Environmental determinants associated with the development of asthma in childhood [State of the Art Series. Asthma in high- and low-income countries, Edited by M. Chan-Yeung. Number 2 in the series]

Asthma is a common chronic respiratory disease, and many epidemiological studies have documented an increasing trend over the past few decades. Comparative studies have shown that asthma is more prevalent in Westernised societies than in rural or developing regions. Environmental factors are likely to be important in explaining such disparities and increasing trends. Although allergen exposure and atopic sensitisation have been thought to be important in the pathogenesis of asthma, recent cross-sectional and longitudinal studies suggest that allergic sensitisation is likely a marker rather than a causative factor for asthma. There is accumulating evidence confirming the role of early exposure to infections in altering the regulation of cytokine production and reduction of subsequent development of atopic disorders. The consistent finding of a lower prevalence of asthma in subjects brought up in a farming environment and the inverse relationship between microbial exposure and asthma symptoms further support the importance of early environmental exposure affecting the risk of subsequent development of asthma. Confirmation of the pathogenetic role of these environmental determinants may allow us to develop primary preventive strategies against the development of asthma and related atopic diseases.