• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. May 2001; 56(5): 406–411.
PMCID: PMC1746034

Continuing the debate about measuring asthma in population studies

Abstract

The reasons for measuring atopy and airway hyperresponsiveness (AHR) and the methods of validating measurements of asthma in population studies continue to be debated. The debate has centred around standards against which to validate asthma measurements but the absence of a "gold standard" makes the criterion validation of measurements difficult. Questionnaires will always be useful but cannot be validated against a doctor diagnosis because of self-selection and recall biases. In practice, measurements should be selected on the merits of what they measure rather than being regarded as validated or non-validated alternatives. The measurement of AHR is invaluable because it is reliable, not influenced by variations in symptom perception or diagnostic trends, and is closely related to the underlying mechanisms of asthma. The value of AHR lies in its high specificity (rate of true negatives) and low sensitivity (rate of false positives) against asthma symptoms which gives additional information about symptomatic subjects. Atopy is also a useful test and, in quantifying its association with asthma, we should not place any currency on ecological evidence. Atopy is a strong risk factor for asthma in the presence of regionally specific allergens and ecological analyses that ignore these effects are diversionary rather than productive. For preventing asthma, we need to identify the group at greatest risk of developing it, measure the risk factors with precision, and develop interventions that are effective in changing environmental exposures and homogenous outcomes. This is the only approach that has the potential to lead to significant public health benefits.

Full Text

The Full Text of this article is available as a PDF (113K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Pearce N, Beasley R, Pekkanen J. Role of bronchial responsiveness testing in asthma prevalence surveys. Thorax. 2000 May;55(5):352–354. [PMC free article] [PubMed]
  • Pearce N, Pekkanen J, Beasley R. How much asthma is really attributable to atopy? Thorax. 1999 Mar;54(3):268–272. [PMC free article] [PubMed]
  • Pearce N, Douwes J, Beasley R. Is allergen exposure the major primary cause of asthma? Thorax. 2000 May;55(5):424–431. [PMC free article] [PubMed]
  • Pekkanen J, Pearce N. Defining asthma in epidemiological studies. Eur Respir J. 1999 Oct;14(4):951–957. [PubMed]
  • von Mutius E, Fritzsch C, Weiland SK, Röll G, Magnussen H. Prevalence of asthma and allergic disorders among children in united Germany: a descriptive comparison. BMJ. 1992 Dec 5;305(6866):1395–1399. [PMC free article] [PubMed]
  • Duhme H, Weiland SK, Rudolph P, Wienke A, Kramer A, Keil U. Asthma and allergies among children in West and East Germany: a comparison between Münster and Greifswald using the ISAAC phase I protocol. International Study of Asthma and Allergies in Childhood. Eur Respir J. 1998 Apr;11(4):840–847. [PubMed]
  • Jõgi R, Janson C, Björnsson E, Boman G, Björkstén B. Atopy and allergic disorders among adults in Tartu, Estonia compared with Uppsala, Sweden. Clin Exp Allergy. 1998 Sep;28(9):1072–1080. [PubMed]
  • Gislason D, Björnsson E, Gislason T, Janson C, Sjöberg O, Elfman L, Boman G. Sensitization to airborne and food allergens in Reykjavík (Iceland) and Uppsala (Sweden) - a comparative study. Allergy. 1999 Nov;54(11):1160–1167. [PubMed]
  • Peat JK, Tovey E, Toelle BG, Haby MM, Gray EJ, Mahmic A, Woolcock AJ. House dust mite allergens. A major risk factor for childhood asthma in Australia. Am J Respir Crit Care Med. 1996 Jan;153(1):141–146. [PubMed]
  • Rona RJ, Chinn S, Burney PG. Trends in the prevalence of asthma in Scottish and English primary school children 1982-92. Thorax. 1995 Sep;50(9):992–993. [PMC free article] [PubMed]
  • Luyt DK, Burton PR, Simpson H. Epidemiological study of wheeze, doctor diagnosed asthma, and cough in preschool children in Leicestershire. BMJ. 1993 May 22;306(6889):1386–1390. [PMC free article] [PubMed]
  • Beasley R, Pearce N, Crane J. International trends in asthma mortality. Ciba Found Symp. 1997;206:140–159. [PubMed]
  • Toelle BG, Peat JK, Salome CM, Mellis CM, Woolcock AJ. Toward a definition of asthma for epidemiology. Am Rev Respir Dis. 1992 Sep;146(3):633–637. [PubMed]
  • Peat JK, Salome CM, Bauman A, Toelle BG, Wachinger SL, Woolcock AJ. Repeatability of histamine bronchial challenge and comparability with methacholine bronchial challenge in a population of Australian schoolchildren. Am Rev Respir Dis. 1991 Aug;144(2):338–343. [PubMed]
  • Peat JK, Toelle BG, Mellis CM. Problems and possibilities in understanding the natural history of asthma. J Allergy Clin Immunol. 2000 Sep;106(3 Suppl):S144–S152. [PubMed]
  • Peat JK, Toelle BG, Gray EJ, Haby MM, Belousova E, Mellis CM, Woolcock AJ. Prevalence and severity of childhood asthma and allergic sensitisation in seven climatic regions of New South Wales. Med J Aust. 1995 Jul 3;163(1):22–26. [PubMed]
  • Sears MR, Herbison GP, Holdaway MD, Hewitt CJ, Flannery EM, Silva PA. The relative risks of sensitivity to grass pollen, house dust mite and cat dander in the development of childhood asthma. Clin Exp Allergy. 1989 Jul;19(4):419–424. [PubMed]
  • Britton J, Pavord I, Richards K, Knox A, Wisniewski A, Wahedna I, Kinnear W, Tattersfield A, Weiss S. Factors influencing the occurrence of airway hyperreactivity in the general population: the importance of atopy and airway calibre. Eur Respir J. 1994 May;7(5):881–887. [PubMed]
  • Halonen M, Stern DA, Wright AL, Taussig LM, Martinez FD. Alternaria as a major allergen for asthma in children raised in a desert environment. Am J Respir Crit Care Med. 1997 Apr;155(4):1356–1361. [PubMed]
  • Burrows B, Sears MR, Flannery EM, Herbison GP, Holdaway MD. Relations of bronchial responsiveness to allergy skin test reactivity, lung function, respiratory symptoms, and diagnoses in thirteen-year-old New Zealand children. J Allergy Clin Immunol. 1995 Feb;95(2):548–556. [PubMed]
  • Peat JK, Li J. Reversing the trend: reducing the prevalence of asthma. J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):1–10. [PubMed]
  • Peat JK, Tovey E, Mellis CM, Leeder SR, Woolcock AJ. Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia. Clin Exp Allergy. 1993 Oct;23(10):812–820. [PubMed]
  • Arshad SH, Stevens M, Hide DW. The effect of genetic and environmental factors on the prevalence of allergic disorders at the age of two years. Clin Exp Allergy. 1993 Jun;23(6):504–511. [PubMed]
  • Chan-Yeung M, Manfreda J, Dimich-Ward H, Ferguson A, Watson W, Becker A. A randomized controlled study on the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants. Arch Pediatr Adolesc Med. 2000 Jul;154(7):657–663. [PubMed]
  • Peat JK, Gray EJ, Mellis CM, Leeder SR, Woolcock AJ. Differences in airway responsiveness between children and adults living in the same environment: an epidemiological study in two regions of New South Wales. Eur Respir J. 1994 Oct;7(10):1805–1813. [PubMed]
  • Gøtzsche PC, Hammarquist C, Burr M. House dust mite control measures in the management of asthma: meta-analysis. BMJ. 1998 Oct 24;317(7166):1105–1110. [PMC free article] [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...