Epidemiology of asthma in the Netherlands with special reference to childhood

The aim of this thesis is to examine trends in mortality and morbidity attributed to asthma in the Netherlands in the light of the changing concepts of asthma and the improved pharmacotherapy, against the background of other airway disorders. We analysed national statistics on asthma and COPD from 1980 to 1999, which data are presented in the first part of the thesis. Chapter 2 presents the data on mortality in different age groups. Chapter 3 presents the data on hospital admissions in different age groups. Complementary, chapter 4 presents trends in consultations and prescriptions of anti-asthma drugs in patients having ambulatory care for asthma and COPD over the period 1981 to 1993, reflecting prevalence and (changes in) disease management in the Netherlands. Chapter 5 describes the pharmacotherapy for asthma in the Netherlands from 1999 through 2001. The second part of this thesis deals with clinical registration on asthma in children aged 0-4 years, carried out at the Juliana Children's Hospital in The Hague. In this age group, the rising morbidity from asthma is of great concern. Studies pointed to increasing hospital admissions for asthma especially in children aged 0-4 years [86-88], which age group appeared to be at highest risk for hospital readmissions as well [88-90]. Early recognition of risk of (severe) asthma in clinical practice and improvement of asthma management could help to reduce morbidity in children. The aim of the registration study was to examine prognostic characteristics of asthma diagnosis, to identify predisposing risk factors related to exacerbations and hospital admissions, and to assess whether threshold of admission and severity of episode differed in fust admissions and readmissions.

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