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A mixed picture was also found to exist in the United States. Akinbami and Schoendorf (75) reported that annual asthma prevalence increased from 3.7% (1980/1981) Selleckchem RSL-3 to 6.9% (1995/1996) (Table?4), whereas Mannino et?al. (76) reported a decline from 1997 to 1999 (Table?5). In Alaska, a yearly increase in asthma prevalence was reported (from 1.0% in 1999 to 2.2% in 2002 (P?Succimer (81) reported an increase in wheezing for the last 12?months using the ISAAC questionnaire, data were only presented for 1999/2000. Although a global picture of trends in asthma prevalence can be presented (Fig.?2), there are still areas where little or no data have been collected, these including parts of Asia, Africa and South America. In areas where asthma prevalence has only been reported in single cross-sectional studies, it would seem prudent to invest resources to generate serial data. These areas include Africa, Trinidad and Tobago (82), Dhakar (83), Albania (84), Greece (85), Nigeria (18), Israel (86), Beirut (87), United Arab Emirates (88), Kuwait (89), Palestine (90), Tamil Nadu, India (35) and Qatar (91). This systematic review of the international literature has clearly shown that there is overall no decline in the prevalence of asthma. This is particularly apparent from the various higher quality epidemiological studies, many of which AG-221 in vitro reveal that, if anything, the prevalence of symptoms suggestive of asthma may still be increasing. The Global Burden of Asthma report (2004) (1) indicates that the highest prevalence of physician-diagnosed asthma is still in the UK and Australasia but that the USA and parts of South America have high prevalence. The lowest prevalence is in Indonesia, Albania, Nepal and India. This report thus highlights that asthma is still predominantly a western English- speaking area disease but that people in all world regions are nonetheless now affected. It has been suggested that this epidemiological picture may reflect the English origin bias of many of the asthma instruments used. Indeed, the word asthma and asthma-related symptoms are translated differently or can have different meanings in non-English speaking countries (92). For example, the word ��wheezing�� cannot be translated literally in most other languages.