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Prospects for preventing asthma
  1. PETER J HELMS,
  2. GORDON CHRISTIE
  1. Department of Child Health
  2. University of Aberdeen Medical School
  3. Foresterhill, Aberdeen AB25 2ZD, UK
  4. email: p.j.helms@abdn.ac.uk

    https://doi.org/10.1136/adc.80.5.401

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      There is substantial evidence from epidemiological surveys that asthma prevalence has increased significantly in the school age population over the past 30 years.1-6 In children in one community, doctor diagnosed asthma increased from 4.1% in 1964 to 10.2% in 19891 and to 19.6% in 1994.3 In part these results may reflect increased awareness of symptoms and diagnostic transfer, although these effects are unlikely to explain the magnitude of the changes.4 Increases in the prevalence of bronchial hyperresponsiveness (BHR), such as induced falls in peak expiratory flow on exercise5 or methacholine bronchial challenge testing6 have also been reported, supporting a true increase in the prevalence of asthma. It is also becoming apparent that this increase is mainly in children from “low risk” families; those with no strong family history of atopic disease.7 8Assuming that the reported increase in asthma is real, are there opportunities to reduce the prevalence and turn the clock back to an earlier time when asthma was less common?

      Which population?

      If an intervention is to be assessed an important question must be what is the appropriate population for such an intervention? There is no doubt that allergen sensitisation and atopic disorders are more prevalent in high risk children; those with one or both parents with an atopic history. However, the environmental contribution is arguably greater than the genetic contribution, as shown by the relatively low concordance of atopic sensitisation and atopic symptoms in identical twins: as low as 20% in a large twin study.9 The significant increase in asthma and wheezing illness in the UK and other industrialised countries over the past 30 years also points to a significant environmental contribution. Although there is evidence from a birth cohort7 and cross sectional studies8that the large increase in …

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