Disease burden of mild asthma in China
Medical Evidence and Observational Research, AstraZeneca Gothenburg, Mölndal, Sweden;
Respiratory Research, Adelphi
Real World, Macclesﬁeld, UK
Background and objective: The impact, treatment pat-
terns and control of mild asthma are poorly understood
for Chinese patients. This study describes the character-
istics, therapeutic interventions and burden of mild
asthma on patients residing in major cities of China.
Methods: The Respiratory Disease Speciﬁc Program
2015, a cross-sectional survey, was conducted with Chi-
nese physicians and their patients. The survey assessed
clinical characteristics, asthma symptoms, exacerba-
tions, rescue inhaler usage, treatment adherence,
asthma control, work and activity impairments and
healthcare utilization for patients prescribed Global Ini-
tiative for Asthma (GINA) Step 1 or 2 treatment deﬁned
Results: From a total sample of 988 patients,
229 patients met the criteria for mild asthma, with
25.3% classiﬁed as Step 1 and 74.7% as Step 2. Overall,
12.6% of patients were considered of high adherence to
prescribed treatment. Physicians reported that 75% of
patients overall were well controlled, although well-
controlled asthma as deﬁned by GINA was achieved in
only 14.2% of patients. 26.5% of patients indicated daily
use of as-needed rescue medication in the last 4 weeks.
17.8% of patients experienced ≥1 exacerbations in the
last 12 months and impaired work productivity was
Conclusion: Less than 15% of patients were well con-
trolled according to GINA criteria despite physicians
reporting the majority of patients were well controlled.
Over one-fourth of patients relied on daily rescue
inhaler medication, while exacerbation frequency and
work and activity impairment were higher than might
reasonably be expected in a mild asthmatic population.
asthma control, China, disease burden, exacerba-
tions, mild asthma.
ACT, Asthma Control Test; DSP, Disease
Speciﬁc Program; ED, emergency department; FEV
expiratory volume in 1 s; GINA, Global Initiative for Asthma;
ICS, inhaled corticosteroid; LTRA, leukotriene receptor
antagonist; SOB, shortness of breath; TCM, traditional Chinese
Asthma is a common, chronic respiratory disease esti-
mated to affect 1.0–18.0% of the population depending
on the country.
The 2002 prevalence estimates of
3.0–6.0% for Asia-Paciﬁc nations are lower compared
with Western countries, although prevalence in Asia
appears to be on the rise.
This increase has been
attributed to environmental exposures,
and the elderly at highest risk.
Thirty million people in China are affected by
A household survey of more than 180 000
individuals 14 years or older residing in eight provinces
of China revealed an overall asthma prevalence of
while other studies report a prevalence of
1.1% across all age groups. Prevalence is higher in
urban areas at 1.4% versus 0.9% for rural locations.
Crucially and consistent with trends in other Asia-
Paciﬁc countries, asthma prevalence in China appears
to be increasing.
Treatment goals include optimal symptom control,
maintenance of normal activity levels and reductions in
exacerbations and ﬁxed airﬂow limitations, with mini-
mal side effects.
Pharmacological treatment options
are guided by severity.
Mild asthma is asthma that is
well controlled with Step 1 or Step 2 treatment includ-
ing as-needed reliever medication monotherapy (Step
1) or a low-intensity controller treatment, such as low-
dose inhaled corticosteroids (ICS), leukotriene receptor
antagonists (LTRA) or theophylline (Step 2).
Health and Wellness Surveys conducted between 2010
and 2013, 1.99% reported a diagnosis of asthma, with
77.0% considered to have mild asthma based on GINA
A cross-sectional survey of 13 645 individ-
uals residing in Jinan, China, revealed that poor asthma
Correspondence: Bo Ding, Medical Evidence and
Observational Research, AstraZeneca Gothenburg,
Pepparedsleden 1 SE-431 83 Mölndal, Västra Götaland, Sweden.
Received 18 April 2017; invited to revise 19 June 2017;
revised 2 August 2017; accepted 29 August 2017 (Associate
Editor: Giorgio Piacentini; Senior Editor: Paul King).
SUMMARY AT A GLANCE
This observational study of Chinese patients with
mild asthma reveals that physicians considered 75%
to be well or completely controlled, although only
14.2% were well controlled according to the Global
Initiative for Asthma criteria. Treatment adherence
was low, and many patients experienced nocturnal
symptoms, exacerbations and work and activity
© 2017 Asian Paciﬁc Society of Respirology Respirology (2018) 23, 369–377