Decreasing ten-year (20082018) trends of the prevalence of childhood asthma and air pollution in Southern Taiwan

Background: Asthma is a common pediatric chronic respiratory disease worldwide. Previous studies showed the prevalence of childhood asthma increased in developed countries as well as in Taiwan in the late 20th century. Recently, several reports from different parts of the world showed a reversed trend in this epidemic of childhood asthma prevalence. This study investigated the trend of childhood asthma through serial cross-section questionnaire surveys in the southern part of Taiwan, and identified associated factors related to this trend in elementary school children. Methods: We used the Chinese version of the International Study of Asthma and Allergies in Childhood (ISAAC)(29) questionnaire to assess the asthma status of elementary school students aged 6-12 years in Tainan city in 3 independent study periods, namely, 2008-2009, 2010-2012, and 2017-2018. We assessed the trend of "asthma" and "related respiratory symptom across 3 study periods. Results: Of the 19,633 respondents, 17,545 (89.4%) completed the questionnaires. After adjustment for covariates, the prevalence of asthma and related respiratory symptoms was significantly lower in 2017-2018 than in the 2 earlier periods. Among the protective factors, the increasing rate of breastfeeding might be partly responsible for the observed reduced prevalence of current asthma and exercise-induced wheeze, but not physician-diagnosed asthma. The presence of pets in the house was the risk factor that correlated with the prevalence of nocturnal cough. Pearson correlation analysis showed a significant correlation of the prevalence of physiciandiagnosed asthma, current asthma, and exercise-induced wheezing with the concentrations of air pollutant particles with aerodynamic diameter <= 10 mu M (PM10) (r = 0.84, 0.77 and 0.81, respectively). Conclusion: The prevalence of asthma and related respiratory symptoms has declined in elementary school-age children in southern Taiwan. The increased prevalence of breastfeeding, decreased rate of the presence of pets in the house, and improvement in outdoor air pollution seem to be related to this decreasing trend of asthma in school children. Our findings will provide the scientific base to empower prevention policy to reverse the trend of childhood asthma prevalence.