Prevalence of asthma ISAC 1999

Allergy and asthma control in Poland Prof. Marek L. Kowalski, M.D., Ph.D. Department of Immunology, Rheumatology and Allergy, Chair of Immunology, Medical University of Łódź, Poland

Prevalence of asthma ISAC 1999

. ISAAC Prevalence of asthma in Poland

Epidemiology of Asthma and Allergy in Poland -Population 20 study of 14 701 randomly selected subjects -Questionnaire- based diagnosis verified by experts 19.2 Prevalence % 15 10 Adults Children 3-16y 15.8 8.6 8.7 8.9 5 5.4 3.0 2.1 1.4 4.7 2.0 1.0 Asthma Seasonal rhinitis Perennial rhinitis Atopic dermatitis Contact dermatitis Any disorder ( Małolepszy J. et al. Alergia Astma Immunol 2000,5 suppl 2)

20 15 10 5 Regional differences in the prevalence of asthma in Poland 15.8 11.8 10.5 9.5 10.1 8.4 7.0 6.9 2.8 4.9 Białystok Bydgoszcz Zabrze Rabka Łódź Poznań Kraków Wrocław Warszawa Gdańsk (Młolepszy J. et al. Alergia Astma Immunol 2000,5 suppl 2) Prevalence %

ISAAC Phases One and Three surveys Cross-sectional questionaire survey (7 years apart) 193 404 children aged 6-7years from 37 countries 304 679 children aged 13-14 years from 56 countries Region N/E Europe W Europe Bronchial asthma 6-7 years age group Phase 1 4.6-11.1 6.2-18.4 13-14 years age group Phase 2 2.6-13.1 9.3-35.1 Asher MI Lancet 2006,368,733-743 743

Trends in asthma prevalence in Europe Age 6-7year Age 13-14year 14year

Changes in the prevalence of bronchial asthma in children in Poland 7 [%] 6 5 4 3 1994-1995 2001-2002 2 1 0 Kraków Poznań 6-7 years Kraków Poznań 13-14 years old Lis G, Breborowicz et al. Pneumonol Alergol Pol. 2003;71(7-8):336-43

Changes in the prevalence of allergic Występowanie alergicznego nieżytu nosa i spojówek u dzieci w wieku 6-7 lat i 13-14 lat w Krakowie i Poznaniu w latach 1994-95 i rhinits/conjunctivitis in children in 2001-2002 Poland [%] 35 30 25 20 1994-1995 2001-2002 15 10 5 0 Kraków Poznań 6-7 years Kraków Poznań 13-14 years old Lis G, Breborowicz et al. Pneumonol Alergol Pol. 2003;71(7-8):336-43

Prevalence of allergy in rural and urban children Rural area 200 children Urban area 200 children Questionaires + Clinical examination physician made diagnosis of allergy SPT (15 allergens) Serum total IgE and sige Derp1,tymothy, (Unicap Unicap) Allergen concentration in house dust Der p1, Fel d1, Can d1 Majkowska at al. 2006

Prevalence of allergic diseases in rural and urban children 40% 35% 30% Urban Rural wskaźnik struktury [%] 25% 20% 15% 10% 5% 0% Alergiczne Alergia Pokrzywka Wyprysk ANN zap. Astma ZAZS AR RC Asthma Food pokarmowa Eczema Contct alergiczna Urticaria kontaktowy Spojówek Allergy dermatitis miasto 38,81% 11,94% 16,42% 2,49% 2,49% 0,50% 0,50% wieś 10,84% 0,00% 1,97% 0,00% 0,49% 0,49% 0,00% Majkowska at al. 2006

Allergic sensitisation (SPTs) in rural and urban children 35% 35% 30% miasto 30% miasto 25% wieś 25% wieś w s k a ź n i k w a rt o ś c i [ % ] 20% 15% 10% wskaźnik struktury [%] 20% 15% 10% s 5% 5% 0% der p der f kot pies Der p1 Der f1 Cat Dog 0% brzoza trawy/zboża babka bylica Alternaria Birch Grass Mug Alt. Majkowska at al. 2006

Prevalence of allergy among school children ( 13-16 years old) in Poland 60 Prevalence % 50 40 30 20 10 Urban Rural 0 Symptoms Sensitization Majkowska, Kowalski 2006 Majkowska at al. 2006

Rural vs urban environment and prevalence of asthma in Poland Rural 2 % Urban 16. 7%

Risk of development of asthma in urban children Decreased risk contact with live stock OR= 0,22 (0,09-0,59), 0,59), p<0,001)]. attendance to kindergarten OR=0,05, (0,004-0,48); 0,48); p=0,001], Increased risk daily contact with dog/cat during first 3 years of life [OR= (1,46-8,79); p<0,005] a history of frequent URT infections OR=5,20 (2,56-10,56); p<0,0001] child s birth from first or second pregnancy OR=3,6 1,46-8,79); p=0,005] delivery by Cesarean labor OR=2,36 (1,03-5,41); p=0,049].

Patient Scientist Asthma control Physician Society

AIRCEE 1998: 2509 patients Asthma Inside and Reality in Central and Eastern Europe 1999:7 countries in western Europe 2 803patients 2000: 12 countries in Central and Eastern Europe 1617 patients

Asthma symptoms reported during previous 4 weeks Nie było 25% codziennie 20% 57%>2x/week Raz w m-cu 2% 2 razy w m-cu 1% Raz w tyg. 8% większość dni 20% 2 razy w tyg. 7% 3 dni w tyg. 17% Liczba ankietowanychn=300. Kowalski i wsp. Alergia Astma Immunologia 2004

Nocturnal symptoms during previous 4 weeks Nie było 51% Co noc 11% 45% - > 1x/week Większość nocy 14% 2 x w m-cu 1% Raz w m-cu 1% 1 noc w tyg. 3% 3-4 razy w m-cu 2% 3 noce w tyg. 10% 2 noce w tyg. 7% Kowalski i wsp. Alergia Astma Immunologia 2004

Emergency visits (ER or ambulance) due to asthma exacerbation during last year 70% 60% 50% 40% 37% 36% 41% 30% 20% 10% 0% Total (N=300) Adults(N=239) Children (N=61) Kowalski i wsp. Alergia Astma Immunologia 2004

Hospital admission due to asthma exacerbation during last year 60% 50% 40% 30% 20% 16% 18% 10% 8% 0% Total Adults Children Łącznie (N=300) Dorośli (N=239) Dzieci (N=61) Kowalski i wsp. Alergia Astma Immunologia 2004

Patients with prescribed inhaled glucocorticosteroids Prescribed Obecnie nie stosuje In past 13% 16% Nigdy nie przepisano steroidów wziewnych 57% 57% Never Curently using 27% Stosuje steroidy wziewne 30% (N=300)

Asthma Insights & Reality Central, Eastern Europe 100 % patients on IGCS 80 60 40 35.4 41.1 27.0 20 0 USA Europe Poland Rabe, Eur Respir J, 2000 GSK,Data in file, AIRCEE AAI 2004: AIRIAP

Reliever and anti inflammatory treatment reported by patients in AIRCEE study 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 27% 56% 8% 62% 16% 62% Poland Hungary Czech Republic 70% 60% 57% 57% 59% 50% 44% 48% 39% 26% 20% 14% 15% 17% 17% 8% 2% 4% Slovenia Croatia Lithuania Slovakia Bulgaria Russia Romania Ukraine Latvia Anti-inflammatories Quick relief medications

Summary of the situation Allergy and asthma have significant prevalence in Poland A significant regional differences in the prevalence of asthma and allergy are observed In majority of patients asthma is not well controlled Asthma is undertreated in most patients

Costs of allergy and asthma in Europe (bilions ECU) Direct Non-direct Total Asthma 6.5 13.9 20.4 Allergic 1.3 1.7 3.0 rhinitis Eczema 0.3 0.4 0.7 Contact 3.0 2.5 5.5 dermatitis Total 29.4

Member countries succes ratio for 2/3 of 6 FP budget 30000 25000 20000 15000 10000 5000 0 DE IT UK FR ES NL GR BE SE PL AT FI PT DK HU CZ IE SI SK LT EE LV CY MT LU Number of calls Number of calls - New Members Number of projects=succes Number of projects=succes for New Members

Allergic diseases from FP6 to FP7 «Allergy» covered in the Food section of the programme although food allergy represents only 8% of allergic diseases. EAACI and GA²LEN are raising awareness on the need to have «allergic diseases» in the Health theme Meeting with the Rapporteur prof. Jerzy Buzek February 2006 Presentation to the members of EP in Brussels -March 2006

Allergic diseases from FP6 to FP7 Amendment 114 Annex I, Chapter I "Cooperation", Theme 1 "Health", Subtitle "Activities", bullet 2, indents 3 and 4 Amendment by Jerzy Buzek on behalf of the PPE-ED Group, Philippe Busquin on behalf of the PSE Group, Vittorio Prodi on behalf of the ALDE Group and Umberto Guidoni on behalf of the GUE/NGL Group FP7 framework text :, allergy is proposed to be included under the Health theme, Translating research for human health, Translational research in major diseases as respiratory diseases, including those induced by allergies.

Łódź

29th Congress of the EAACI Warsaw,June 2009