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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Verlato G et al; "Is the Prevalence of Adult Asthma and Allergic Rhinitis Still Increasing? Results of an Italian Study." Journal of Allergy and Clinical Immunology; V.111; No.6; 6/03; p1232
      STUDY DESIGN: The present study evaluated, using a repeated survey approach, whether any significant variation in the prevalence of asthma, asthma-like symptoms, and allergic rhinitis had occurred in the adult population of northern Italy during the 1990s. The survey was performed in 3 centers of northern Italy, Turin, Pavia, and Verona, located in the plain of the Po River and characterized by a temperate climate. Turin is a large urban area (909,717 residents in 1998) with large manufacturing industries. Pavia is a smaller town (74,290 inhabitants) in the middle of a farming area, and Verona is a middle-size town (254,712 residents) involved in tourism and services. Data was controlled for age class (20 to 26.2, 26.3 to 32.4, 32.5 to 38.7 years, 38.8 years or older), among other variables.
      PREVALENCE (ITALY): The adjusted prevalence of respiratory symptoms and antiasthmatic treatment in 1991 to 1993 versus 1998 to 2000, respectively, in the 3 Italian centers was reported as follows: asthma attacks, 3.6% vs 3.2%; wheezing, 9.8% vs 9.6%; wheeze with breathlessness, 2.8% vs 2.1%; wheezing without a cold, 6.7% vs 6.5%; chest tightness, 7.9% vs 6.5%; shortness of breath, 7.0% vs 5.2%. No significant change was observed in the adjusted prevalence of asthma attacks, which declined slightly from 3.6% in 1991 to 1993 to 3.2% in 1998 to 2000. The adjusted prevalence of asthma-like symptoms either remained stable (for wheezing and wheezing without a cold), or decreased slightly (for wheeze with breathlessness, chest tightness, and shortness of breath). The only significant variation was decline in shortness of breath.
      The prevalence of asthma attacks, while decreasing in people older than 26 years from 3.8% to 3.2%, increased slightly from 3.6% to 4.3% in people aged 20 to 26 years. The prevalence of asthma attacks and asthma-like symptoms was usually higher in urban than in suburban areas; the difference was significant for asthma attacks.
      Overall, the percentage of people who self-reported to be under antiasthmatic treatment increased slightly from 1.9% to 2.5%, although not significantly. This increase was observed in suburban areas (from 0.7% to 2.9%) but not in urban areas (from 2.3% to 2.5%), as denoted by the significant interaction between site of residence and time of survey. The increase in treatment was substantial in people aged 20 to 26 years (from 2.0% to 3.8%) and only moderate in older age classes (from 2.0% to 2.4%), but this difference in temporal trend was not significant. The proportion of people free from asthma attacks increased among subjects currently taking medicines for asthma in all centers from 21.8% in 1991-1993, to 31.8% in 1998-2000.
      DISCUSSION: In the overall young adult population, the prevalence of asthma attacks and asthma-like symptoms has not increased during the 1990s in Italy. However, when considering age classes separately, a generational effect emerged because asthma-like symptom prevalence tended to decrease in older subjects (32.5 to 45 years) and to increase in younger subjects (20 to 26.2 years). The prevalence of self-reported allergic rhinitis has increased during the same period in all age classes (20 to 38 years) but the last one (39 to 45 years). This increasing trend was more pronounced in suburban areas. The proportion of people under antiasthmatic treatment has increased remarkably in suburban areas, while remaining stable in urban areas.
      Asthma-like symptom prevalence, after increasing dramatically and worldwide in the 1970s and 1980s, has not increased further during the 1990s in Italy, probably because the management of asthma has improved.

Search Criteria: Text - Journal of Allergy and Clinical Immunology; V.111; No.6; 6/03; p1232