(24.91–25.67)
(29.28–30.08)
(61.09–62.05)
(37.99–38.53)
(56.27–56.85)
(42.9–43.54)
Fig. 2. Frequency of all signs and symptoms.
Table 2.
Five Most Frequent Signs and Symptoms
Signs and Symptoms
Pooled Proportion (95% CI)
Nasal congestion
61.57 (61.09–62.05)
Sleep disturbance
56.56 (56.27–56.85)
Chest tightness
50.41 (50.18–50.64)
Breathlessness
50.31 (50.11–50.51)
Wheezing
46.97 (46.80–47.14)
S
IGNS AND
S
YMPTOMS IN
A
DULT
A
STHMA
256
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ESPIRATORY
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65 N
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2
regation was reported). Further, the combined utilization
of inhaled and oral corticosteroids was 49.75% (95% CI
49.53–49.97) in 19 studies. Short- and long-acting
ago-
nists were administered to a pooled population of 63.32%
(95% CI 62.99–63.35) and 64.79% (95% CI 64.32–65.26)
in 8 and 4 studies, respectively.
Severity of Symptoms or Disease
Figure 5 presents the severity of asthma in the subjects
included in our analysis. The highest proportion of sub-
jects in our analysis were reported to have moderate to
severe asthma (62.42% [95% CI 38.78–80.13%]), which
was reported in 6 studies. Twelve studies included sub-
jects with severe asthma, for which the pooled proportion
was 26.17% (95% CI 16.55–37.11%). The pooled propor-
tion of moderate and mild asthma were 20.64% (95% CI
10.62–32.95%) and 23.70% (95% CI 15.32–33.25%), re-
spectively. In addition, some of the studies included in the
analysis enrolled subjects with only moderate to severe
asthma, so these results should be interpreted with caution.
Combination of Symptoms and Asthma Severity
Symptoms reported within a single study were presented
as combinations. A total of 37 symptom combinations
(defined as symptoms that exist concurrently in a subject)
were reported in the included 67 studies (see the supple-
mentary materials at ). We also
calculated the average proportion of subjects affected by
the different combinations of symptoms, the number of
studies reporting the combination of symptoms, and the
frequency of subjects with different severity of asthma
(see the supplementary materials at -
.com). In terms of prevalence, concurrent symptoms in-
cluding wheezing, breathlessness, and bronchial hyper-re-
sponsiveness (combination 35) affected the highest number
of subjects (
n
11,297), followed by combination 17, in
which subjects were affected by symptoms of wheezing,
breathlessness, chest tightness, cough, sneezing, runny
nose/rhinorrhea, sleep disturbances, bronchial hyper-
responsiveness, and sinusitis (
n
6,590). The least prev-
alent symptom combination was combination 20 (13.36%),
which was a concurrent existence of wheezing, breathless-
ness, chest tightness, cough, exercise-induced bronchoc-
onstriction, sleep disturbances, asthma exacerbations, and
bronchial hyper-responsiveness.
A random-effects model (heterogeneity 100%,
2
0.6047,
P
0.004) was used to determine the association between
the combination of symptoms and the risk of asthma (Fig.
6). The risk of mild asthma was 0.78 (95% CI 0.57–1.08),
History
n
/
N
Allergy/atopy
Rhinitis
Smoking
Family history
Past repiratory illness (other than asthma)
Hospitilzation (due to asthma)
Absence from work/school due to respiratory systems
Occupational exposure
Sinusitis
16,756/38,196
7,078/10,076
8,844/27,472
250/4,092
4,969/13,458
3,263/16,094
394/1,590
1,234/5,651
4,454/8,930
33
18
45
7
9
16
3
9
4
(63.37–63.69)
(76.17–76.57)
(44.96–45.26)
(25.4–26.04)
(42.55–43.19)
(57.65–58.13)
(35.12–36.2)
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