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Respiratory symptoms, bronchitis and asthma in children of Central and Eastern Europe

¹ London School of Hygiene and Tropical Medicine, London, UK. ² National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands. ³ National Centre of Hygiene, Sofia, Bulgaria. ⁴ Regional Institute of Hygiene, Ostrava, Czech Republic. ⁵ National Institute of Environmental Health, Budapest, Hungary. ⁶ Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland. ⁷ Environmental Health Centre, Cluj, Romania. ⁸ State Health Institute, Banska, Bystrica, Slovak Republic. ⁹ Institute for Risk Assessment Sciences, Utrecht, the Netherlands

CORRESPONDENCE: G. Leonardi, Environmental Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Fax: 44 2075804524. E-mail: giovanni.leonardi@lshtm.ac.uk

Keywords: asthma, bronchitis, Central and Eastern Europe, cross-sectional, prevalence, symptoms

Received: July 17, 2001
Accepted December 21, 2001

The Central European Study of Air Pollution and Respiratory Health (CESAR) was funded by the Commission of the European Communities (CEC): Directorate General XII, Science Research and Development in the framework of the Cooperation with Third Countries and International Organisations research and technological development programme, and Directorate General I, External Economic Relations, in the framework of the financial and technical assistance provided to Central and Eastern Europe (CEE) under the Phare Multi-Country Environment programme.

The multicentre Central European Study of Air Pollution and Respiratory Health (CESAR) aimed to measure the respiratory health of schoolchildren using a standardised questionnaire in six countries of Central and Eastern Europe (CEE), allowing comparisons within this region and with other European countries.

A cross-sectional study was conducted in 25 urban areas of Bulgaria, Czech Republic, Hungary, Poland, Romania, and Slovakia in 1996. Parents of 21,743 schoolchildren of age 7–11 yrs completed a questionnaire based on items from the World Health Organization and International Study of Asthma and Allergies in Childhood questions on cough and wheeze symptoms, as well as on diagnoses by doctors.

Life-time prevalence of bronchitis was 55.9%, asthma 3.9%, and asthmatic, spastic or obstructive bronchitis 12.3%. In CEE countries the prevalence of bronchitis is higher and prevalence of asthma appears lower than in Western Europe. However, if asthma is defined as a diagnosis of either asthma or asthmatic, spastic or obstructive bronchitis, then its prevalence is comparable to Western Europe, or higher.

In this region, within-country variation for most respiratory parameters is less than between-country variation. Between-country comparisons in doctors' diagnoses appear dependent on the choice of definition of asthma. Europe-wide comparisons in prevalence of respiratory symptoms and diagnosis are reported in this study. Some of the East-West difference in asthma prevalence may be attributable to differences in diagnostic practice.

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