Th e n e w eng l a nd j o ur na l of m e dic i n e
n engl j med 355;21 www.nejm.org november 23, 2006
The Asthma Epidemic
Waltraud Eder, M.D., Markus J. Ege, M.D., M.P.H., and Erika von Mutius, M.D.
From University Children’s Hospital, Mu-
nich, Germany. Address reprint requests
to Dr. von Mutius at University Children’s
Hospital, Lindwurmstr. 4, D-80337 Mu-
nich, Germany, or at erika.von.mutius@
N Engl J Med 2006;355:2226-35.
Copyright © 2006 Massachusetts Medical Society.
he prevalence and incidence of asthma are very high in the
Western world. There is widespread concern that the prevalence of asthma
is still rising in developed countries, but the economic and humanitarian
effects of asthma are probably greater in the developing world, where the preva-
lence is also rising. Primary prevention strategies to combat the asthma epidemic
are therefore urgently sought, but they must be based on a sound understanding of
the various determinants of the onset of asthma. In this synopsis of the temporal
trends and determinants of asthma and associated features such as atopy, we seek
to provide insight into the complex nature of this illness.
Time Tr ends
Diagnosis of Asthma
According to the Centers for Disease Control and Prevention, the prevalence of
asthma among U.S. children increased from 3.6% in 1980 to 5.8% in 2003. Asthma
is the third leading cause of hospitalization among persons under 18 years of age
in the United States, exceeded only by pneumonia and injuries.1 Increases in the
prevalence of asthma of similar or even greater magnitude were reported from
other countries during the second half of the 20th century (Fig. 1A). For example, in
1964, 19% of Australian children were reported by their parents to have had asthma
or wheezing at some time during their first 7 years of life; in 1990, such symptoms
were reported for 46% of children.52 For many countries, there are no data on tem-
poral changes in the prevalence of asthma befor