Global Burden of Asthma, and Its Impact on Specific Subgroups: Nasal Polyps, Allergic Rhinitis, Severe Asthma, Eosinophilic Asthma

Adrian Paul J Rabe; Wei Jie Loke; Khushboo Gurjar; Allison Brackley; Don Eliseo Lucero-Prisno Iii

doi:10.2147/JAA.S418145

Global Burden of Asthma, and Its Impact on Specific Subgroups: Nasal Polyps, Allergic Rhinitis, Severe Asthma, Eosinophilic Asthma

J Asthma Allergy. 2023 Oct 6:16:1097-1113. doi: 10.2147/JAA.S418145. eCollection 2023.

Authors

Adrian Paul J Rabe^{1

2}, Wei Jie Loke³, Khushboo Gurjar⁴, Allison Brackley⁵, Don Eliseo Lucero-Prisno Iii^{6

7}

Affiliations

¹ BioPharmaceutical Medical, Respiratory & Immunology, AstraZeneca, Cambridge, UK.
² Imperial College, London, UK.
³ East and North Hertfordshire NHS Trust, Stevenage, UK.
⁴ RWA Health Economics, Cytel Health Canada, Toronto, Ontario, Canada.
⁵ RWA Health Economics, Cytel, Inc, Waltham, MA, USA.
⁶ Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
⁷ University of the Philippines Open University, Los Baños City, Philippines.

Abstract

Background: The complex nature of asthma has resulted in a poor understanding of its epidemiology, particularly in low-and middle-income countries (LMIC). Clinical subgroups, such as patients with severe asthma, eosinophilic asthma, allergic rhinitis, or nasal polyps, experience additional barriers to care.

Methods: Prevalence estimates for asthma and key clinical subgroups were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 and from a targeted literature review conducted through PubMed in October of 2021. National estimates were calculated and the roles of potential explanatory factors were explored through qualitative analysis.

Results: In total, 162 publications from 69 countries were included. Across continents, asthma prevalence values ranged from 3.44% (Asia), 3.67% (Africa), 4.90% (South America), 5.69% (Europe), 8.29% (North America), to 8.33% (Oceania). Globally, of those with asthma, 26.70% had severe asthma, 30.99% had eosinophilic asthma, 48.95% had allergic rhinitis, and 7.0% to 25.40% had nasal polyps. Countries with higher air quality, income status, and healthcare access and quality reported a higher asthma prevalence.

Conclusion: Asthma prevalence values were low in LMICs, potentially indicating health system deficiencies resulting in low diagnosis and reporting. The prevalence of eosinophilic asthma and severe asthma phenotypes was high in many countries, although the prevalence estimates of all asthma subgroups were quite variable.

Keywords: diagnosis; epidemiology; low- and middle-income countries; prevalence.

Grants and funding

This study was funded by AstraZeneca (Cambridge, UK). AstraZeneca reviewed the publication, without influencing the opinions of the authors, to ensure medical and scientific accuracy, and the protection of intellectual property.