The Global Asthma Report 2018

China

Social stigma barrier to effective asthma treatment.

Although asthma is uncommon in China, the population size (1.4 billion) means huge numbers of people are affected.

Prevalence

The Third Nationwide Survey of Childhood Asthma in Urban Areas of China (2010) found that in the 43 cities studied the prevalence of asthma in children under 14 years had increased to 3.0% from 2.0% in 2000. There was large variation between cities: the highest rate of 7.6% in Shanghai and the lowest rate of 0.5% in Tibet. Asthma prevalence was 3.5% in boys and 2.3% in girls. Prevalence of asthma in preschool-aged children was 3.8%, higher than that in infants or school-aged children (Figure).

Respiratory infections triggered asthma symptoms in 90% children. Only 67% of the children with asthma symptoms had asthma diagnosed by a doctor. Inhaled corticosteroid (ICS) use increased from 36% (2000) to 62% (2010), whereas oral corticosteroid use decreased from 74% to 39% over the same period. However, the hospitalisation rate for asthma did not change. Only 14% of children with asthma aged over 5 years used a peak flow meter to monitor disease symptoms.

Urban rural differences

In Beijing, the total prevalence of asthma in children aged less than 14 years in rural areas (1.3%) was much lower than in urban areas (3.7%), as was the diagnosis of asthma in those with symptoms (49% versus 74%). Compared with urban asthmatic children (57%), only 36% of rural asthmatic children received ICS. Results of a recent follow-up in urban Beijing found only 19% of children with asthma had symptoms of asthma in the past 12 months after 6 years.

Improvements

The diagnosis and treatment of asthma has improved throughout China. Contributing factors have been the promotion of Global Initiative for Asthma (GINA) guidelines in China since 1994, the establishment of the National Cooperation Group of Children’s Asthma, use of asthma action plans, the availability of lung function and peak flow meters in many children’s hospitals, and new portable electronic spirometers. However, there is still a long way to go to promote standard treatment. China can achieve this by enhancing disease awareness, reducing stigma, and improving diagnostic, treatment and monitoring skills.

Chuanhe Liu, Yuzhi Chen

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Patient Story

A 4 year old child with recurrent wheezing attended a Tier III hospital to consider asthma diagnosis and management. The specialist suggested an asthma preventive medicine; however, the parent asked “could you NOT prescribe corticosteroids for my child” as they did not want an asthma diagnosis. This can also lead to parents stopping prescribed asthma treatment once symptoms have improved.