Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Asthma in children younger than 12 years: Epidemiology and pathophysiology

Gregory Sawicki, MD, MPH
Kenan Haver, MD
Section Editors
Robert A Wood, MD
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS


Asthma is a chronic, inflammatory lung disease characterized by [1]:

Symptoms of cough, wheezing, dyspnea, and chest tightness and are usually related to specific triggering events

Airway narrowing that is partially or completely reversible

Increased airways responsiveness to a variety of stimuli

This topic provides an overview of the epidemiology and pathophysiology of chronic childhood asthma. The evaluation and treatment of chronic childhood asthma are discussed separately. (See "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Asthma in children younger than 12 years: Rescue treatment for acute symptoms" and "Asthma in children younger than 12 years: Treatment of persistent asthma with controller medications".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 11, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051). www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on December 31, 2008).
  2. Huang C, Liu W, Hu Y, et al. Updated prevalences of asthma, allergy, and airway symptoms, and a systematic review of trends over time for childhood asthma in Shanghai, China. PLoS One 2015; 10:e0121577.
  3. Anandan C, Nurmatov U, van Schayck OC, Sheikh A. Is the prevalence of asthma declining? Systematic review of epidemiological studies. Allergy 2010; 65:152.
  4. Lai CK, Beasley R, Crane J, et al. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009; 64:476.
  5. Akinbami LJ, Simon AE, Rossen LM. Changing Trends in Asthma Prevalence Among Children. Pediatrics 2016; 137.
  6. Anthracopoulos MB, Pandiora A, Fouzas S, et al. Sex-specific trends in prevalence of childhood asthma over 30 years in Patras, Greece. Acta Paediatr 2011; 100:1000.
  7. Zilmer M, Steen NP, Zachariassen G, et al. Prevalence of asthma and bronchial hyperreactivity in Danish schoolchildren: no change over 10 years. Acta Paediatr 2011; 100:385.
  8. Wennergren G, Ekerljung L, Alm B, et al. Asthma in late adolescence--farm childhood is protective and the prevalence increase has levelled off. Pediatr Allergy Immunol 2010; 21:806.
  9. Zöllner IK, Weiland SK, Piechotowski I, et al. No increase in the prevalence of asthma, allergies, and atopic sensitisation among children in Germany: 1992-2001. Thorax 2005; 60:545.
  10. Osman M, Tagiyeva N, Wassall HJ, et al. Changing trends in sex specific prevalence rates for childhood asthma, eczema, and hay fever. Pediatr Pulmonol 2007; 42:60.
  11. Data from yearly National Health Interview Survey. National Center for Health Statistics. US Department of Health and Human Services. Centers for Disease Control and Prevention. http://www.cdc.gov/asthma/most_recent_data.htm (Accessed on January 12, 2016).
  12. Almqvist C, Worm M, Leynaert B, working group of GA2LEN WP 2.5 Gender. Impact of gender on asthma in childhood and adolescence: a GA2LEN review. Allergy 2008; 63:47.
  13. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2012. Vital Health Stat 10 2013; :1.
  14. Gergen PJ, Mullally DI, Evans R 3rd. National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics 1988; 81:1.
  15. Pesek RD, Vargas PA, Halterman JS, et al. A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas. Ann Allergy Asthma Immunol 2010; 104:125.
  16. Keet CA, McCormack MC, Pollack CE, et al. Neighborhood poverty, urban residence, race/ethnicity, and asthma: Rethinking the inner-city asthma epidemic. J Allergy Clin Immunol 2015; 135:655.
  17. Taylor WR, Newacheck PW. Impact of childhood asthma on health. Pediatrics 1992; 90:657.
  18. Lipstein EA, Perrin JM, Kuhlthau KA. School absenteeism, health status, and health care utilization among children with asthma: associations with parental chronic disease. Pediatrics 2009; 123:e60.
  19. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992; 326:862.
  20. Wang LY, Zhong Y, Wheeler L. Direct and indirect costs of asthma in school-age children. Prev Chronic Dis 2005; 2:A11.
  21. Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. J Allergy Clin Immunol 2011; 127:145.
  22. Fanta CH. Asthma. N Engl J Med 2009; 360:1002.
  23. Hegele RG, Hogg JC. The pathology of asthma: An inflammatory disorder. In: Severe asthma: Pathogenesis and clinical management, Szefler S, Leung DYM (Eds), Marcel Dekker, New York 1996. p.61.
  24. Laitinen LA, Heino M, Laitinen A, et al. Damage of the airway epithelium and bronchial reactivity in patients with asthma. Am Rev Respir Dis 1985; 131:599.
  25. Sobonya RE. Quantitative structural alterations in long-standing allergic asthma. Am Rev Respir Dis 1984; 130:289.
  26. Beasley R, Roche WR, Roberts JA, Holgate ST. Cellular events in the bronchi in mild asthma and after bronchial provocation. Am Rev Respir Dis 1989; 139:806.
  27. Djukanović R, Roche WR, Wilson JW, et al. Mucosal inflammation in asthma. Am Rev Respir Dis 1990; 142:434.
  28. Fahy JV, Liu J, Wong H, Boushey HA. Cellular and biochemical analysis of induced sputum from asthmatic and from healthy subjects. Am Rev Respir Dis 1993; 147:1126.
  29. Barnes PJ. The cytokine network in asthma and chronic obstructive pulmonary disease. J Clin Invest 2008; 118:3546.
  30. Holgate ST. Pathophysiology of asthma: what has our current understanding taught us about new therapeutic approaches? J Allergy Clin Immunol 2011; 128:495.
  31. Busse WW, Lemanske RF Jr. Asthma. N Engl J Med 2001; 344:350.
  32. Fitzpatrick AM, Teague WG, Holguin F, et al. Airway glutathione homeostasis is altered in children with severe asthma: evidence for oxidant stress. J Allergy Clin Immunol 2009; 123:146.
  33. Larsen GL, Cherniack RM, Irvin CG. Pulmonary physiology of severe asthma in children and adults. In: Severe asthma: Pathogenesis and clinical management, Szefler SJ, Leung DY (Eds), Marcel Dekker, New York 1995. p.77.
  34. Gern JE. Viral respiratory infection and the link to asthma. Pediatr Infect Dis J 2008; 27:S97.
  35. Avital A, Noviski N, Bar-Yishay E, et al. Nonspecific bronchial reactivity in asthmatic children depends on severity but not on age. Am Rev Respir Dis 1991; 144:36.
  36. Joseph-Bowen J, de Klerk NH, Firth MJ, et al. Lung function, bronchial responsiveness, and asthma in a community cohort of 6-year-old children. Am J Respir Crit Care Med 2004; 169:850.