Am. J. Respir. Crit. Care Med., Volume 164, Number 7, October 2001, 1133-1137

Incidence of Asthma and Its Determinants among Adults in Spain

XAVIER BASAGAÑA, JORDI SUNYER, JAN-PAUL ZOCK, MANOLIS KOGEVINAS, ISABEL URRUTIA, JOSÉ A. MALDONADO, ENRIQUE ALMAR, FÉLIX PAYO, and JOSEP MARIA ANTÓ, on behalf of the Spanish Working Group of the European Community Respiratory Health Survey

Respiratory and Environmental Health Research Unit, IMIM, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Galdakao Unidad de Epidemiología, Subdirección de Salud Pública de Bizkaia, Galdakao, Spain; Departamento de Sanidad del Gobierno Vasco, Bilbao, Spain; Servicio de Neumología, Hospital General Juan Ramón Jiménez de Huelva, Huelva, Spain; Sección de Epidemiología, Consejería de Sanidad Junta de Comunidades de Castilla-La Mancha, Albacete, Spain; and Instituto Nacional de Silicosis, Oviedo, Spain

The objective was to measure the incidence of asthma and its determinants in Spain, where the prevalence of asthma is low to medium. A follow-up of subjects participating in the European Community Respiratory Health Survey (ECRHS) was conducted in 1998- 1999 (n = 1,640, 85% of those eligible). Subjects were randomly selected from the general population and were 20 to 44 yr old in 1991-1993. Time of follow-up was on average 6.75 yr (range, 5.3 to 7.9 yr). Asthma was defined as reporting ever having had asthma. The incidence of asthma was 5.53 (95% confidence interval, 4.28- 7.16) per 1,000 person-years (6.88 in females, 4.04 in males). Incidence was highest in subjects who at the baseline survey had bronchial hyperresponsiveness (incidence rate ratio [IRR], 3.85), in those with positive IgE against timothy grass (IRR, 3.16), and in females (IRR, 1.80). These results persisted after adjusting for respiratory symptoms at baseline. There was no significant association (p < 0.2) with high total serum IgE, atopy defined by reactivity to any allergen, smoking, occupational exposure, or maternal asthma. A sensitivity analysis using four definitions of population at risk yielded incidence rates varying from 5.53 to 1.50. In this population of subjects without self-reported asthma or asthma-type symptoms at baseline, bronchial hyperresponsiveness and IgE reactivity to grass appeared as the main determinants of new asthma.

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