Die Europäische Studie zu Atemwegserkrankungen bei Erwachsenen (ECRHS)

Zusammenfassung

In der Europäischen Studie zu Atemwegserkrankungen (European Community Respiratory Health Survey, ECRHS) wurde die geografische Variation des Auftretens von Asthma, Atemwegssymptomen, allergischer Rhinitis sowie der allergischen Sensibilisierung bei jungen Erwachsenen in Europa und einigen außereuropäischen Ländern untersucht. Auf der Grundlage einer validierten und standardisierten Untersuchung wurden Anfang der 90er Jahre von 140 000 Erwachsenen im Alter von 20 - 44 Jahren aus 22 Ländern Daten zur Atemwegsgesundheit ermittelt. Das Ziel dieser Übersicht besteht darin, die wesentlichen Ergebnisse der ECRHS-Studie zusammenzufassen und den Beitrag der beiden deutschen Studienzentren in Hamburg und Erfurt hervorzuheben. Die Häufigkeiten variieren zwischen 2,0 - 11,9 % für Asthma, 9,5 - 40,9 % für die allergische Rhinitis, 4,0 - 32,0 % für Atemwegssymptome (pfeifende oder brummende Atemgeräusche), 3,4 - 27,9 % für die bronchiale Hyperreaktivität und 16,2 - 44,5 % für die allergische Sensibilisierung gegen häufige Aeroallergene. In Hamburg waren die Beschwerden im Vergleich zu Erfurt viel häufiger. Regionale Unterschiede zeigten sich aber auch innerhalb anderer europäischer Länder. Die innerdeutschen Häufigkeitsunterschiede ordnen sich wie folgt in den europäischen Rahmen ein: Im europäischen Vergleich wurden die niedrigsten Prävalenzen in Osteuropa, inklusive Erfurt gesehen und geringfügig höhere in den Mittelmeerländern. Die höchsten Häufigkeiten wurden in Englisch sprechenden Studienzentren ermittelt. Asthma ist oft unbehandelt und die Behandlung variiert deutlich zwischen den Studienregionen. Umweltfaktoren und dabei insbesondere arbeitsplatzbezogene Expositionen durch Tabakrauch, Gase und Dämpfe spielen neben Risikofaktoren in der frühen Kindheit und genetischen Faktoren eine maßgebliche Rolle bei der Entwicklung von Asthma sowie der allergischen Sensibilisierung.

Abstract

The European Community Respiratory Health Survey (ECRHS) was the first study to assess the geographical variation in asthma, allergy, and allergic sensitization in adults using the same instruments and definitions. The database of the ECRHS includes information from approximately 140 000 individuals aged 20 - 44 years from 22 countries. The aim of this review is to summarize the results of the ECRHS and to present the specific contribution of the German centers in Hamburg and Erfurt. The prevalence ranged from 2.0 - 11.9 % for asthma, 9.5 - 40.9 % for allergic rhinitis, 4.0 - 32.0 % for wheeze, 3.4 - 27.9 % for bronchial hyperreactivity, and 16.2 - 44.5 % for allergic sensitisation against common aeroallergens. Although the prevalence of these atopic disorders were found to be consistently higher for the Hamburg center compared to the Erfurt center, strong regional differences in the prevalences were also found within several other European countries. Overall Europe, the lowest prevalences were seen in the Eastern and Middle European countries with the center Erfurt, followed by the Mediterranean region. The highest prevalences were reported for all English speaking centers. Strong geographic variation was reported for medication for asthma. Asthma seems to be undertreated in several countries. Environmental exposures and in particular indoor factors, and exposures at the workplace are playing a major role for asthma in adulthood. Furthermore, protective effects on atopy were found for exposures to pets (dogs) and a large number of siblings in early childhood. In conclusion, the ECRHS has shown that the prevalence of asthma varies widely. The fact that the geographical pattern is consistent with the distribution of atopy and bronchial responsiveness supports the conclusion that the geographical variations in the prevalence of asthma are true and likely due to environmental factors.

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