Asthma epidemiology: risk factors, case finding, and the role of asthma coalitions

Asthma has no cure, and given that clinicians still do not understand what causes it in the first place, it is not preventable. With implementation of environmental control measures to minimize exposure to allergens and irritants, appropriate pharmacologic therapy, and patient and health care provider education, the disease can be managed successfully. Health care access and appropriate case management are essential components of any plan to address asthma as a public health problem. Asthma is now one of the most important diseases of childhood in developed countries. In the International Study of Asthma and Allergies in Childhood (ISAAC) study, the highest asthma prevalence was observed in westernized English-speaking countries (e.g., the United Kingdom, Australia, and New Zealand), with much lower prevalence rates in Eastern Europe, India, China, other countries in Asia, and Africa [18]. This observation has led to the belief that the rapid increases in asthma prevalence are more likely to be attributable to environmental than genetic factors. The rising prevalence in the United States and worldwide seems to be correlated with modern industrialization, suggesting that changes in the ambient environment may contribute to this increase in morbidity and mortality. Indoor factors that have been suggested to influence asthma pathogenesis include allergy to house dust mite and cockroaches, poor heating and ventilation, and exposure to cigarette smoke and other irritants. Scientific evaluation of the links between indoor and outdoor air pollution and asthma is incomplete, however. Much work remains to be done in defining the environmental factors that may cause asthma and that may trigger asthma exacerbations in individuals with the disease. Until then, clinicians must focus on developing a hard-hitting, comprehensive, interdisciplinary asthma program and work toward its successful and broad-based implementation. It is the only way to win the "war against asthma."