Asthma severity according to Global Initiative for Asthma and its determinants: an international study.
BACKGROUND
The identification of the factors associated with severe asthma may shed some light on its etiology and on the mechanisms of its development. We aimed to describe asthma severity using the Global Initiative for Asthma (GINA) classification and to investigate its determinants in a cross-sectional, population-based sample in Europe.


METHODS
In the European Community Respiratory Health Survey II (1999-2002), 1,241 adults with asthma were identified. Severity was assessed using the 2002 GINA classification (intermittent, mild persistent, moderate persistent, severe persistent) and it was related to potential determinants by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios.


RESULTS
About 30% of asthmatic subjects were affected by moderate-to-severe asthma. Sensitization to Cladosporium was associated with a more than 5-fold greater risk of having (mild, moderate or severe) persistent asthma than intermittent asthma. Persistent asthma was positively associated with sensitization to house dust mite, nonseasonal asthma, an older age at asthma onset, and chronic cough and phlegm. Sensitization to cat increased the risk of severe asthma only. Smoking was more strongly associated with asthma severity in men, while rhinitis was more strongly associated with asthma severity in women.


CONCLUSIONS
One third of the asthmatic population have moderate-to-severe asthma. Sensitization to perennial indoor allergens, particularly Cladosporium, is strongly associated with asthma severity. The role of smoking and rhinitis in determining asthma severity may differ between the sexes, and it should be further investigated.
Cazzoletti
Lucia
L
Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy. lucia.cazzoletti@univr.it
Marcon
Alessandro
A
Corsico
Angelo
A
Janson
Christer
C
Jarvis
Deborah
D
Pin
Isabelle
I
Accordini
Simone
S
Bugiani
Massimiliano
M
Cerveri
Isa
I
Gislason
David
D
Gulsvik
Amund
A
de Marco
Roberto
R
D000328:Adult; D000485:Allergens / Q000276:immunology; D001249:Asthma / Q000453:epidemiology* / Q000276:immunology; D002963:Cladosporium / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
D000485:Allergens