Asthma in Iranian Children: What the First National Survey Reveals
"Discover the prevalence of pediatric asthma across Iran and understand the key risk factors affecting young children."
Asthma is a significant chronic disease worldwide, and while much research has been conducted in developed countries, data from developing nations remains limited. This is especially true in eastern developing countries. Understanding the prevalence and characteristics of asthma in these regions is crucial for effective public health planning and resource allocation.
A recent national population-based survey in Iran sought to address this gap by evaluating the prevalence of pediatric asthma across the country. This study, the first of its kind in Iran, provides valuable insights into the condition's impact on Iranian children and identifies key factors contributing to its development.
Using a cross-sectional study design, researchers estimated asthma symptom prevalence using a randomized multistage stratified cluster sampling method. They surveyed 16,410 individuals aged 6-7 years and 16,850 individuals aged 13-14 years, employing a validated questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC) core questions. Data was collected between November 2015 and February 2016.
Current Burden
U.S. estimates vary by dataset and measure: the CDC reports asthma in 4,804,000 children under 18, with a prevalence of 6.7%, while AAAAI reports 6.2% among children. AAAAI also reports that pediatric asthma prevalence rose from 8.7% in 2001 to 9.4% in 2010. Globally, asthma is described as the most common chronic disease among children, with childhood asthma death rates ranging from 0 to 0.7 per 100,000 people.
Diagnosis and Limits
There is no universally accepted gold standard for diagnosing asthma in children. Practical diagnostic guidance recommends spirometry and bronchodilator reversibility testing, although the best diagnostic approach remains uncertain. Reported prevalence also varies with age, ranging from 1.9% in children aged 0 to 4 years to 7.7% among older children and adolescents.
Changing Patterns
U.S. childhood asthma prevalence increased from 8.7% in 2001 to 9.4% in 2010, then declined to 8.3% in 2016. Research on pediatric incidence found substantial variation by age, sex, parental asthma history, race, and calendar year, with higher incidence among children aged 0 to 4 years. One historical account also estimates that asthma affects 4.5 million U.S. children, or 6.2% of children.
Key Findings: Prevalence, Risk Factors, and Regional Differences
The survey revealed that the total prevalence of asthma among Iranian children was 10.9% (n=3624) with a 95% confidence interval of 10.6% to 11.2%. This figure indicates a significant health concern, highlighting the need for targeted interventions and improved management strategies.
- Age: Asthma was more prevalent among 13- to 14-year-olds (12.4%) compared to the 6- to 7-year-old group (9.4%, p<0.001).
- Gender: Males exhibited a higher prevalence of asthma (12.1%) than females (9.8%, p<0.001).
- Location: Children residing in urban areas showed a higher asthma prevalence compared to those in rural areas (p=0.003).
- Severe Asthma: The prevalence of severe asthma was 3.9%, with higher rates in older age groups and males (p<0.001).
- Passive Smoking: A significant relationship was found between asthma and passive smoking in both age groups (p<0.001).
Recent Evidence
A 2025 systematic review and meta-analysis estimated the overall prevalence of childhood asthma at 10.2%, with a 95% confidence interval of 9.5% to 11.0%. Another 2025 review examined asthma prevalence trends among children and adolescents from 1990 through 2021. Severe asthma appears to affect a minority of children with asthma, but estimates vary widely from 2.1% to 10%.
Severity and Inequality
The distinction between difficult-to-treat and severe asthma remains important because severe wheezing episodes can affect up to 20% of children aged 6 to 7 years. The available evidence also shows that asthma outcomes are not distributed equally across populations. Non-Hispanic Black children have a reported 23% prevalence of asthma exacerbations, emergency-department visits, and hospitalizations, with Hispanic children also experiencing higher rates.
U.S. and Japan
U.S. asthma hospitalization prevalence has decreased across racial and ethnic groups, although the reported rates of decline are similar between groups. Japan shows a different long-term pattern: prevalence increased between 1982 and 2002, from 3.8% to 8.1% among boys and from 2.5% to 5.0% among girls. It then decreased by 2022 to 3.2% among boys and 2.1% among girls.
Implications and Future Directions
The study's conclusion that the prevalence of asthma and severe asthma in the pediatric population of Iran is similar to other developing countries suggests shared challenges and potential solutions. Targeted attention to urban regions, male individuals, and older age groups is essential for better asthma control.
Adapting Guidelines
An Italian expert-opinion group was convened to translate the 2025 GINA strategy report into pediatric asthma management suited to the national context. The effort aligns clinical practice with GINA while adapting recommendations for Italy. This example emphasizes the role of national expert groups in interpreting international asthma guidance.
Emerging Trends
U.S. childhood asthma prevalence increased from 2001 to 2009, plateaued, and then declined in 2013, while prevalence continued increasing among 10- to 17-year-olds. A separate projection estimated that global asthma prevalence among children and adolescents reached 130.52 million cases in 2023, with a 95% uncertainty interval of 89.518 to 190.284 million. These findings point to continuing changes in both age-specific and global asthma patterns.
Comorbidities and Burden
The WHO identifies asthma as a major noncommunicable disease affecting children and adults and as the most common chronic disease among children. Asthma frequently intersects with other pediatric conditions, including allergic rhinitis. A recent review and meta-analysis reported a 10.48% prevalence of physician-diagnosed allergic rhinitis in children, while self-reported current allergic rhinitis prevalence was 18.12%.
Lived Disease Burden
The Global Asthma Network reported current asthma symptoms in 9.1% of children and 11.0% of adolescents during Phase I, compared with 6.6% of adults. The burden differed by country, indicating that children and adolescents do not experience asthma uniformly across settings. These figures illustrate how asthma symptoms affect everyday life across age groups rather than representing only a clinical diagnosis.
The researchers recommend that public health professionals develop suitable health endorsement programs, including asthma control education and limiting indoor cigarette smoking. These measures align with global best practices and could significantly reduce the burden of asthma in Iranian children.
Further national surveys are necessary to determine the trend of pediatric asthma in Iran and to evaluate the effectiveness of implemented interventions. Longitudinal studies could provide valuable insights into the long-term impact of asthma on children's health and development.