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Vol. 48. Issue 5.
Pages 475-483 (September - October 2020)
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Vol. 48. Issue 5.
Pages 475-483 (September - October 2020)
Original Article
DOI: 10.1016/j.aller.2019.11.003
Divergent trends in the prevalence of asthma-like symptoms and asthma in a developing country: three repeated surveys between 2002 and 2016
E. Vlaskia,
Corresponding author

Corresponding author.
, K. Stavrikjb, M. Kimovskac, V.C. Cholakovskaa, J.A. Lawsond
a Department of Pulmonology and Allergology, University Children's Clinic, Skopje, Republic of North Macedonia
b Department of Immunology, University Children's Clinic, Skopje, Republic of North Macedonia
c Intensive Care Unit, University Children's Clinic, Skopje, Republic of North Macedonia
d Department of Medicine and Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
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Figures (1)
Tables (4)
Table 1. Characteristics of the study population by year of study.
Table 2. Adjusted associations between year and respiratory outcome.
Table 3. Proportion of children using inhaled corticosteroids by study year.
Table 4. Adjusteda associations between personal, environmental, and behavioural variables with each of the outcomes.
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Introduction and objectives

There have been differences in temporal trends of asthma prevalence by geographic region and economic prosperity. The aim of this study was to assess temporal trends in asthma prevalence among young adolescents in Skopje, Republic of North Macedonia as a developing country with a low asthma prevalence.

Subjects and methods

Data were obtained from three cross-sectional surveys (2002, 2006, and 2016) of adolescents (12–15 years) from randomly selected schools in Skopje. Trends in the prevalence of asthma and asthma-like symptoms were investigated descriptively and using multiple logistic regression to adjust for potential confounding factors.


The prevalence of asthma increased, although the changes were not statistically significant (2002: 1.7%; 2006: 2.0%; 2016: 2.8%; p=0.075). Statistically significant (p<0.05) reductions in wheeze prevalence over time (2002, 2006, 2016) were observed for current wheeze (8.8%, 7.2%, 5.5%), exercise-induced wheeze (14.2%, 7.9%, 1.9%), and night dry cough (16.5%, 13.5%, 9.6%). After adjustment for potential confounding factors, there was an increase in asthma likelihood by year compared to 2002 (2006: OR=1.22, 95%CI=0.67–2.22; 2016: OR=2.45, 95%CI=1.24–4.84). In the adjusted analyses, associations between year and the asthma-like symptoms confirmed the descriptive results, except for current wheeze, where statistical significance disappeared.


Divergent trends in prevalence with a decrease in asthma-like symptoms and an increase in physician-diagnosed asthma in Skopje during a period of 14 years were established. Improved asthma labelling and effective preventative treatment of symptoms may explain some of these changes, although changes in environment and lifestyle could not be ruled out.

Temporal trends
Risk factors


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