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Researchers call for more research into asthma in Latin America
MEDICINE AND HEALTH POLICY
Researchers call for more research into asthma in Latin America Manual E Soto-Quirós (Centro Medico Metropolitano, San Jose, Costa Rica). Costa Rica, Soto-Quirós noted, although not a rich country, has a relatively high standard of living and good social and health services. The Costa Rican per capita income is greater than US$4000, life expectancy is 77·7 years, and infant mortality just 11 per 1000 births. Nicaragua, Costa Rica’s northern neighbour, however, is much poorer and provides much less in the way of social and health services to its population. The per capita income in Nicaragua is US$486, life expectancy is 68·7 years, and infant mortality 36 per 1000 births. Asthma prevalence among schoolchildren in Costa Rica, Soto-Quirós noted, is quite high: 26% of children have a doctor’s diagnosis of asthma and 33% report having had wheezing in the last 12 months. The rates in Nicaragua are about half those in Costa Rica with about 16% having a doctor’s
diagnosis of asthma and 15·5% reporting wheezing in the last 12 months. Why asthma prevalence rates differ so much is not known, Soto-Quirós said. But preliminary data from a study of 300 Nicaraguan children who immigrated to Costa Rica indicate that it is something in the
“. . . data coming from the developing countries may not be applicable to our situation” environment or lifestyle, because after the Nicaraguan children settled in Costa Rica their asthma rates became the same as native-born Costa Rican children. Costa Rica is also the site of an effort to unravel the genetics of asthma in Latino populations. Juan C Celedón, a native Columbian who is now at Brigham and Women’s Hospital (Boston, MA, USA), is part of team doing a large family-pedigree study in the Central Valley of
the country. This region was settled in the mid-to-late 1500s by Spanish colonists. Since then there has been little mixing or immigration. As a result, the researchers believe they might be able to identify asthma genes introduced by a few of the original “founders”. Although this will be the first genome scan for asthma genes in Latin Americans, the results should not be thought to apply to all Latinos, Celedón warned. Too often researchers have assumed that “all Latinos are the same”, he said, but there is a wide variation between countries and between communities within the countries, he said. “If you were to collect data only from the south of Brazil and nothing from the Amazon region, you would be losing an incredible amount of valuable information”, Celedón said, “It’s in the variation where you are going to find the interesting data.” Michael McCarthy
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Still Pictures
atin American researchers attending the yearly conference of the American Thoracic Society in Seattle, WA, USA (May 16–21) called for more research into asthma in Central and South America, where asthma rates among children in some countries are among the highest in the world. Although asthma rates are low in many Latin American countries, rates in Brazil, Peru, and Costa Rica rival those found in developed nations with the highest prevalence—such as the UK, USA, Australia, and New Zealand. “Asthma is a heavy burden in Latin American countries”, said Renato Stein of the Pontificia Universidade Catolica RS (Porto Alegre, RS, Brazil). “It is winter now in Latin America and if you go to the emergency room, you will find they are packed with kids wheezing.” But although the prevalence rates might be similar to the rates seen in high-prevalence developed nations, the type and pattern of asthma tend to be different. For example, whereas asthma in developed countries tends to be associated with allergies, asthma in many Latin American communities is not. These and other differences, Stein said, raise the question whether the asthma seen in Latin America is the same as that seen in the UK or Australia. “It is absolutely important for us to understand that data coming from the developing countries may not be applicable to our situation”, Stein said, “We have to do the studies in Latin America.” Differences in asthma between Latin American countries could provide clues to the causes of asthma and lead to new ways to treat and prevent the disease, said
L
Asthma prevalence in Nicaraguan schoolchildren is relatively low despite poor health services
THE LANCET • Vol 361 • May 24, 2003 • www.thelancet.com
1797
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Researchers call for more research into asthma in Latin America Manual E Soto-Quirós (Centro Medico Metropolitano, San Jose, Costa Rica). Costa Rica, Soto-Quirós noted, although not a rich country, has a relatively high standard of living and good social and health services. The Costa Rican per capita income is greater than US$4000, life expectancy is 77·7 years, and infant mortality just 11 per 1000 births. Nicaragua, Costa Rica’s northern neighbour, however, is much poorer and provides much less in the way of social and health services to its population. The per capita income in Nicaragua is US$486, life expectancy is 68·7 years, and infant mortality 36 per 1000 births. Asthma prevalence among schoolchildren in Costa Rica, Soto-Quirós noted, is quite high: 26% of children have a doctor’s diagnosis of asthma and 33% report having had wheezing in the last 12 months. The rates in Nicaragua are about half those in Costa Rica with about 16% having a doctor’s
diagnosis of asthma and 15·5% reporting wheezing in the last 12 months. Why asthma prevalence rates differ so much is not known, Soto-Quirós said. But preliminary data from a study of 300 Nicaraguan children who immigrated to Costa Rica indicate that it is something in the
“. . . data coming from the developing countries may not be applicable to our situation” environment or lifestyle, because after the Nicaraguan children settled in Costa Rica their asthma rates became the same as native-born Costa Rican children. Costa Rica is also the site of an effort to unravel the genetics of asthma in Latino populations. Juan C Celedón, a native Columbian who is now at Brigham and Women’s Hospital (Boston, MA, USA), is part of team doing a large family-pedigree study in the Central Valley of
the country. This region was settled in the mid-to-late 1500s by Spanish colonists. Since then there has been little mixing or immigration. As a result, the researchers believe they might be able to identify asthma genes introduced by a few of the original “founders”. Although this will be the first genome scan for asthma genes in Latin Americans, the results should not be thought to apply to all Latinos, Celedón warned. Too often researchers have assumed that “all Latinos are the same”, he said, but there is a wide variation between countries and between communities within the countries, he said. “If you were to collect data only from the south of Brazil and nothing from the Amazon region, you would be losing an incredible amount of valuable information”, Celedón said, “It’s in the variation where you are going to find the interesting data.” Michael McCarthy
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Still Pictures
atin American researchers attending the yearly conference of the American Thoracic Society in Seattle, WA, USA (May 16–21) called for more research into asthma in Central and South America, where asthma rates among children in some countries are among the highest in the world. Although asthma rates are low in many Latin American countries, rates in Brazil, Peru, and Costa Rica rival those found in developed nations with the highest prevalence—such as the UK, USA, Australia, and New Zealand. “Asthma is a heavy burden in Latin American countries”, said Renato Stein of the Pontificia Universidade Catolica RS (Porto Alegre, RS, Brazil). “It is winter now in Latin America and if you go to the emergency room, you will find they are packed with kids wheezing.” But although the prevalence rates might be similar to the rates seen in high-prevalence developed nations, the type and pattern of asthma tend to be different. For example, whereas asthma in developed countries tends to be associated with allergies, asthma in many Latin American communities is not. These and other differences, Stein said, raise the question whether the asthma seen in Latin America is the same as that seen in the UK or Australia. “It is absolutely important for us to understand that data coming from the developing countries may not be applicable to our situation”, Stein said, “We have to do the studies in Latin America.” Differences in asthma between Latin American countries could provide clues to the causes of asthma and lead to new ways to treat and prevent the disease, said
L
Asthma prevalence in Nicaraguan schoolchildren is relatively low despite poor health services
THE LANCET • Vol 361 • May 24, 2003 • www.thelancet.com
1797
For personal use. Only reproduce with permission from The Lancet Publishing Group.