Asthma in the Americas: An Update: A Joint Perspective from the Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, and American Thoracic Society
Asthma affects a large number of people living in the Americas, a vast and diverse geographic region comprising 35 nations in the Caribbean and North, Central, and South America. The marked variability in the prevalence, morbidity, and mortality from asthma across and within nations in the Americas offers a unique opportunity to improve our understanding of the risk factors and management of asthma phenotypes and endotypes in children and adults. Moreover, a better assessment of the causes and treatment of asthma in less economically developed regions in the Americas would help diagnose and treat individuals migrating from those areas to Canada and the United States. In this focused review, we first assess the epidemiology of asthma, review known and potential risk factors, and examine commonalities and differences in asthma management across the Americas.
We then discuss future directions in research and health policies to improve the prevention, diagnosis, and management of pediatric and adult asthma in the Americas, including standardized and periodic assessment of asthma burden across the region; large-scale longitudinal studies including omics and comprehensive environmental data on racially and ethnically diverse populations; and dissemination and implementation of guidelines for asthma management across the spectrum of disease severity.
New initiatives should recognize differences in socioeconomic development and health care systems across the region while paying particular attention to novel or more impactful risk factors for asthma in the Americas, including indoor pollutants such as biomass fuel, tobacco use, infectious agents and the microbiome, and psychosocial stressor and chronic stress.
Pulmonologists, critical care specialists, translational researchers, and clinicians
At the conclusion of this activity, learners should be able to:
- Describe the epidemiology of asthma across the Americas
- Apply knowledge of potential and known risk factors for asthma to the design and implementation of research studies in the diverse population of the Americas
- Develop new strategies for asthma diagnosis and management in population subgroups across the Americas
The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Erick Forno, M.D., M.P.H. (Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA) reported no relevant financial relationships.
Diego D. Brandenburg, M.D. (Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil) reported receiving payments for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, GSK, and AstraZeneca.
Jose A. Castro-Rodriguez, M.D., Ph.D. (Pontificia Universidad Católica de Chile, Santiago, Chile) reported no relevant financial relationships.
Carlos A. Celis-Preciado, M.D., M.Sc. (Hospital Universitario San Ignacio, Bogota, Colombia) reported receiving personal payments from AstraZeneza, Boehringer Ingelheim, GSK, Novartis, and Sanofi.
Fernando Holguin, M.D., M.P.H. (University of Colorado, Denver, CO, USA) reported receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, GSK, and AstraZeneca; participating on a Data Safety Monitoring Board of Advisory Board for Member Adjudication Committee INSMED; serving on a board, society, committee or advocacy group for Pulmonary and Allergy Drugs Advisory Committee FDA.
Chris Licskai, M.D. (Western University, London, Ontario, Canada) reported receiving grants from Novartis, Ontario Ministry of Health, Canadian Institutes of Health Research, federal Economic Development Agency for Southern Ontario, Academic Medical Organization of Southwestern Ontario, AstraZeneca, and Pfizer; receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, and Novartis; participating on a Data Safety Monitoring Board of Advisory Board for GlaxoSmithKline, AstraZeneca, Snaofi, Teva, and Novartis; serving on a board, society, committee or advocacy group for Canadian Thoracic Society and Asthma Research Group.
Stephanie Lovinsky-Desir, M.D., M.S. (Columbia University Irving Medical Center, New York, NY, USA) reported receiving grants K01HL140216 and the Amos Medical Faculty Development Award.
Marcia Pizzichini, M.D., Ph.D. (Universidade Federal de Santa Catarina, Florianópolis, Brazil) reported receiving consulting fees from Boehringer Ingelheim, GSK, Janssen, and Sanofi; receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, GSK, Janssen, and Sanofi; receiving support for attending meetings from Boehringer Ingelheim and Sanofi.
Alejandro Teper, M.D. (El Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina) reported no relevant financial relationships.
Connie Yang, M.D., M.Sc. (British Columbia Children’s Hospital, Vancouver, British Columbia, Canada) reported receiving honorarium for attending an advisory board meeting for Novartis, Covis, and GSK.
Juan C. Celedón, M.D., Dr.P.H. (University of Pittsburgh, Pittsburgh, PA, USA) reported receiving research materials from Pharmavite (vitamin D and placebo capsules) and GSK and Merck (inhaled steroids) in order to provide medications free of cost to participants in NIH-funded studies, unrelated to the current work.
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The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence.
AnnalsATS CME Planners
Alan M. Fein, M.D.
Podcast Editor, AnnalsATS
Dr. Fein reported that he has no financial relationships with ineligible companies.
Constantine Manthous, M.D.
Associate Editor, AnnalsATS
Dr. Manthous reported that he has no financial relationships with ineligible companies.
Gregory A. Schmidt, M.D.
Editorial Board, AnnalsATS
Dr. Schmidt reported payments for writing a textbook on critical care medicine (McGraw-Hill) and for writing contributions for UptoDate.
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