Trends of prevalence and mortality of asthma in Germany

In many countries, during the last decades a clear increase of asthma prevalence has been documented, both for children and adults. German data art: sparse, but they fit into the international picture. Multiple reasons for their increase are discussed, and lifestyle and exposure to allergens seem to be most important. In Germany prevalence of asthma and asthma symptoms as well as atopic sensitization is more frequent in the Western part than in the Eastern part. The reasons for this difference are not yet understood. Due to the assimilation of the living conditions in Eastern Germany during the next years a clear increase of prevalence is expected. This is - under the hypothesis of a dominating influence of early childhood for allergies in later life - to be earliest expected for children born after 1990, the year of German reunification. Indeed, until now no increase of "objective" parameters like sensitization is seen. An increase of answers on questionnaires for allergies and asthma in Eastern Germany is already observed, but it might be explained by changed diagnostic habits of the doctors and higher awareness of these diseases in the population. The trends of asthma mortality are difficult to interpret. In some countries clear increases and in others clear decreases are seen. In Germany asthma mortality has not increased during the last 20 years but seems to go down slightly. Reasons for this heterogeneous picture might be differences of the health care systems, of self medication or of exposure to allergens and environmental factors which might show up differently in different countries.