REVIEW

CURRENT
OPINION Epidemiology of asthma
Patricia A. Loftus and Sarah K. Wise

Purpose of review
This article reports the findings of recently published research articles and Centers for Disease Control
(CDC) data on the epidemiology of asthma. Numerous otolaryngologic diseases are associated with
asthma, such as allergic rhinitis, chronic rhinosinusitis, and obstructive sleep apnea. In addition, asthma
causes a significant health burden and its prevalence is increasing.
Recent findings
Currently, 8.4% of persons in the United States have asthma as compared with 4.3% of the population
worldwide, and both numbers are on the rise. The average annual asthma prevalence is higher in children
(9.5%) than adults (7.7%). The prevalence of asthma is higher in black persons than white persons, and
the ethnicity most affected is the Puerto Rican population. Asthma prevalence increases with each
successive lower poverty level group. There are interesting relationships between asthma and certain
otolaryngologic diseases. The impact of asthma on both morbidity and mortality is particularly noteworthy.
Summary
The prevalence of asthma is increasing both domestically and globally. The impact is most significant in the
minority and lower socioeconomic populations. Future research should work to elucidate the reasons for
this increase in asthma and promote better access to care for persons across all ethnic and socioeconomic
classes.
Keywords
asthma, asthma children, asthma minorities, asthma prevalence, epidemiology

INTRODUCTION increased 2.9% each year, with 20.3 million persons

Epidemiologic data have shown that over the last carrying a diagnosis of asthma in 2001 and
few decades, the prevalence of asthma has increased 25.7 million persons having this diagnosis in 2010
both domestically and globally [1,2]. Therefore, it is [1]. This national surveillance report estimated
no surprise that asthma has become not only a asthma prevalence in the United States population
major national health issue, but also a significant to be 8.4% in 2010. This is a dramatic increase from
global health issue. This review aims to present the reported asthma prevalence in past years, with prior
most recent statistics and epidemiologic data CDC reports documenting the prevalence of asthma
concerning the domestic and global prevalence, in the United States as 3.0% in 1970 [3,4] and 5.5%
age, race/ethnicity, sex, and socioeconomic classes in 1996 [5]. The most up-to-date statistics can be
associated with asthma. The trends in asthma epi- found on the CDC website, where they provide an
demiology as well as the substantial health burden early release of data from their January–March 2015
of this disease process are also discussed. A specific National Health Interview Survey, citing that 8.2%
focus on the impact of asthma in otolaryngologic of persons of all ages in the United States currently
&&

disease is presented. have asthma [6 ].

Department of Otolaryngology – Head and Neck Surgery, Emory Uni-

TEXT OF REVIEW
versity, Atlanta, Georgia, USA
Correspondence to Sarah K. Wise, MD, MSCR, Department of Otolar-
Domestic impact yngology – Head and Neck Surgery, Emory University, Atlanta, GA, USA.
The most recent Centers for Disease Control (CDC) Tel: +1 404 778 3381; fax: +1 404 778 4295;
asthma epidemiology statistics were published in e-mail: skmille@emory.edu
2012 for the 2001–2010 decade. A major finding Curr Opin Otolaryngol Head Neck Surg 2016, 24:245–249
was that the number of persons with asthma DOI:10.1097/MOO.0000000000000262

1068-9508 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-otolaryngology.com

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Allergy

have lived in the United States for less than 10 years.

KEY POINTS As stated above, the global prevalence of doctor-

The domestic prevalence of asthma increased 2.9% diagnosed asthma is 4.3%, but this number varies
each year from 2001 to 2010 (20.3 million persons in between countries. Notably, a very high rate of
the United States had asthma in 2001 as compared doctor-diagnosed asthma is reported in Australia
with 25.7 million in 2010); the global prevalence of at 21.0% [11]. Interestingly, within developed
asthma is approximately 300 million people or 4.3% of countries, such as Australia, asthma is more com-
the worldwide population and is also on the rise. mon among the economically disadvantaged, yet in

Current asthma prevalence is higher in black persons developing countries an asthma diagnosis is more
(11.2%) than in white persons (7.7%), and is highest in common among the higher class. This topic of
the Puerto Rican population (17.0%) and lowest in the socioeconomic status as it relates to asthma will
Mexican-American population (3.9%). be further discussed later in this article.

There is a male predominance in the diagnosis of
asthma prior to puberty, but a higher prevalence in
females in adulthood, as well as more severe cases of Impact on age
asthma in women than in men. In terms of age, 18.7 million of the 25.7 million
persons with asthma in the United States in 2010

Asthma prevalence has been shown to be higher with
each successive lower poverty level group, and were adults (with 3.1 million being age 65 or older),
disparities exist with asthma diagnosis and treatment and 7.0 million were children [1]. Similarly, the
based on race, ethnicity, and income. National Health Interview Survey reported that
6.7 million or 9% of children ages 0–17 years in

Data regarding quality of life issues, morbidity, and
the United States had asthma in 2007, with a life-
mortality for people with asthma are astounding, with
3404 deaths from asthma in 2010 alone. time prevalence as high as 13% [12]. The global
prevalence of pediatric asthma is reported to be
approximately 14%, and similarly to the adult
group, is rising [13]. In fact, from 2008–2010, the
Global impact average annual asthma prevalence was higher in
Asthma is a nonreportable disease. Therefore, it is children aged 0–17 years (9.5%) than in adults aged
difficult to determine its global prevalence since 18 and over (7.7%) [1]. A recent study of school
differences exist in regards to diagnostic protocols children in Poland (ages 7–10 years) showed an
and access to healthcare. Furthermore, many increase in asthma prevalence from 3.4% in 1993
asthma patients may be undiagnosed, as a recent &
to 12.6% in 2014 [14 ].
study from Russia demonstrated that 6.9% of adults
answering a questionnaire reported an asthma diag-
nosis, but 25.7% of the same population reported Impact on race and ethnicity
&
asthma symptoms [7 ]. According to Croisant’s epi- The breakdown of race and ethnicity in asthma was
demiology section in the textbook Heterogeneity in reported by the CDC in 2002 with the following
Asthma published in 2014, approximately 300 results: a 7.6% prevalence in the non-Hispanic
million people or 4.3% of the world’s population White population, 9.3% in the Black population,
&&
suffer from asthma [8 ]. A recent study from Italy 2.9% in the Asian population, 1.3% in the Native
has confirmed that asthma is on the rise in countries Hawaiian/Pacific Islander population, 11.6% in the
outside of the United States, as they showed an American Indian/Alaska Native population, 5.0% in
increase in asthma prevalence in Italy from 3.4 to the Hispanic population, 15.6% in the Multiracial
7.2% over an approximately 25 year study period (non-Hispanic) population, and 7.2% in the Other
&&
[9 ]. The Global Initiative for Asthma estimates that (non-Hispanic) population [15].
there will be an additional 100 million people with More current numbers indicate that 19.1
asthma by the year 2025 [2]. million persons with asthma in 2010 were white
and 4.7 million were black, and current asthma
prevalence was higher in black persons (11.2%) than
Domestic vs. global impact in white persons (7.7%) [1]. In terms of ethnicity
&
A 2014 study by Iqbal and colleagues [10 ] demon- from the 2008 to 2010 time period, Hispanic and
strated that the prevalence of asthma is higher in the Puerto Rican persons had a higher asthma preva-
United States than in other countries, and even lence (16.1%) as compared with Mexican persons
more interesting is that higher asthma rates were (5.4%) [1]. Other data corroborate these findings by
noted in those people who have lived in the United demonstrating the highest asthma prevalence in the
States for 10 years or more compared with those who Puerto Rican population (17.0%) and the lowest

246 www.co-otolaryngology.com Volume 24
Number 3
June 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

 Epidemiology of asthma Loftus and Wise

prevalence in the Mexican-American population 100% of the federal poverty threshold level
(3.9%) [16]. Looking at the CDC’s early release stat- (11.2%). This is compared with 8.7% for persons
istics from January–March 2015, for children under with incomes 100–200% of the poverty level, and
15 years of age, the sex-adjusted prevalence of 7.3% for persons with incomes at least 200% of the
asthma was higher among non-Hispanic black chil- poverty level [17]. A recent study evaluated asthma
dren (17.7%) than among Hispanic children (6.8%) prevalence in inner-city vs. noninner-city United
and non-Hispanic white children (6.9%); and for States children, and found that the prevalence of
people over 15 years of age, the sex-adjusted preva- current asthma was 12.9% in inner-city and 10.6%
lence of asthma was 7.4% for Hispanic persons, 8.1% in noninner-city areas. After adjusting for race/eth-
for non-Hispanic white persons, and 9.9% for non- nicity, region, age, and sex, it was found that this
&&
Hispanic black persons [6 ]. difference was not significant. However, black race,
It is also important to note that disparities exist Puerto Rican ethnicity, and lower household
with asthma diagnosis and treatment based on race, income were independent risk factors for asthma
&
ethnicity, and income. For example, blacks had a rather than living in an inner-city area [20 ].
higher rate of emergency department visits for
asthma, more hospitalizations per 100 persons with
asthma, and a higher asthma death rate per 1000 Impact on otolaryngologic diseases
persons with asthma as compared with whites from There are interesting relationships between asthma
2007–2009 [17]. A higher prevalence of asthma and other otolaryngologic diseases that also affect
morbidity and mortality in black and Latino chil- the airway, such as allergy rhinitis, chronic sinusitis
dren living in low socioeconomic societies vs. whites with nasal polyposis, obstructive sleep apnea (OSA),
has also been demonstrated, with possible reasons and gastroesophageal reflux disease. In adult asth-
for this disparity being poorer access to treatment matics, the prevalence of allergy rhinitis is as high as
and a high allergen environment related to their 80% [21] and the prevalence of chronic sinusitis
&
housing conditions [18]. with nasal polyposis is as high as 65% [22 ]. Con-
versely, asthma prevalence is as high as 40% in
allergy rhinitis patients [21] and as high as 35.1%
Impact on gender in patients with OSA [23]. In a recent study by
&
In terms of gender, studies have shown a male Madama and colleagues [24 ], OSA was diagnosed
predominance in the diagnosis of asthma prior to in 57.4% of adults with asthma who underwent a
puberty, but a higher prevalence in females in adult- sleep study, a number that is higher than the per-
hood, as well as more severe cases of asthma in centage of OSA in the general population. Lastly,
women than in men [19]. The CDC statistics for asthma patients are three times more likely to have
the period of 2008–2010 corroborate these findings, gastroesophageal reflux disease, and 64% of asthma
reporting that asthma prevalence was higher in patients have improvement in asthma symptoms
females (9.2%) than in males (7.0%), and also dem- with reflux treatment [25].
onstrating a difference in males vs. females by age
group [1]. For example, boys (0–17 years) had a
higher prevalence than girls (11.1% compared with Asthma trends
7.8%) and men (>/ ¼ 18 years) had a lower prevalence The epidemiological trends of asthma are as follows:
than women (5.7% compared with 9.7%) [1]. Again asthma prevalence has increased at a rate of 1.4% per
referring to the CDC’s early release statistics from year in the pediatric population (0–17 years) and at
January–March 2015, the prevalence of asthma a rate of 2.1% per year in the adult population
was higher among females than males for persons (18 years and older). Current asthma prevalence
&&
age 35 and older [6 ]. Furthermore, males 35 years of has increased at a yearly rate of 1.8% for both males
age and older were less likely to have asthma than and females. Trends in race include a yearly rate
males under 15 years of age, whereas females 35 years increase of 1.4% among the white population and a
of age and older were more likely to have asthma than yearly rate increase of 3.2% among the black popu-
&&
females under 15 years of age [6 ]. lation; whereas trends in ethnicity include a yearly
rate increase of 3.2% among Hispanic persons (7.2%
of the population in 2010) and a yearly rate increase
Impact on socioeconomic status of 1.9% among non-Hispanic persons (8.7% of the
Asthma prevalence has been shown to be higher population in 2010) [1]. A recent study by Yoo et al.
&
with each successive lower poverty level group [1]. [26 ] demonstrated a nationwide increase in asthma
From 2001–2010, asthma was more prevalent prevalence of 1.2-fold in the outpatient setting and
among persons with a family income less than 1.3-fold in the inpatient setting over a 9-year period.

1068-9508 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-otolaryngology.com 247

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Allergy

Impact on geographic region REFERENCES AND RECOMMENDED

There are also differences in asthma prevalence by READING
Papers of particular interest, published within the annual period of review, have
geographic region. From 2008–2010, it was highest been highlighted as:
in the Northeast (8.8%), followed by the Midwest & of special interest
&& of outstanding interest

(8.7%), the West (8.0%), and then the South (7.6%).

Asthma prevalence did not differ between metro- 1. Moorman JE, Akinbami LJ, Bailey CM, et al. National surveillance of asthma:
United States, 2001–2010. Vital Health Stat 2012; 3:1–58.
politan and nonmetropolitan areas [1], but a recent 2. Masoli M, Fabian D, Holt S, Beasley R; Global Initiative for Asthma Program.
&
study by Lundback and colleagues [27 ] reports an The global burden of asthma: executive summary of the GINA Dissemination
Committee report. Allergy 2004; 59:469–478.
increase in asthma associated with urbanization, 3. Moorman JE, Rudd RA, Johnson CA, et al. National surveillance for asthma:
especially among young people living in urban areas United States, 1980–2004. MMWR Surveill Summ 2007; 56:1–54.
4. Evans R 3rd, Mullally DI, Wilson RW, et al. National trends in the morbidity
of lower level income countries. and mortality of asthma in the US. Prevalence, hospitalization and death
from asthma over two decades: 1965–1984. Chest 1987; 91:65S–
74S.
5. Mannino DM, Homa DM, Akinbami LJ, et al. Surveillance for asthma: United
Health burden States, 1980-1999. MMWR Surveill Summ 2002; 51:1–13.
6. http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201509_15.
Data regarding quality of life issues, morbidity, and && pdf.
mortality for people with asthma are astounding. A The link outlines the most recent CDC asthma epidemiology statistics for
the United States, providing information from January to March of the current
National Health Statistics Report published in 2011 year. It is the most up-to-date information on the topic of domestic asthma
accounted 1.75 million emergency department vis- epidemiology.
7. Chuchalin AG, Khaltaev N, Antonov NS, et al. Chronic respiratory diseases
its for asthma exacerbations and 456 000 asthma- & and risk factors in 12 regions of the Russian Federation. Int J Chron Obstruct
related hospitalizations in the year 2007 [28]. In Pulmon Dis 2014; 9:963–974.
The interesting study out of Russia demonstrates that many people have symptoms
2008, 10.5 million school days and 14.2 million of asthma without an actual asthma diagnosis, meaning that undiagnosed cases of
work days were missed because of asthma, which asthma may make the actual global prevalence of this disease even higher than
what the statistics show.
is an average of four missed school days for children 8. Croisant S. Epidemiology of asthma: prevalence and burden of disease. Adv
and five missed work days for adults [28,29]. A && Exp Med Biol 2014; 795:17–29.
The link outlines the most recent global asthma epidemiology statistics and is the
recent burden of childhood disease analysis was most up-to-date information on the topic of worldwide asthma epidemiology.
performed, which showed that asthma and allergies 9. Maio S, Baldacci S, Carrozzi L, et al. Respiratory symptoms/diseases pre-
&& valence is still increasing: a 25-yr population study. Respir Med 2015;
were the most prevalent childhood diseases. How- 100:58–65.
ever, these diseases were associated with the least The recent study out of Italy is important as it confirms that the worldwide
prevalence of asthma is on the rise, and that this epidemic not only affects us
amount of burden compared with other childhood domestically but also globally.
&
diseases such as cerebral palsy [30 ]. The overall 10. Iqbal S, Oraka E, Chew GL, Flanders WD. Association between birthplace
& and current asthma: the role of environment and acculturation. Am J Public
number of deaths because of asthma in 2010 alone Health 2014; 104 (Suppl 1):S175–S182.
was 3404 [29]. The study demonstrates that the prevalence of asthma is highest in the United
States as compared with other countries throughout the world.
11. To T, Stanojevic S, Moores G, et al. Global asthma prevalence in adults:
findings from the cross-sectional world health survey. BMC Public Health
2012; 12:204.
CONCLUSION 12. Hill VL, Wood PR. Asthma epidemiology, pathophysiology, and initial evalua-
Asthma is a significant domestic and global health tion. Pediatr Rev 2009; 30:331–335.
13. Asher MI, Montefort S, Bjorksten B, et al. Worldwide time trends in the
issue that is currently on the rise, especially in lower prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in
socioeconomic classes with less access to appropri- childhood: ISAAC Phases One and Three repeat multicountry cross-sectional
surveys. Lancet 2006; 368:733–743.
ate healthcare. With current data predicting a con- 14. Brozek G, Lawson J, Szumilas D, Zejda J. Increasing prevalence of asthma,
tinued rise in the future, the health burden of this & respiratory symptoms, and allergic diseases: four repeated surveys from
1993-2014. Respir Med 2015; 109:982–990.
disease process is even more concerning. Future The study from Poland is important as it shows that the prevalence of asthma in the
research should focus on elucidating the reasons pediatric population is quickly on the rise worldwide.
15. Centers for Disease Control and Prevention. Asthma prevalence and control
for this continued increase in asthma prevalence characteristics by race/ethnicity: United States, 2002. MMWR Morb Mortal
and work to promote better access to preventive Wkly Rep 2004; 53:145–148.
16. Rose D, Mannino DM, Leaderer BP. Asthma prevalence among US adults,
education and healthcare treatment across all 1998-2000: role of Puerto Rican ethnicity and behavioral and geographic
ethnic and socioeconomic classes. factors. Am J Public Health 2006; 96:880–888.
17. Akinbami LJ, Moorman JE, Bailey C, et al. Trends in asthma prevalence,
healthcare use, and mortality in the United States, 2001-2010. NCHS Data
Brief 2012; 94:1–8.
Acknowledgements 18. Bryant-Stephens T. Asthma disparities in urban environments. J Allergy Clin
Immunol 2009; 123:1199–1206.
None. 19. Postma DS. Gender differences in asthma development and progression.
Gend Med 2007; 4 (Suppl B):S133–S146.
20. Keet CA, McCormack MC, Pollack CE, et al. Neighborhood poverty, urban
Financial support and sponsorship & residence, race/ethnicity, and asthma: rethinking the inner-city asthma epi-
None. demic. J Allergy Clin Immunol 2015; 135:655–662.
The recent study demonstrates that black race, Puerto Rican ethnicity, and lower
household income are independent risk factors for asthma.
Conflicts of interest 21. Guerra S, Sherrill DL, Martinez FD, Barbee RA. Rhinitis as an independent
risk factor for adult-onset asthma. J Allergy Clin Immunol 2002; 109:419–
There are no conflicts of interest. 425.

248 www.co-otolaryngology.com Volume 24
Number 3
June 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

 Epidemiology of asthma Loftus and Wise

22. Hakansson K, Thomsen SF, Konge L, et al. A comparative and descriptive 27. Lundback B, Backman H, Lotvall J, Ronmark E. Is asthma prevalence still
& study of asthma in chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy & increasing? Expert Rev Respir Med 2016; 10:39–51.
2014; 28:383–387. Asthma prevalence does not differ between metropolitan and nonmetropolitan
There is a strong relationship between asthma and chronic rhinosinusitis with nasal areas, but this study shows that there has been an increase in asthma associated
polyposis, and it is important for otolaryngologists who treat the latter disease to be with urbanization, mostly in the younger urban population living in lower income
aware of the interplay between the two as well as the appropriate management and countries.
treatment options for each. 28. Akinbami LJ, Moorman JE, Liu X. Asthma prevalence, healthcare use, and
23. Alharbi M, Almutairi A, Alotaibi D, et al. The prevalence of asthma in patients mortality: United States, 2005-2009. Natl Health Stat Report 2011; 32:
with obstructive sleep apnoea. Prim Care Respir J 2009; 18:328–330. 1–14.
24. Madama D, Silva A, Matos MJ. Overlap syndrome: asthma and obstructive
& sleep apnea. Rev Port Pneumol 2016; 22:6–10. 29. Centers for Disease Control and Prevention. Vital signs: asthma pre-
OSA is more common in patients with asthma than it is in the general population, and valence, disease characteristics, and self-management education: United
otolaryngologists should be aware of this relationship when treating these diseases. States, 2001–2009. MMWR Morb Mortal Wkly Rep 2011; 60:547–
25. Harding SM, Guzzo MR, Richter JE. The prevalence of gastroesophageal 552.
reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med 30. Craig BM, Hartman JD, Owens MA, Brown DS. Prevalence and
2000; 162:34–39. & losses in quality-adjusted life years of child health conditions: a burden
26. Yoo B, Park Y, Park K, Kim H. A 9-year trend in the prevalence of allergic of disease analysis. Matern Child Health J 2015; 1–8. [Epub ahead of
& disease based on national health insurance data. J Prev Med Public Health print]
2015; 48:301–309. Asthma and allergies are the most common disease of childhood, although the
Over the past decade, there has been a trend toward increased asthma prevalence health burden is not as significant as other childhood diseases such as cerebral
in both the inpatient and outpatient setting in the United States. palsy.

1068-9508 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-otolaryngology.com 249

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.