Original Article

Prevalence and Severity of Adolescent Asthma in Yazd, Iran: Based on the 2020 Global Asthma Network (GAN) Survey

Adolescents Asthma Prevalence in Central Iran


Asthma, as the most common chronic disease in children, encompasses substantial health and socioeconomic burden worldwide. This study aimed to evaluate the prevalence, severity, and management of asthma in adolescents aged 13-14 years.
This cross-sectional study, which was part of the Global Asthma Network (GAN) 2020 survey, was conducted in early 2020 in Yazd, Iran. A total of 48 schools in Yazd city were selected by cluster sampling.
In this study, 5141 students, including 3069 (59.7%) females and 2072 (40.3%) males participated. Prevalence of ever and current wheezing was 19% and 9% respectively. The former was significantly higher in males than females (p<0.001). About 2% of the participants, which was 22.1% of students with current wheezing, had severe asthma. The prevalence of severe asthma was significantly higher in males (p=0.026). Our results showed that 4.8% of students had confirmed asthma by a doctor, significantly predominant in males (p<0.001). The prevalence of using inhaled medicines in the past 12 months was 3.8%, which was significantly higher in males than females (p<0.001). The prevalence of using short-acting β-agonists (SABA) and long-acting β-agonists (LABA) was 2.3% and 1.4% among the students, respectively, with a male predominance (p=0.019). About 1.2% and 0.8% of participants were using inhaled corticosteroids (ICS) and the combination of ICS and LABA, respectively, which was significantly higher in male participants (p<0.001).

According to our findings and in comparison to the previous ISAAC study in Yazd, the prevalence of severe asthma has decreased which indicates better management of asthma during the past two decades.

1. Christiansen ES, Kjaer HF, Eller E, Bindslev‐Jensen C, Høst A, Mortz CG, et al. The prevalence of atopic diseases and the patterns of sensitization in adolescence. Pediatr Allergy Immunol. 2016;27(8):847-53.
2. Bissell K, Ellwood P, Ellwood E, Chiang C-Y, Marks GB, El Sony A, et al. Essential Medicines at the National Level: The Global Asthma Network’s Essential Asthma Medicines Survey 2014. Int J Environ Res Public Health. 2019;16(4):605.
3. Zhou M, Wang H, Zhu J, Chen W, Wang L, Liu S, et al. Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet. 2016;387(10015):251-72.
4. Khoshkhui M, Alyasin S, Sarvestani EK, Amin R, Ariaee N. Evaluation of serum interleukin-35 level in children with persistent asthma. Asian Pac J Allergy Immunol. 2017;35(2):91-5.
5. Ellwood P, Asher MI, Billo NE, Bissell K, Chiang C-Y, Ellwood EM, et al. The Global Asthma Network rationale and methods for Phase I global surveillance: prevalence, severity, management and risk factors. Eur Respir J. 2017;49(1):1601605.
6. Asher M, Keil U, Anderson H, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483-91.
7. Asher M, Weiland S. The International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Steering Committee. Clin Exp Allergy. 1998;(28 Suppl 5)
8. Dharmage SC, Perret J, Custovic A. Epidemiology of asthma in children and adults. Front Pediatr. 2019;7:246.
9. Pawankar R. Allergic diseases and asthma: a global public health concern and a call to action. World Allergy Organ J. 2014;7(1):12.
10. Hassanzadeh J, Mohammadbeigi A, Mousavizadeh A, Akbari M. Asthma prevalence in Iranian guidance school children, a descriptive meta-analysis. J Res Med Sci. 2012;17(3):293–7.
11. Fazlollahi MR, Najmi M, Fallahnezhad M, Sabetkish N, Kazemnejad A, Bidad K, et al. Paediatric asthma prevalence: The first national population‐based survey in Iran. Clin Respir J.2019;13(1):14-22.
12. Entezari A, Mehrabi Y, Varesvazirian M, Pourpak Z, Moin M. A systematic review of recent asthma symptom surveys in Iranian children. Chron Respir Dis. 2009;6(2):109-14.
13. Masjedi MR, Fadaizadeh L, Najafizadeh K, Dokouhaki P. Prevalence and Severity of Asthma Symptoms in Children of Tehran- International Study of Asthma and Allergies in Childhood (ISAAC). Iran J Allergy Asthma Immunol. 2004;3(1):25-30.
14. Karimi M, Mirzaei M, Ahmadieh MH. The Prevalence of Asthma, Allergic Rhinitis and Eczema symptomsamong 13-14 year-old school chidren in Yazd in 2003. Jundishapur Scientific Medical Journal. 2007;6(3 (54)):270-5
15. Committee IS. International Study of Asthma and Allergies in Childhood. ISAAC Phase One Manual (2nd Edition) Auckland/Münster Auckland/Münster. 1993.
16. Mohammadzadeh I, Barari-Savadkoohi R, Alizadeh-Navaei R. The prevalence of allergic rhinitis in Iranian children: A systematic review and descriptive meta-analysis. J Pediatr Rev. 2013;1(2):19-24.
17. Zamanfar D, Ghaffari J, Behzadnia S, Yazdani-charati J, Tavakoli S. The prevalence of allergic rhinitis, eczema and asthma in students of guidance schools in Mazandaran Province, Iran. Open Access Maced J Med Sci. 2016;4(4):619–23.
18. Gashi V, Ahmetaj L. The Prevalence of Self-reported Respiratory Symptoms, Asthma and use of Asthma Medication Among Young Adolescents from Southeast Kosovo. Med Arch. 2020; 74(1):19-23.
19. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S, et al. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009;64(6):476-83.
20. Anderson H, Gupta R, Kapetanakis V, Asher M, Clayton T, Robertson C, et al. International correlations between indicators of prevalence, hospital admissions and mortality for asthma in children. Int J Epidemiol. 2008;37(3):573-82.
21. Hsu J, Qin X, Beavers SF, Mirabelli MC. Asthma-related school absenteeism, morbidity, and modifiable factors. Am J Prev Med. 2016;51(1):23-32.
22. Kim S-H, Sohn K-H, Kang S-Y, Kim J-H, Kwon J-W, Na J-I, et al. School Absenteeism Associated with Asthma and Allergic Diseases in Korean School-Aged Children. Pediatr Allergy Immunol Pulmonol. 2018;31(3):151-7.
23. Chinratanapisit S, Suratannon N, Pacharn P, Sritipsukho P, Vichyanond P. Prevalence and severity of asthma, rhinoconjunctivitis and eczema in children from the Bangkok area: The Global Asthma Network (GAN) Phase I. Asian Pac J Allergy Immunol. 2019;37(4):226-31.
24. Mirsadraee R, Gharagozlou M, Movahedi M, Behniafard N, Nasiri R. Evaluation of factors contributed in nonadherence to medication therapy in children asthma.Iran J Allergy Asthma Immunol. 2012;11(1):23-7.
IssueVol 20 No 1 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijaai.v20i1.5410
Adolescent Asthma Prevalence

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Behniafard N, Nafei Z, Mirzaei M, Karimi M, Vakili M. Prevalence and Severity of Adolescent Asthma in Yazd, Iran: Based on the 2020 Global Asthma Network (GAN) Survey. Iran J Allergy Asthma Immunol. 20(1):24-32.