this paper is to provide a succinct update of trends in available national-level data on asthma in the UK over the past 50 years (1955 to 2004). Data were derived from a variety of sources chosen for the reliability of their estimates over time. They comprised routine prescribing, admissions and mortality data, large-scale general practitioner databases, national survey series, and local ad hoc surveys of asthma diagnosis and symptoms.
      The sources of data described in this review do not provide a complete picture of trends in morbidity and use of health services for asthma. In particular, there aren't adequate data on morbidity in adults, nor are there data on the use of emergency or outpatient departments. Nevertheless, a number of conclusions may be drawn.
      TRENDS (UK): Trends in the prevalence of childhood asthma generally indicate an increase in asthma symptoms of all grades of severity from the 1960s, when the earliest surveys were done. There is some evidence that trends flattened or even began to fall in the late 1990s and early 2000s. Evidence for adults is sparse and conflicting, but national surveys suggest that little change has occurred in recent years. There has been an upward trend in a lifetime diagnosis of asthma and in the proportion of currently wheezing children diagnosed as having asthma. Hospital admissions increased until the late 1980s and have been declining since. The rise and fall in hospital admissions was highest in younger age groups but affected all age groups around the same period, indicating that any important cohort effect was unlikely. The incidence of asthma episodes presenting to general practitioners rose in all ages to a plateau in the mid-1990s and has declined since. The prevalence of treated asthma in general practice rose and then flattened out during the 1990s, while at the same time incident asthma in general practice remained steady.
      Mortality, hospital admissions and general practitioner consultations for chronic obstructive pulmonary disease have risen or remained stable, but this condition is much more common than asthma and it would require only a small shift in diagnosis to make a considerable impact on asthma trends. If this were the case, a greater change in the elderly patients compared with younger adults might be expected, but this was not seen.
      DISCUSSION: The subsequent decline in the incidence of severe asthma indicated by trends in both hospital and general practitioner data, during a time when the prevalence of treated asthma in general practice has remained fairly stable, is consistent with the greater penetration and effective use of inhaled corticosteroids. The recent fall in prevalence of moderate to severe asthma in 13- to 14-year-old children is also consistent with this, although it would not explain the concomitant fall in mild symptoms.

Search Criteria: Text - Thorax; V.62; 2007; p85