The European Community Respiratory Health Survey: what are the main results so far?

Abstract

The European Community Respiratory Heath Survey (ECRHS) was the first study to assess the geographical variation in asthma and allergy in adults using the same instruments and definitions. The database of the ECRHS includes information fromy140,000 individuals from 22 countries. The aim of this review is to summarize the results of the ECRHS to date.The ECRHS has shown that there are large geographical differences in the prevalence of asthma, atopy and bronchial responsiveness, with high prevalence rates in English speaking countries and low prevalence rates in the Mediterranean region and Eastern Europe. Analyses of risk factors have highlighted the importance of occupational exposure for asthma in adulthood. The association between sensitization to individual allergens and bronchial responsiveness was strongest for indoor allergens (mite and cat). Analysis of treatment practices has confirmed that the treatment of asthma varies widely between countries and that asthma is often undertreated.In conclusion, the European Community Respiratory Health Survey has shown that the prevalence of asthma varies widely. The fact that the geographical pattern is consistent with the distribution of atopy and bronchial responsiveness supports the conclusion that the geographical variations in the prevalence of asthma are true and most likely due to environmental factors. Eur Respir J 2001; 18: 598-611. During the first half of the 1990s, information on the variation in asthma prevalence, known or suspected risk factors for atopy and asthma, and information on the management of asthma in young adults was collected in the European Community Respiratory Health Survey (ECRHS).The reason for undertaking the ECRHS was a rapid increase in the prevalence of asthma that had been reported from many different countries [1][2][3][4]. This increase was over too short a time period to be explained by genetic factors and must therefore have been related to nongenetic or environmental changes. Further evidence of the importance of environmental factors in asthma was that studies comparing prevalence in urban and rural areas in developing countries had shown large differences in asthma prevalence [5][6][7]. Treatment patterns of asthma [8] and asthma mortality [9] had been found to vary considerably in Europe which raised the question of whether the variation in mortality was due to geographical differences in the prevalence of asthma or differences in asthma fatality. Research directed towards identifying the environmental factors that explain this geographical variation in asthma was required to identify potential strategies to counter the global increase in the prevalence of asthma.The information available on the variation in the prevalence of asthma and allergy at the beginning of the 1990s had been collected through several studies using different protocols. The ECRHS was, therefore, the first study that assessed the prevalence of asthma and allergic disease in a large number of countries

Under‐report and underdiagnosis of chronic respiratory diseases in an African country

“…The rates of an asthma diagnosis found were well above the 4.5% median value found for instance in the European Community Respiratory Health Survey (ECRHS) (23). However, the question used in this study (ÔHave you ever been told by a doctor…Õ) was different from the question used in ECRHS that took in account the previous 12 months.…”

Sensitization to Common Allergens in Adults with Asthma

“…The same observations were reported in the ECRHS studies conducted at 30 sites, mostly in Europe. 5,[13][14][15][16] Many studies have also explored the utility of total serum IgE as a marker of atopy and found some level of discordance with allergen-specific tests. 3,17 In this study, 21% of patients had a positive allergen-specific test while exhibiting normal total IgE.…”

European Union meets the challenge of the growing importance of allergy and asthma in Europe

“…This programme represented a landmark study of allergic diseases and asthma. It was the first to have made comparisons possible across Europe and beyond and it has enabled the identification and quantification of several risk factors for asthma (21,22).…”