Asthma in late adolescence--farm childhood is protective and the prevalence increase has levelled off.

Pediatr Allergy Immunol 21(5):806-13 (2010) PMID 20408968

While the prevalence of and risk factors for asthma in childhood have been studied extensively, the data for late adolescence are more sparse. The aim of this study was to provide up-to-date information on the prevalence of and risk factors for asthma in the transitional period between childhood and adulthood. A secondary aim was to analyze whether the increase in asthma prevalence has levelled off. A large-scale, detailed postal questionnaire focusing on asthma and respiratory symptoms, as well as possible risk factors, was mailed to 30 000 randomly selected subjects aged 16-75 in Gothenburg and the surrounding western Sweden region. The present analyses are based on the responses from 1261 subjects aged 16-20 (560 men and 701 women). The prevalence of physician-diagnosed asthma was 9.5%, while 9.6% reported the use of asthma medicine. In the multivariate analysis, the strongest risk factors for physician-diagnosed asthma and other asthma variables were heredity for asthma and heredity for allergy, particularly if they occurred together. Growing up on a farm significantly reduced the prevalence of physician-diagnosed asthma and the likelihood of using asthma medication, OR 0.1 (95% CI 0.02-0.95). Smoking increased the risk of recurrent wheeze, long-standing cough, and sputum production. In conclusion, the prevalence of physician-diagnosed asthma and the use of asthma medication in the 16- to 20-yr age group support the notion that the increase in asthma prevalence seen between the 1950s and the 1990s has now levelled off. In line with the hygiene hypothesis, a farm childhood significantly reduced the likelihood of asthma. The adverse effects of smoking could already be seen at this young age.