Asthma prevalence and associated factors among lebanese adults: the first national survey.

BACKGROUND: No national research has yet explored the prevalence of asthma among adults in Lebanon. This study aims to evaluate the prevalence of physician-diagnosed asthma and current asthma, and their determinants among Lebanese adults 16 years old or above. METHODS: A cross-sectional study was carried out using a multistage cluster sampling. The questionnaire used collected information on asthma, respiratory symptoms, and risk factors. RESULTS: The prevalence of physician-diagnosed asthma was 6.7% (95% CI 5-8.7%), and that of current asthma was 5% (95% CI 3.6-6.9%). Chronic symptoms such as cough, wheezing, and shortness of breath were worst at night. Factors positively associated with physician-diagnosed asthma were a secondary educational level (adjusted OR, aOR = 4.45), a family history of chronic respiratory diseases (aOR = 2.78), lung problems during childhood (15.9), and allergic rhinitis (4.19). Additionally, consuming fruits and vegetables less than once per week (3.36), a family history of chronic respiratory diseases (3.92), lung problems during childhood (9.43), and allergic rhinitis (8.12) were positively associated with current asthma. CONCLUSIONS: The prevalence of asthma was within the range reported from surrounding countries. However, repeated cross-sectional studies are necessary to evaluate trends in asthma prevalence in the Lebanese population.

Agreement between current and active asthma classification methods, Asthma Call-back Survey, 2011-2012.

OBJECTIVE: Various approaches have been developed to identify persons with asthma using survey data. To assess agreement between current and active asthma classifications, 2011-2012 Asthma Call-back Survey landline telephone household data from 38 states, District of Columbia, and Puerto Rico for adults aged ≥18 years who have ever been told by a health professional they have asthma were analyzed. METHODS: Respondents were classified to have current asthma if they reported still having asthma, and active asthma if they reported within the past year: 1) talking to a doctor about asthma, 2) taking asthma medication, or 3) having any symptoms of asthma. Agreement between classifications was assessed using the Kappa statistic. RESULTS: Among adults ever told by a health professional they have asthma, an estimated 72% had current asthma and 75% had active asthma. Overall, 67% of individuals met classifications of both current and active asthma and 20% had neither current nor active asthma (Kappa = 0.68). The Kappa increased to 0.72 when talking to a doctor about asthma was removed from the active asthma classification. CONCLUSIONS: Results indicated substantial agreement between current and active asthma. Agreement was strengthened when talking to a doctor about asthma was removed from the active asthma classification.

Racial and ethnic differences in asthma and mental health among US adults: results from the National Survey on Drug Use and Health.

OBJECTIVE: Evaluate the racial and ethnic differences in asthma and mental health comorbidity. METHODS: A secondary analysis of 2008-2013 National Survey on Drug Use and Health was conducted, resulting in a total of 206 993 civilian adult respondents to evaluate the association between asthma and mental health (past year serious psychological distress [SPD] and doctor diagnosis of depression). Both survey weighted bivariate (chi-square) and multivariable (binary logistic) regression analyses, after accounting for control variables, were conducted to evaluate the asthma/mental health nexus. A p value of less than 0.05 was used to denote significance. RESULTS: Current asthma was significantly associated with past year SPD for non-Hispanic Whites (adjusted odds ratio [aOR] = 1.45), Hispanics (aOR = 1.68), and Black/African Americans (aOR = 1.47). A similar association was noted for current asthma and past year doctor diagnosis of depression (non-Hispanic White aOR = 1.74; Hispanics aOR = 1.77; Black/African American aOR = 1.62). Among those with lifetime asthma, higher odds of SPD were reported for non-Hispanic Whites (aOR = 1.42), Hispanics (aOR = 1.64), and Black/African Americans (aOR = 1.50). Lifetime asthma also significantly associated with past year doctor diagnosis of depression for non-Hispanic Whites (aOR = 1.42), Hispanics (aOR = 1.41), and Black/African Americans (aOR = 1.46). CONCLUSION: Our results demonstrate the significant burden of asthma and mental health comorbidity among diverse racial and ethnic groups. Improved public health efforts through promotion of integrated care for early screening and preventive measures are needed to alleviate the burden for at-risk groups.

Assessing asthma severity among children and adults with current asthma.

BACKGROUND: Asthma severity is a key indicator to assess asthma care and management. Severity status may vary over time. Assessing asthma severity periodically is important for monitoring the health and well-being of people with asthma. OBJECTIVE: To assess population-based asthma severity and to identify related-risk factors among children and adults with asthma. METHODS: We used the 2006-2010 BRFSS child and adult Asthma Call-back Survey. Asthma severity was classified as intermittent or persistent. We performed multivariate logistic regression to identify related-risk factors. RESULTS: Overall, 63.8% of persons with asthma had persistent asthma. Persistent asthma was more prevalent among children aged 0-4 years (71.8%; prevalence rate ratio [PR] = 1.3). Among adults with current asthma, persistent asthma was more prevalent among those who were 45 years or older (aged 45-54: 69.4%; PR = 1.1, aged 55-64: 72.6%; PR = 1.2, and aged 65+: 77.8%; PR = 1.3); annual household incomes of <$15 000 (74.1%; PR = 1.1); and first diagnosed at age 55 years or older (first diagnosed at age 55-64: 80.4%; PR = 1.1, at age 65 + : 81.5%; PR = 1.1). The prevalence of persistent asthma was also higher among current smokers who were also exposed to secondhand smoke (SHS) (74.7%; PR = 1.1); and among those with Chronic Obstructive Pulmonary Disease (COPD) (77.1%; PR = 1.2). CONCLUSIONS: Nearly two-thirds of children and adults with asthma had persistent asthma. Identifying related-risk factors could help improve targeted interventions or strategies to reduce modifiable predictors (low income, smoking, and SHS) of increased asthma severity. Such strategies could improve asthma care and quality of life.

Asthma Control and Associated Factors Among Children with Current Asthma - Findings from the 2019 Child Behavioral Risk Factor Surveillance System - Asthma Call-Back Survey.

Purpose: This study aimed to determine the prevalence and correlates of uncontrolled asthma among children with current asthma in four US states. We also determined the rates and correlates of asthma-related hospitalization, urgent care center (UCC), or emergency department (ED) visits. Participants and Methods: We analyzed the 2019 Behavioral Risk Factor Surveillance Survey (BRFSS) Asthma Call-back Survey (ACBS) datasets. Asthma control status was classified as well-controlled or uncontrolled asthma based on day- and night-time asthma symptoms, activity limitation or use of rescue medications. Multivariable logistic regression models were used to identify the correlates of uncontrolled asthma and asthma-related hospitalization or UCC/ED visits. Results: Among 249 children with current asthma, 55.1% had uncontrolled asthma while 40% reported asthma-related hospitalization or UCC/ED visits in the past year. Non-Hispanic ethnicity, ages of 0-9 and 15-17 years, household income <$25,000, and not having a flu vaccination had higher odds of uncontrolled asthma. Conversely, asthma self-management education and households with two children compared to one were positively associated with uncontrolled asthma. For healthcare utilization, male and non-Hispanic children, along with those from households earning <$25,000 exhibited higher odds of asthma-related hospitalization and UCC/ED visits. Conclusion: Uncontrolled asthma and asthma-related visits to UCC/ED and hospitalization are common among children with current asthma. These outcomes are influenced by low household income and male sex, among other factors which call for multi-faceted interventions by healthcare providers and policymakers. Targeted strategies to effectively manage asthma and reduce the need for emergency healthcare services are recommended.

Asthma control and associated risk factors among adults with current asthma: Findings from 2019 behavioral risk factor surveillance system asthma call-back survey.

BACKGROUND: Despite the availability of effective treatments, many adults with asthma have uncontrolled asthma. Uncontrolled asthma can lead to severe exacerbations. This study aimed to determine the prevalence and predictors of uncontrolled asthma among adults (≥18 years) with current asthma in the United States. METHODS: We analyzed the 2019 Behavior Risk Factor Surveillance System Asthma Call-Back Survey data from 27 states. Asthma control status was classified as "well-controlled" or "uncontrolled" according to the National Asthma Education and Prevention guidelines. The study population consisted of 7937 adults (weighted n = 13,793,220) with current asthma. We used multivariable logistic regression models to identify predictors of uncontrolled asthma. RESULTS: Overall, 62 % of adults with asthma reported having uncontrolled asthma, and 26 % had emergency or urgent care visits or hospitalizations in the past year. Potentially modifiable risk factors associated with uncontrolled asthma included cost barriers to asthma-related healthcare (OR = 2.94; 95%CI 1.96-4.40), complementary and alternative medicine use (OR = 1.84; 95%CI 1.45-2.32), current smoking (OR = 2.25; 95%CI 1.48-3.44), obesity (OR = 1.39; 95%CI 1.02-1.89), COPD (OR = 1.98; 95%CI 1.43-2.74), depression (OR = 1.47; 95%CI 1.16-1.88), fair/poor general health (OR = 1.54; 95%CI 1.14-2.07), household income <$15,000 (OR = 2.59; 95%CI 1.42-4.71), and less than high school education (OR = 2.59; 95%CI 1.42-4.71). Non-modifiable risk factor was Hispanic ethnicity (OR = 1.73; 95%CI 1.09-2.73). CONCLUSION: Our findings suggest that uncontrolled asthma is common among adults and can be impacted by several factors. Effective asthma control programs are needed to improve asthma management and reduce unnecessary healthcare utilization.

Epidemiology of Current Asthma in Children Under 18: A Two-Decade Overview Using National Center for Health Statistics (NCHS) Data.

OBJECTIVE:  This study conducted a comprehensive two-decade analysis of current asthma among children under 18 in the United States using National Center for Health Statistics (NCHS) data. The primary objective was to assess the prevalence of current asthma, evaluate temporal trends, and identify disparities based on gender, age, insurance status, household poverty levels, and race/ethnicity. METHODS:  Data spanning 2003-2019 from NCHS were analyzed, focusing on current asthma prevalence among children under 18. Age-adjusted prevalence rates were calculated and stratified by various factors, including gender, age groups, health insurance status, poverty levels, and race/ethnicity. RESULTS:  The study revealed substantial disparities in current asthma prevalence. Over the two-decade period, the overall prevalence of current asthma fluctuated. It increased from 2003 (8.5%) to 2009 (9.6%) and then decreased by 2019 (7.0%). Gender disparities were evident, with males (9.9%) consistently reporting a higher prevalence than females (7.5%). Older children aged between 10-17 years (10.4%) consistently had a higher prevalence of asthma than younger children aged 0-4 (5.3%) and 5-9 years (9.5%). Children with Medicaid insurance (11.2%) had the highest prevalence, followed by insured (8.9%), privately insured (7.7%), and uninsured children (6.1%). Children living below the federal poverty level (FPL) consistently reported the highest prevalence (11.3%), while children above 400% of the FPL (7.1%) had the lowest prevalence. Racial disparities were observed, with Black children (14.3%) having higher asthma prevalence, followed by White (7.6%) and Asian children (5.4%). CONCLUSION: The study highlights significant disparities in current asthma prevalence over the two-decade period analyzed. While the overall prevalence showed fluctuations, it generally increased from 2003 to 2009 and then decreased by 2019. Gender disparities were evident, with males consistently reporting a higher prevalence compared to females. Older children in the 10-17 age group consistently had a higher asthma prevalence than younger age groups. Moreover, disparities based on insurance status and income levels were also apparent, with children on Medicaid and those living below the FPL reporting higher asthma prevalence. Racial disparities were observed, with Black children having the highest prevalence, followed by White and Asian children. These findings emphasize the importance of addressing these disparities and tailoring interventions to improve asthma management and prevention across different demographic groups.

Asthma Among Adults and Children by Urban-Rural Classification Scheme, United States, 2016-2018.

OBJECTIVES: Although data on the prevalence of current asthma among adults and children are available at national, regional, and state levels, such data are limited at the substate level (eg, urban-rural classification and county). We examined the prevalence of current asthma in adults and children across 6 levels of urban-rural classification in each state. METHODS: We estimated current asthma prevalence among adults for urban-rural categories in the 50 states and the District of Columbia and among children for urban-rural categories in 27 states by analyzing 2016-2018 Behavioral Risk Factor Surveillance System survey data. We used the 2013 National Center for Health Statistics 6-level urban-rural classification scheme to define urban-rural status of counties. RESULTS: During 2016-2018, the current asthma prevalence among US adults in medium metropolitan (9.5%), small metropolitan (9.5%), micropolitan (10.0%), and noncore (9.6%) areas was higher than the asthma prevalence in large central metropolitan (8.6%) and large fringe metropolitan (8.7%) areas. Current asthma prevalence in adults differed significantly among the 6 levels of urban-rural categories in 19 states. In addition, the prevalence of current asthma in adults was significantly higher in the Northeast (9.9%) than in the South (8.7%) and the West (8.8%). The current asthma prevalence in children differed significantly by urban-rural categories in 7 of 27 states. For these 7 states, the prevalence of asthma in children was higher in large central metropolitan areas than in micropolitan or noncore areas, except for Oregon, in which the prevalence in the large central metropolitan area was the lowest. CONCLUSIONS: Knowledge about county-level current asthma prevalence in adults and children may aid state and local policy makers and public health officers in establishing effective asthma control programs and targeted resource allocation.

Occupational Exposures to Organic Solvents and Asthma Symptoms in the CONSTANCES Cohort.

Solvents are used in many workplaces and may be airway irritants but few studies have examined their association with asthma. We studied this question in CONSTANCES (cohort of 'CONSulTANts des Centres d'Examens de Santé'), a large French cohort. Current asthma and asthma symptom scores were defined by participant-reported respiratory symptoms, asthma medication or attacks, and the sum of 5 symptoms, in the past 12 months, respectively. Lifetime exposures to 5 organic solvents, paints and inks were assessed by questionnaire and a population-based Job-Exposure Matrix (JEM). Cross-sectional associations between exposures and outcomes were evaluated by gender using logistic and negative binomial regressions adjusted for age, smoking habits and body mass index. Analyses included 115,757 adults (54% women, mean age 47 years, 9% current asthma). Self-reported exposure to ≥1 solvent was significantly associated with current asthma in men and women, whereas using the JEM, a significant association was observed only in women. Significant associations between exposures to ≥1 solvent and asthma symptom score were observed for both self-report (mean score ratio, 95%CI, women: 1.36, 1.31-1.42; men: 1.34, 1.30-1.40) and JEM (women: 1.10, 1.07-1.15; men: 1.14, 1.09-1.18). Exposure to specific solvents was significantly associated with higher asthma symptom score. Occupational exposure to solvents should be systematically sought when caring for asthma.

Health risk behaviors, violence exposure, and current asthma among adolescents in the United States.

BACKGROUND: Asthma may worsen during adolescence, due to both health risk behaviors and psychosocial stressors commonly encountered during this life stage. METHODS: Cross-sectional study of 24 612 high school students who participated in the 2009 and 2011 National Youth Risk Behavior Survey. Multivariable logistic regression was used to examine the relation between self-reported health risk behaviors or psychosocial stressors and current asthma. Mediation analysis was performed to assess whether depressive symptoms or suicidal behavior contribute to the link between psychosocial stressors and asthma. RESULTS: Current asthma was reported by 13.1% of the study participants. In a multivariable analysis, female sex, obesity, shorter sleep duration, frequent soda/pop consumption, and marijuana use were each significantly associated with 14-36% increased odds of asthma. Any violent behavior (adjusted odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.02-1.24), any victimization (OR = 1.43, 95%CI = 1.29-1.58), any suicidal behavior (OR = 1.41, 95%CI = 1.22-1.64) and having felt sad or hopeless in the past year (OR = 1.57, 95%CI = 1.40-1.75) were each associated with current asthma. In a mediation analyses, having felt sad/hopeless and suicidal behaviors accounted for 21% and 14%, respectively, of the victimization-asthma association. CONCLUSION: Potentially modifiable risk factors, including obesity, short sleep duration, frequent soda/pop consumption, and psychosocial stressors are associated with asthma in US adolescents. Promoting healthier lifestyles, as well as screening for violence exposure and treating depressive symptoms, could help reduce asthma burden in this population.

Serum cytokine profiles as predictors of asthma control in adults from the EGEA study.

BACKGROUND: To which extent serum cytokines may predict asthma control in adults remains understudied. OBJECTIVES: We investigated cross-sectional and longitudinal associations between cytokine profiles and asthma outcomes. METHODS: Serum interleukin (IL)-1Ra, IL-5, IL-7, IL-8, IL-10, IL-13 and TNF-α levels were determined in 283 adults with current asthma from the 2nd survey of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA2). Participants were followed-up seven years later. Asthma symptom control was assessed according to GINA 2015 guidelines. Cytokine profiles were identified by principal component (PC) analyses, and expressed as above/below the median. RESULTS: The first two PCs captured 82.5% of the variability. While all seven cytokines scored high on PC1, only IL-1Ra and IL-10 scored high on PC2. At EGEA2, neither PC1 nor PC2 were related to exacerbations, asthma attacks, asthma symptom control, lung function, or allergic diseases. High level of PC1 (above the median) was associated with higher blood neutrophil counts (P = 0.02), while high level of PC2 was associated with lower IgE levels (P = 0.04). High level of PC2 at EGEA2 was associated with lower bronchial hyperresponsiveness (adjusted(a) OR[95%CI] = 0.46[0.23; 0.91]) and with subsequent lower risk of worsening asthma control and attacks (aOR[95%CI] = 0.24[0.09; 0.60]; 0.31[0.11; 0.85] respectively). CONCLUSIONS: Serum cytokine profiles with high levels of IL-1Ra and IL-10 were associated with lower subsequent risks of worsening asthma control and attacks in adults. This study adds new findings for the role of serum cytokine profiles to help identifying adults with subsequent risk of asthma burden that could be targeted for specific therapies.

Current asthma contributes as much as smoking to chronic bronchitis in middle age: a prospective population-based study.

BACKGROUND AND OBJECTIVE: Personal smoking is widely regarded to be the primary cause of chronic bronchitis (CB) in adults, but with limited knowledge of contributions by other factors, including current asthma. We aimed to estimate the independent and relative contributions to adult CB from other potential influences spanning childhood to middle age. METHODS: The population-based Tasmanian Longitudinal Health Study cohort, people born in 1961, completed respiratory questionnaires and spirometry in 1968 (n=8,583). Thirty-seven years later, in 2004, two-thirds responded to a detailed postal survey (n=5,729), from which the presence of CB was established in middle age. A subsample (n=1,389) underwent postbronchodilator spirometry between 2006 and 2008 for the assessment of chronic airflow limitation, from which nonobstructive and obstructive CB were defined. Multivariable and multinomial logistic regression models were used to estimate relevant associations. RESULTS: The prevalence of CB in middle age was 6.1% (95% confidence interval [CI]: 5.5, 6.8). Current asthma and/or wheezy breathing in middle age was independently associated with adult CB (odds ratio [OR]: 6.2 [95% CI: 4.6, 8.4]), and this estimate was significantly higher than for current smokers of at least 20 pack-years (OR: 3.0 [95% CI: 2.1, 4.3]). Current asthma and smoking in middle age were similarly associated with obstructive CB, in contrast to the association between allergy and nonobstructive CB. Childhood predictors included allergic history (OR: 1.3 [95% CI: 1.1, 1.7]), current asthma (OR: 1.8 [95% CI: 1.3, 2.7]), "episodic" childhood asthma (OR: 2.3 [95% CI: 1.4, 3.9]), and parental bronchitis symptoms (OR: 2.5 [95% CI: 1.6, 4.1]). CONCLUSION: The strong independent association between current asthma and CB in middle age suggests that this condition may be even more influential than personal smoking in a general population. The independent associations of childhood allergy and asthma, though not childhood bronchitis, as clinical predictors of adult CB raise the possibility of some of this burden having originated in childhood.