Prevalence, risk factors, and management of asthma in China: a national cross-sectional study.

Administration, Inhalation Adrenal Cortex Hormones / therapeutic use Adult Asthma / drug therapy Bronchitis / complications China / epidemiology Cigarette Smoking / adverse effects Cross-Sectional Studies Disease Management Female Humans Male Middle Aged Pneumonia / complications Prevalence Rhinitis, Allergic / complications Risk Factors Surveys and Questionnaires

Journal

Lancet (London, England)
ISSN: 1474-547X
Titre abrégé: Lancet
Pays: England
ID NLM: 2985213R

Informations de publication

Date de publication:
03 08 2019
Historique:
received: 13 02 2019
revised: 30 04 2019
accepted: 07 05 2019
pubmed: 25 6 2019
medline: 27 8 2019
entrez: 25 6 2019
Statut: ppublish

Résumé

Asthma is a common chronic airway disease worldwide. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of asthma. We therefore aimed to estimate the national prevalence of asthma in a representative sample of the Chinese population. A representative sample of 57 779 adults aged 20 years or older was recruited for the national cross-sectional China Pulmonary Health (CPH) study using a multi-stage stratified sampling method with parameters derived from the 2010 census. Ten Chinese provinces, representative of all socioeconomic settings, from six geographical regions were selected, and all assessments were done in local health centres. Exclusion criteria were temporary residence, inability to take a spirometry test, hospital treatment of cardiovascular conditions or tuberculosis, and pregnancy and breastfeeding. Asthma was determined on the basis of a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. All participants were assessed with a standard asthma questionnaire and were classed as having or not having airflow limitation through pulmonary function tests before and after the use of a bronchodilator (400 μg of salbutamol). Risk factors for asthma were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was assessed by the self-reported history of physician diagnosis, treatments, and hospital visits in people with asthma. Between June 22, 2012, and May 25, 2015, 57 779 participants were recruited into the CPH study. 50 991 (21 446 men and 29 545 women) completed the questionnaire survey and had reliable post-bronchodilator pulmonary function test results and were thus included in the final analysis. The overall prevalence of asthma in our sample was 4·2% (95% CI 3·1-5·6), representing 45·7 million Chinese adults. The prevalence of asthma with airflow limitation was 1·1% (0·9-1·4), representing 13·1 million adults. Cigarette smoking (odds ratio [OR] 1·89, 95% CI 1·26-2·84; p=0·004), allergic rhinitis (3·06, 2·26-4·15; p<0·0001), childhood pneumonia or bronchitis (2·43, 1·44-4·10; p=0·002), parental history of respiratory disease (1·44, 1·02-2·04; p=0·040), and low education attainment (p=0·045) were associated with prevalent asthma. In 2032 people with asthma, only 28·8% (95% CI 19·7-40·0) reported ever being diagnosed by a physician, 23·4% (13·9-36·6) had a previous pulmonary function test, and 5·6% (3·1-9·9) had been treated with inhaled corticosteroids. Furthermore, 15·5% (11·4-20·8) people with asthma reported at least one emergency room visit and 7·2% (4·9-10·5) at least one hospital admission due to exacerbation of respiratory symptoms within the preceding year. Asthma is prevalent but largely undiagnosed and undertreated in China. It is crucial to increase the awareness of asthma and disseminate standardised treatment in clinical settings to reduce the disease burden. National Key R&D Program of China, Ministry of Science and Technology of China; the Special Research Foundation for Public Welfare of Health, Ministry of Health of China; the Chinese National Research Program for Key Issues in Air Pollution Control; and the National Natural Science Foundation of China.

Sections du résumé

BACKGROUND
Asthma is a common chronic airway disease worldwide. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of asthma. We therefore aimed to estimate the national prevalence of asthma in a representative sample of the Chinese population.
METHODS
A representative sample of 57 779 adults aged 20 years or older was recruited for the national cross-sectional China Pulmonary Health (CPH) study using a multi-stage stratified sampling method with parameters derived from the 2010 census. Ten Chinese provinces, representative of all socioeconomic settings, from six geographical regions were selected, and all assessments were done in local health centres. Exclusion criteria were temporary residence, inability to take a spirometry test, hospital treatment of cardiovascular conditions or tuberculosis, and pregnancy and breastfeeding. Asthma was determined on the basis of a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. All participants were assessed with a standard asthma questionnaire and were classed as having or not having airflow limitation through pulmonary function tests before and after the use of a bronchodilator (400 μg of salbutamol). Risk factors for asthma were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was assessed by the self-reported history of physician diagnosis, treatments, and hospital visits in people with asthma.
FINDINGS
Between June 22, 2012, and May 25, 2015, 57 779 participants were recruited into the CPH study. 50 991 (21 446 men and 29 545 women) completed the questionnaire survey and had reliable post-bronchodilator pulmonary function test results and were thus included in the final analysis. The overall prevalence of asthma in our sample was 4·2% (95% CI 3·1-5·6), representing 45·7 million Chinese adults. The prevalence of asthma with airflow limitation was 1·1% (0·9-1·4), representing 13·1 million adults. Cigarette smoking (odds ratio [OR] 1·89, 95% CI 1·26-2·84; p=0·004), allergic rhinitis (3·06, 2·26-4·15; p<0·0001), childhood pneumonia or bronchitis (2·43, 1·44-4·10; p=0·002), parental history of respiratory disease (1·44, 1·02-2·04; p=0·040), and low education attainment (p=0·045) were associated with prevalent asthma. In 2032 people with asthma, only 28·8% (95% CI 19·7-40·0) reported ever being diagnosed by a physician, 23·4% (13·9-36·6) had a previous pulmonary function test, and 5·6% (3·1-9·9) had been treated with inhaled corticosteroids. Furthermore, 15·5% (11·4-20·8) people with asthma reported at least one emergency room visit and 7·2% (4·9-10·5) at least one hospital admission due to exacerbation of respiratory symptoms within the preceding year.
INTERPRETATION
Asthma is prevalent but largely undiagnosed and undertreated in China. It is crucial to increase the awareness of asthma and disseminate standardised treatment in clinical settings to reduce the disease burden.
FUNDING
National Key R&D Program of China, Ministry of Science and Technology of China; the Special Research Foundation for Public Welfare of Health, Ministry of Health of China; the Chinese National Research Program for Key Issues in Air Pollution Control; and the National Natural Science Foundation of China.

Identifiants

DOI: 10.1016/S0140-6736(19)31147-X PMID: 31230828
pubmed: 31230828
pii: S0140-6736(19)31147-X
doi: 10.1016/S0140-6736(19)31147-X
pii:
doi:

Substances chimiques

Adrenal Cortex Hormones 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

407-418

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2019 Elsevier Ltd. All rights reserved.

Auteurs

Kewu Huang (K)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Ting Yang (T)

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China.

Jianying Xu (J)

Department of Pulmonary and Critical Care Medicine, Shanxi Dayi Hospital, Taiyuan, China.

Lan Yang (L)

Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Jianping Zhao (J)

Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Xiangyan Zhang (X)

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China.

Chunxue Bai (C)

Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.

Jian Kang (J)

Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China.

Pixin Ran (P)

State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.

Huahao Shen (H)

Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.

Fuqiang Wen (F)

State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.

Yahong Chen (Y)

Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.

Tieying Sun (T)

Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China; National Center of Gerontology, Beijing Hospital, Beijing, China.

Guangliang Shan (G)

Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.

Yingxiang Lin (Y)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Guodong Xu (G)

Institute of Clinical Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.

Sinan Wu (S)

Institute of Clinical Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China.

Chaolong Wang (C)

School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Ruiying Wang (R)

Department of Pulmonary and Critical Care Medicine, Shanxi Dayi Hospital, Taiyuan, China.

Zhihong Shi (Z)

Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Yongjian Xu (Y)

Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Xianwei Ye (X)

Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China.

Yuanlin Song (Y)

Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.

Qiuyue Wang (Q)

Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China.

Yumin Zhou (Y)

State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.

Wen Li (W)

Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.

Liren Ding (L)

Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.

Chun Wan (C)

State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.

Wanzhen Yao (W)

Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.

Yanfei Guo (Y)

Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China; National Center of Gerontology, Beijing Hospital, Beijing, China.

Fei Xiao (F)

National Center of Gerontology, Beijing Hospital, Beijing, China.

Yong Lu (Y)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Xiaoxia Peng (X)

Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.

Biao Zhang (B)

Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.

Dan Xiao (D)

Tobacco Medicine and Tobacco Cessation Center, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China.

Zuomin Wang (Z)

Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

Zhengming Chen (Z)

Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Xiaoning Bu (X)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Hong Zhang (H)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Xiaolei Zhang (X)

Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China.

Li An (L)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Shu Zhang (S)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Jianguo Zhu (J)

National Center of Gerontology, Beijing Hospital, Beijing, China.

Zhixin Cao (Z)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Qingyuan Zhan (Q)

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China.

Yuanhua Yang (Y)

Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Lirong Liang (L)

Department of Epidemiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.

Xunliang Tong (X)

Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China.

Huaping Dai (H)

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China.

Bin Cao (B)

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China.

Tangchun Wu (T)

School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Kian Fan Chung (KF)

National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Trust, London, UK.

Jiang He (J)

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

Chen Wang (C)

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: cyh-birm@263.net.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Voies d'administration de substances chimiques et des médicaments › Administration par inhalation › Prevalence, risk factors, and management of...
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