22. Epidemiology and prevention of asthma

Epidemiology
- Prevalence: 7% in world
  - Increasing
- Black > white
- Mostly in children
- Allergic asthma – childhood onset
- Nonallergic asthma – adulthood onset
Etiology
- For allergic asthma
  - Atopy
    - Allergic rhinitis
    - Eczema
  - Air pollution
  - Allergies
    - Mold
    - Dust mite
- For non-allergic asthma
  - Respiratory infections in childhood
- Both
  - Smoking or second-hand smoke
  - Low socioeconomic status
  - Obesity
  - Occupational air pollution exposure
Prognosis
- Developing countries have fewer medications and options for treatment -> higher mortality and morbidity
- Therapy is expensive
- 80% of deaths in low income countries
Prevention
- Primary
  - Prevention of development of atopy
  - Breastfeeding
  - Prevention of passive smoking
  - Adequate control of childhood infections
- Secondary
  - Screen high-risk
- Tertiary
  - Avoid triggers
  - Get vaccinations
  - Effective medication and management