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Int J Sports Med 2000; 21(Suppl 2): 98-102
DOI: 10.1055/s-2000-8498
Georg Thieme Verlag Stuttgart ·New York

Asthma

W. Nystad
  • Section of Epidemiology, Department of Population Health Sciences, The National Institute of Public Health, Oslo, Norway
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Publication Date:
31 December 2000 (online)

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From an epidemiological point of view four issues are briefly emphasized here: the definition of asthma, time trends and regional differences, and risk factors for asthma. Furthermore, I will focus upon a few aspects regarding the relation between exercise and asthma. The definition of asthma has presented problems for those involved in studying the disease in general populations, where the estimates rely solely on reported asthma and respiratory symptoms. A standardized questionnaire does not fully overcome differences in languages and interpretations of the concepts of asthma and wheeze over time and in different communities. Although the belief of an upward trend of childhood asthma seems to be widely accepted, studies with the proper methodology to investigate this issue are scarce. The prevalence of asthma varies within and between countries. There is no clear urban rural gradient, and the prevalence of atopy appears to be higher in western than in eastern Europe. Amazingly little is still known about genetic and environmental factors that are causally related to the manifestation of allergic disorders in previously asymptomatic individuals. The effect of exercise on asthma may be many-sided. Children with asthma can actively take part in sport. However, to what extent extensive exercise may affect the occurrence of bronchial responsiveness is unclear, and among athletes exercise may be a risk factor for the development of “athlete's asthma”. In conclusion, epidemiological studies have to date not reached their potential due to the lack of longitudinal studies including objective measures of exposures and health outcomes. Causal inference is limited, and further studies designed to answer specific research questions are needed.

Key words:

Asthma, epidemiology, exercise, sports.

References

  • 1 Ciba Guest Symposium . Terminology, definitions and classifications of chronic pulmonary emphysema and related conditions.  Thorax. 1959;  14 286-299
    CrossrefPubMedGoogle Scholar
  • 2 Respiratory Health Effects of Passive Smoking .Lung Cancer and Other Disorders. Washington, DC; U.S. Environmental Protection Agency: EPA/600/6 - 90/006F 1992
    Google Scholar
  • 3 Aas K. Heterogeneity of bronchial asthma. Sub-populations - or different stages of the disease.  Allergy. 1981;  36 3-14
    PubMedGoogle Scholar
  • 4 American Thoracic Society . Definitions and classifications of chronic bronchitis, asthma and pulmonary emphysema.  Am Rev Respir Dis. 1962;  85 762-768
    PubMedGoogle Scholar
  • 5 Anderson H R, Butland B K, Strachan D P. Trends in prevalence and severity of childhood asthma.  BMJ. 1994;  308 1600-1604
    PubMedGoogle Scholar
  • 6 Anderson H R. Is asthma really increasing.  Paed Resp Med. 1993;  1 6-10
    PubMedGoogle Scholar
  • 7 Asher M I, Keil U, Anderson H R, Beasley R, Crane J, Martinez F D, Mitchell E A, Pearce N, Sibbald B, Stewart A W, Strachan D, Weiland S K, Williams H C. International study of asthma and allergies in childhood (ISAAC): rationale and methods.  Eur Respir J. 1995;  8 483-491
    CrossrefPubMedGoogle Scholar
  • 8 Austin J B, Russel G, Adam M G, Makintosch D, Kelsey S, Peck D F. Prevalence of asthma and wheeze in the Highlands of Scotland.  Arch Dis Child. 1994;  71 211-216
    PubMedGoogle Scholar
  • 9 Barry D, Burr M L, Limb E S. Prevalence of asthma among 12 year old children in New Zealand and South Wales: a comparative surrey.  Thorax. 1991;  46 405-409
    PubMedGoogle Scholar
  • 10 Bjørksten B. Risk factors in early childhood for the development of atopic diseases.  Allergy. 1994;  49 400-407
    PubMedGoogle Scholar
  • 11 Bjørksten B. Environmental factors and respiratory hypersensitivity: Experiences from studies in Eastern and Western Europe.  Toxicology Letters. 1996;  86 93-98
    CrossrefPubMedGoogle Scholar
  • 12 Bjørksten B. The intrauterine and postnatal environments.  J Allergy Clin Immunol. 1999;  104 1119-1127
    PubMedGoogle Scholar
  • 13 Brunekreef B, Dockery D, Krzyanowski M. Epidemiologic studies on short term-effects of low levels of major ambient air pollution components.  Environ Health Perspect. 1995;  103 3-13
    PubMedGoogle Scholar
  • 14 Bråbæck L, Breborowicz A, Dreborg S, Knutsson A, Pieklik H, Bjørksten B. Atopic sensitization and respiratory symptoms among Polish and Swedish school children.  Clin Exp Allergy. 1994;  24 826-835
    PubMedGoogle Scholar
  • 15 Burney P GJ, Chinn S, Rona R J. Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973 - 86.  BMJ. 1990;  300 1306-1310
    PubMedGoogle Scholar
  • 16 Burr M L, Butland B K, King S, Vaughan-Williams E. Changes in asthma prevalence: two surveys 15 years apart.  Arch Dis Child. 1989;  64 1452-1456
    PubMedGoogle Scholar
  • 17 Carlsen K H, Oseid S, Odden H, Mellbye E. The response to heavy swimming exercise in children with and without bronchial asthma. In: Oseid S, Carlsen KH (eds) Children and Exercise XIII. Champaign, Illinois; Human Kinetics Publishers 1989: 351-360
    Google Scholar
  • 18 Clark C J. Asthma and exercise: a suitable case for rehabilitation?.  Thorax. 1992;  47 765-767
    PubMedGoogle Scholar
  • 19 Cookson W OCM, Moffatt M F. Asthma: An epidemic in the absence of infection?.  Science. 1997;  275 41-42
    CrossrefPubMedGoogle Scholar
  • 20 Dodge R R, Burrows B. The prevalence and incidence of asthma-like symptoms in a general population sample.  Am Rev Respir. Dis 1980;  122 557-575
    PubMedGoogle Scholar
  • 21 Duffy D, Martin N, Battistutta D, Hopper J. Genetics of asthma and hay fever in Australian twins.  Am Rev Respir Dis. 1990;  142 1351-1358
    CrossrefPubMedGoogle Scholar
  • 22 Fitch K D. Management of allergic Olympic athletes.  J Allergy Clin Immunol. 1984;  73 722-727
    CrossrefPubMedGoogle Scholar
  • 23 Freed A N. Models and mechanisms of exercise-induced asthma.  Eur Respir. J 1995;  8 1770-1785
    PubMedGoogle Scholar
  • 24 Hanrahan J, Tager I, Castile R, Segal M, Weiss S, Speizer F. Pulmonary function measures in healthy infants.  Am Rev Respir Dis. 1990;  140 1127-1135
    PubMedGoogle Scholar
  • 25 Harris J R, Nystad W, Magnus P. Using genes and environment to define asthma and related phenotypes: applications to multivariate data.  Clin Exp Allergy. 1998;  28 43-45
    CrossrefPubMedGoogle Scholar
  • 26 Harris J R, Magnus P, Samuelsen S O, Tambs K. No evidence for effects of family environment on asthma.  Am J Respir Crit Care Med. 1997;  156 43-49
    PubMedGoogle Scholar
  • 27 Heir T. Longitudinal variation in bronchial responsiveness in cross-country skiers and control subjects.  Scand J Med Sci Sports. 1994;  4 134-139
    PubMedGoogle Scholar
  • 28 Heir T, Oseid S. Self-reported asthma and exercise-induced asthma symptoms in high-level competitive cross-country skiers.  Scand J Med Sci Sports. 1994;  4 128-133
    PubMedGoogle Scholar
  • 29 Hill R, Williams J, Tattersfield A, Britton J. Changes in use of asthma as a diagnostic label for wheezing illness in schoolchildren.  Br Med J. 1989;  299 898
    CrossrefPubMedGoogle Scholar
  • 30 Holt P G, Sly P D. Allergic respiratory disease: strategic targets for primary prevention during childhood.  Thorax. 1997;  52 1-4
    PubMedGoogle Scholar
  • 31 Larsson K, Ohlsen P, Larsson L, Malmberg P, Rydstøm P O, Ulriksen H. High prevalence of asthma in cross country skiers.  BMJ. 1993;  307 1326-1329
    PubMedGoogle Scholar
  • 32 Larsson L, Hemmingson P, Boethius G. Self-reported obstructive airway symptoms are common in young cross-country skiers.  Scand J Med Sci Sports. 1994;  4 124-127
    PubMedGoogle Scholar
  • 33 Lenney W, Wells N-E J, O'Neill B A. The budren of paediatric asthma.  Eur Respir rev. 1994;  4 49-62
    PubMedGoogle Scholar
  • 34 Magnus P, Jaakkola J K. Secular trend in the occurrence of asthma among children and young adults: critical appraisal of repeated cross sectional surveys.  BMJ. 1997;  314 1795-1799
    PubMedGoogle Scholar
  • 35 Makker H K, Holgate S T. Mechanisms of exercise-induced asthma.  Eur J Clin Invest. 1994;  24 571-585
    PubMedGoogle Scholar
  • 36 Mc Fadden E Jr, Gilbert I A. Execise-induced asthma.  N Engl J Med. 1994;  330 1362-1367
    CrossrefPubMedGoogle Scholar
  • 37 Mitchell E A, Asher A. Prevalence, severity and medical management of asthma in European school children in 1985 and 1991.  J Paediatr Child Health. 1994;  30 398-402
    PubMedGoogle Scholar
  • 38 Muns G. Effect of long-distance running on polymorphonuclear neutrophil phagocytic function of the upper airways.  Int J Sports Med. 1993;  15 96-99
    PubMedGoogle Scholar
  • 39 Nafstad P, Øie L, Mehl R, Gaarder P I, Lødrup-Carlsen K C, Botten G, Magnus P, Jaakkola J K. Residential dampness problems and symptoms and signs of bronchial obstruction in young Norwegian children.  Am J Respir Crit Care Med. 1998;  157 410-414
    PubMedGoogle Scholar
  • 40 Nieman D. Exercise, upper respiratory tract infection, and the immune system.  Med Sci Sports Exerc. 1994;  26 128-139
    PubMedGoogle Scholar
  • 41 Nieman DC. Upper respiratory tract infections and exercise.  Thorax. 1995;  50 1229-1231
    PubMedGoogle Scholar
  • 42 Nystad W, Harris J R, Borgen S J. Asthma and wheezing among Norwegian elite athletes.  Med Sci Sports Exerc. 2000;  32 266-270
    PubMedGoogle Scholar
  • 43 Nystad W. The physical activity level of children with asthma.  Scand J Med Sci Sports. 1997;  7 331-335
    CrossrefPubMedGoogle Scholar
  • 44 Nystad W, Magnus P, Røksund O, Svidal B, Hetlevik Ø. The prevalence of respiratory symptoms and asthma among school children in three different areas of Norway.  Pediatr Allergy Immunol. 1997;  8 35-40
    PubMedGoogle Scholar
  • 45 Omran M, Russel G. Continuing increase in respiratory symptoms and atopy in Aberdeen schoolchildren.  BMJ. 1996;  312 34
    PubMedGoogle Scholar
  • 46 Peat J K, van den Berg R H, Green W F, Mellis C M, Leeder S R, Woolcock A J. Changing prevalence of asthma in Australian children.  BMJ. 1994;  308 1591-1596
    PubMedGoogle Scholar
  • 47 Pearce N, Pekkanen J, Beasley R. How much asthma is really attribuable to atopy?.  Thorax. 1999;  54 268-272
    PubMedGoogle Scholar
  • 48 Platts-Mills T A. How environment affects patients with disease: indoor allergens and asthma.  Ann Allergy. 1994;  72 381-384
    PubMedGoogle Scholar
  • 49 Platts-Mills T A, Ward G W. Epidemiology of the relationship between exposure to indoor allergen and asthma.  Int Arch Allergy Appl Immunol. 1991;  94 339-345
    PubMedGoogle Scholar
  • 50 Redline S, Gold D. Challenges in interpreting gender differences in asthma.  Am J Respir Crit Care Med. 1994;  150 1219-1221
    PubMedGoogle Scholar
  • 51 Rice S G, Bierman C W, Shapiro G G, Furukawa C T, Pierson W E. Identification of exercise-induced asthma among intercollegiate athletes.  Ann Allergy. 1985;  55 790-793
    PubMedGoogle Scholar
  • 52 Rimpelæ A H, Savonius B, Rimpelæ M K, Haahtela T. Asthma and allergic rhinitis among Finnish adolescents in 1977 - 1991.  Scand J Soc Med. 1995;  23 60-65
    PubMedGoogle Scholar
  • 53 Santuz P, Baraldi E, Filippone M, Zachello F. Exercise performance in children with asthma: is it different from that of healthy controls?.  Eur Respir J. 1997;  10 1254-1260
    CrossrefPubMedGoogle Scholar
  • 54 Shaw R A, Crane J, Pearce N E. Validation of a video questionnaire for assessing asthma prevalence.  Clin Exp Allergy. 1992;  22 562-569
    PubMedGoogle Scholar
  • 55 Shaw R A, Crane J, O'Donell T V, Porteus L E, Coleman E D. Increasing asthma prevalence in a rural New Zealand adolescent population: 1975 - 1989.  Arch Dis Child. 1990;  65 1319-1323
    PubMedGoogle Scholar
  • 56 Shaw R, Woodman K, Ayson M, Dibdin S, Winkelman R, Crane J, Beasley R, Pearce N. Measuring the prevalence of bronchial hyper-responsiveness in children.  Int J Epidemiol. 1995;  24 597-602
    PubMedGoogle Scholar
  • 57 Sheffer A L, Bousquet J, Busse W W, Clark T, Dahl R, Evans D, Fabbri L M, Hargreave F E, Holgate S T. International consesus report on diagnosis and treatment of asthma.  Eur Respir J. 1992;  5 601-641
    PubMedGoogle Scholar
  • 58 Sherman C B, Tosteson T D, Tager I B. Early childhood predictors of asthma.  Am J Epidemiol. 1990;  132 83-95
    PubMedGoogle Scholar
  • 59 Sherman C B, Tosteson T D, Tager I B, Speizer F E, Weiss S T. Early childhood predictors of asthma.  Am J Epidemiol. 1990;  132 83-95
    PubMedGoogle Scholar
  • 60 Sibbald B, Horn M, Gregg I. A family study of the genetic basis of asthma and wheezy bronchitis.  Arch Dis Child. 1980;  55 354-357
    PubMedGoogle Scholar
  • 61 Skadhauge L, Christensen K, Kyvik K, Sigsgaard T. Genetic and environmental influence on asthma: a population-based study of 11 688 Danish twin pairs.  Eur Respir J. 1999;  13 8-14
    CrossrefPubMedGoogle Scholar
  • 62 Strachan D P. Hay fever, hygiene and household size.  BMJ. 1989;  299 1259-1260
    CrossrefPubMedGoogle Scholar
  • 63 Strachan D P, Anderson H R, Limbs E S, O'Neill A, Wells N. A national survey of asthma prevalence, severity, and treatment in Great Britain.  Arch Dis Child. 1994;  70 174-178
    PubMedGoogle Scholar
  • 64 Sue-Chu M, Karjalainen A, Altraja A, Laitinen L, Naess A, Larsson L, Bjermer L. Lymphoid aggregates in endobronchial biopsis from young elite cross-country skiers.  Am J Respir Crit Care Med. 1998;  158 597-601
    PubMedGoogle Scholar
  • 65 Sue-Chu M, Larsson L, Moen T, Rennard S I, Bjermer L. Bronchoscopy and bronchoalveolar lavage findings in cross-country skiers with and without “ski asthma”.  Eur Respir J. 1999;  13 626-632
    CrossrefPubMedGoogle Scholar
  • 66 Taylor W R, Newacheck P W. Impact of childhood asthma on health.  Pediatrics. 1992;  90 657-662
    PubMedGoogle Scholar
  • 67 Tepper R, Morgan W, Cota K, Wright A, Taussig L. Physiologic growth and development of the lung during the first years of life.  Am Rev Respir Dis. 1986;  134 513-519
    PubMedGoogle Scholar
  • 68 The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee . Worldwide variations in the prevalence of asthma symptoms: The International Study of Asthma and Allergies in Childhood (ISAAC).  Eur Respir J. 1998;  12 315-340
    CrossrefPubMedGoogle Scholar
  • 69 The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee . Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC.  Lancet. 1998;  351 1225-1232
    CrossrefPubMedGoogle Scholar
  • 70 Vall O, Sancho N, Sunyer J, Anto J M, Busquets R M. Prevalence of asthma-related symptoms and bronchial responsiveness to exercise in children 13 - 14 years in Barcelona, Spain.  Eur Respir J. 1996;  9 2094-2098
    CrossrefPubMedGoogle Scholar
  • 71 von Mutius E, Martinez F D, Fritzsch C, Nicolai T, Roell G, Thieman H H. Prevalence of asthma and atopy in two areas of West and East Germany.  Am J Respir Crit Care Med. 1994;  149 358-364
    PubMedGoogle Scholar
  • 72 Voy R O. The US Olympic Committee experience with exercise-induced bronchospasm, 1984.  Med Sci Sports Exerc. 1986;  18 328-330
    PubMedGoogle Scholar
  • 73 Wardlaw A J. The role of air pollution in asthma.  Clin Exp Allergy. 1993;  23 81-96
    PubMedGoogle Scholar
  • 74 Weiler J M, Metzger W J, Donnelly A L, Crowley E T, Sharat M D. Prevalence of bronchial hyperresponsiveness in highly trained athletes.  Chest. 1986;  90 23-28
    PubMedGoogle Scholar
  • 75 Wilson N, Silverman M. Bronchial responsiveness and its measurement. In: Silverman M (ed) Childhood asthma and other wheezing disorders. London; Chapman & Hall 1995: 141-174
    Google Scholar

W. Nystad

Section of Epidemiology Department of Population Health Sciences The National Institute of Public Health

Box 4404, Torshov 0403 Oslo Norway

Phone: Phone:+ (47) 22042394

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