Abstract
Bronchial asthma (BA) is a major public health problem worldwide and represents a significant health burden in Saudi Arabia. The prevalence and risk factors of asthma vary across regions and are influenced by genetic, environmental, occupational, and lifestyle-related factors. A cross-sectional epidemiological study was conducted among 738 adults residing in the Makkah region of Saudi Arabia. Data were collected using a self-administered questionnaire that included sociodemographic characteristics and potential risk factors for asthma. Crude and adjusted odds ratios were calculated to assess associations between participant characteristics and self-reported BA. Of the 738 participants, 192 (26.0%) reported having BA. Asthma prevalence differed significantly across cities within the Makkah region (Taif, Makkah, and Jeddah) and among individuals who lived or worked near factories (P < .01). Among asthma patients, 76.6% reported using asthma medications. The most frequently reported environmental and lifestyle exposures included the use of chemicals in cleaning, farming, or hair styling (76.6%), use of air conditioners (73.4%), and use of firewood for heating or cooking (70.3%). Passive smoking was reported by 57.3% of patients, while 46.0% were active smokers. The prevalence of BA among adults in the Makkah region was considerable and varied by geographic location and environmental exposure. Living or working near factories and exposure to indoor and occupational risk factors were associated with asthma. These findings underscore the importance of addressing regional environmental and occupational factors in asthma prevention and management strategies in Saudi Arabia.
Keywords: bronchial asthma, Makkah region, prevalence, risk factors
1. Introduction
Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The prevalence and characteristics of asthma can vary across different regions and populations.[1]
Asthma is one of the most common chronic respiratory diseases worldwide and represents a major public health burden across all age groups. According to recent global estimates, asthma affects >300 million individuals globally, with prevalence continuing to rise in many low- and middle-income countries as well as in urbanized regions of high-income nations.[2,3] The disease is characterized by chronic airway inflammation, variable airflow limitation, and recurrent respiratory symptoms that contribute to impaired quality of life, reduced productivity, and increased healthcare utilization. Asthma-related morbidity remains substantial, accounting for millions of emergency department visits, hospital admissions, and preventable deaths each year, particularly in settings where access to optimal diagnosis and long-term management is limited.[2,3]
The prevalence and burden of asthma are influenced by a complex interaction of genetic susceptibility and environmental, occupational, and lifestyle-related factors. Established risk factors include exposure to indoor and outdoor air pollution, tobacco smoke (active and passive), allergens, respiratory infections, occupational sensitizers, and obesity, in addition to socioeconomic determinants and urbanization. Environmental changes, industrialization, climate variability, and increased exposure to airborne pollutants have been implicated in the rising global prevalence of asthma and the persistence of poorly controlled disease.[2,3] Understanding regional variations in asthma prevalence and associated risk factors is therefore essential for informing targeted prevention strategies, optimizing disease management, and reducing the global burden of asthma.[2,3]
Bronchial asthma (BA) in Saudi Arabia remains a significant health issue, particularly among children. The prevalence of childhood asthma in Saudi Arabia varies across different regions, with some studies reporting inconsistent results. However, recent studies suggest an increasing trend in asthma prevalence rates in the country.[4]
Several factors contribute to the risk of developing asthma, and these can include genetic predisposition, exposure to environmental allergens (such as dust mites, pollen, and pet dander), respiratory infections, occupational exposures, and tobacco smoke.[5]
Saudi Arabia’s environment, with its arid climate and exposure to dust and sandstorms, may contribute to respiratory conditions. Additionally, the prevalence of asthma may be influenced by indoor allergens and air pollution.[1]
Saudi Arabia has a well-developed healthcare system, and individuals with asthma have access to medical care, including diagnosis, treatment, and management of the condition. This involves a multidisciplinary approach, including pulmonologists, allergists, and primary care physicians.[6]
However, asthmatic patients who remain uncontrolled and underdiagnosed are at risk of having acute episodes, which can cause patients to miss work or school, the use of more expensive healthcare services, and a poor quality of life.[7]
The Makkah region in Saudi Arabia has a distinctive geography in which some cities are located on the coast, where the weather is warm and humid, some cities are away from the sea, where the weather is warm and dry, and some cities are located in the mountains, where the weather is cooler.[8] These differences in temperature, humidity, and elevation were not considered before for asthma patients in the Makkah region. Many studies were conducted in different cities in the Makkah region, but no overall study for the whole region. However, comprehensive population-based data assessing asthma prevalence and associated risk factors among adults across the entire Makkah region remain limited.
This study aimed to determine the prevalence of self-reported BA and to identify associated sociodemographic, environmental, and occupational factors among adults residing in the Makkah region of Saudi Arabia.
2. Methods
2.1. Study design and setting
This cross-sectional study was conducted among a representative sample of individuals residing in the Makkah region of Saudi Arabia between May 2022 and November 2023. The Makkah region is one of the most densely populated areas in the country and is characterized by diverse topographical features, including mountainous terrain and desert landscapes, with frequent exposure to wind-borne sand from the Red Sea coastal environment.
2.2. Study population and data collection
Scheduled visits to healthcare centers were arranged by the study field teams. During these visits, adult males and females attending the centers for any reason were invited to participate in the study. Written informed consent was obtained from all participants prior to enrollment.
The study included adults residing in the selected region. Individuals with known chest diseases other than BA, chronic systemic diseases, autoimmune diseases, or hepatic or renal failure were excluded from the study.
2.3. Questionnaire and asthma definition
Data were collected using the same questionnaire employed in the Aseer region study.[9] The study used a modified Arabic-translated version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire adapted for adult populations. This version has been validated and previously used to assess asthma prevalence among adults in Sudan.[10]
A study comparing the ISAAC questionnaire with the European Community Respiratory Health Survey demonstrated a strong correlation between prevalence estimates obtained using both instruments in adult populations.[11] In the present study, the presence of wheeze during the past 12 months in the absence of a cold, as defined in the ISAAC questionnaire, was used as a proxy indicator for BA prevalence. This definition is widely accepted and commonly used in epidemiological studies.[12]
2.4. Ethical approval
The study protocol was approved by the Scientific Research Ethics Committee at Taif University (approval number: 44-133).
2.5. Statistical analysis
Statistical analyses were performed using IBM Statistical Package for the Social Sciences Statistics version 25 (SPSS, Inc., Chicago). Descriptive statistics were used to summarize quantitative variables. Crude odds ratios (cOR) and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CI) were calculated to assess associations between participant characteristics and asthma prevalence. A P value < .05 was considered statistically significant, while a P > .05 was considered statistically nonsignificant.
3. Results
A total of 738 adults were included in the study. Females constituted 52.9% of the participants, and 42.7% were married. Nearly half of the respondents resided in Taif city (47.7%), followed by Makkah (26.0%) and Jeddah (26.3%). Among participants from Taif, 72 individuals (37.5%) reported having asthma. >82% of the study population was younger than 45 years of age (Table 1).
Table 1.
Characteristics of the study respondents.
| Characteristics | Total (N = 738) N (%) |
Asthma yes (N = 192) N (%) |
Asthma no (N = 546) N (%) |
P value |
|---|---|---|---|---|
| Gender | .55 | |||
| Male | 348 (47.15) | 87 (45.31) | 261 (47.80) | |
| Female | 390 (52.85) | 105 (54.69) | 285 (52.20) | |
| Age group (y) | .02 | |||
| 18–24 | 300 (40.65) | 64 (33.33) | 236 (43.22) | |
| 25–44 | 310 (42.01) | 96 (50.00) | 214 (39.19) | |
| ≥45 | 128 (17.34) | 32 (16.67) | 96 (17.58) | |
| BMI (kg/m2), mean ± SD | 24.39 ± 4.87 | 25.08 ± 4.73 | 24.15 ± 4.90 | .02 |
| Marital status | .13 | |||
| Married | 315 (42.68) | 101 (52.60) | 224 (41.03) | |
| Single/divorced/widowed | 423 (57.32) | 91 (47.40) | 322 (58.97) | |
| Education level | .45 | |||
| High school or less | 280 (37.94) | 75 (39.06) | 205 (37.55) | |
| Bachelor | 402 (54.47) | 99 (51.56) | 303 (55.49) | |
| Higher education | 56 (7.59) | 18 (9.38) | 38 (6.96) | |
| Monthly income (SR) | .57 | |||
| <10,000 | 522 (70.73) | 135 (70.31) | 388 (70.06) | |
| 10,000–15,000 | 141 (19.11) | 34 (17.71) | 106 (19.41) | |
| >15,000 | 75 (10.16) | 23 (11.98) | 52 (9.52) | |
| City of Makkah region | .0011 | |||
| Taif | 352 (47.70) | 72 (37.50) | 280 (51.28) | |
| Makkah | 192 (26.02) | 67 (34.90) | 125 (22.89) | |
| Jeddah | 194 (26.29) | 53 (27.60) | 141 (25.82) | |
| Health care worker (yes) | 83 (11.25) | 21 (10.94) | 62 (11.36) | .87 |
| Work/live near factory (yes) | 179 (24.25) | 64 (33.33) | 115 (20.15) | .0003 |
BMI = body mass index.
The prevalence of self-reported asthma did not differ significantly according to education level (P = .45), marital status (P = .13), or monthly income (P = .57). Of the total participants, 179 (24.3%) reported working or living near a factory, of whom 33.3% were asthmatic. A statistically significant difference in asthma prevalence was observed across cities within the Makkah region (P = .0011) and among individuals who worked or lived near a factory (P = .0003) (Table 1).
In crude and adjusted logistic regression analyses, female sex was associated with higher odds of asthma compared with males; however, this association was not statistically significant (cOR = 1.178, 95% CI: 0.830–1.671; aOR = 1.105, 95% CI: 0.79–1.53). Participants aged 25–44 years had a higher adjusted odds of asthma compared with those aged 18–24 years (aOR = 1.65, 95% CI: 1.14–2.38), whereas no significant association was observed among those aged 45 years or older (Table 2).
Table 2.
Odds ratios (ORs) and 95% confidence intervals for factors associated with self-reported asthma.
| Characteristics | cOR (95% CI) | aOR (95% CI) |
|---|---|---|
| Sociodemographic factors | ||
| Gender | ||
| Male | Reference | Reference |
| Female | 1.178 (0.830–1.671) | 1.105 (0.79–1.53) |
| Age group (years) | ||
| 18–24 | Reference | Reference |
| 25–44 | 1.501 (0.939–2.381) | 1.65 (1.14–2.38) |
| ≥45 | 0.976 (0.498–1.913) | 1.22 (0.75–1.99) |
| Clinical factor | ||
| Body mass index (BMI) | 1.044 (1.004–1.085) | 1.04 (1.01–1.07) |
| Socioeconomic factors | ||
| Marital status | ||
| Unmarried | Reference | Reference |
| Married | 0.949 (0.604–1.491) | 1.29 (0.93–1.80) |
| Education level | ||
| High school or less | Reference | Reference |
| Bachelor | 0.844 (0.577–1.234) | 0.89 (0.63–1.26) |
| Higher education | 0.963 (0.478–1.942) | 1.29 (0.69–2.41) |
| Monthly income (SR) | ||
| <10,000 | Reference | Reference |
| 10,000–15,000 | 0.710 (0.426–1.182) | 1.26 (0.74–2.15) |
| >15,000 | 1.294 (0.689–2.431) | 0.91 (0.59–1.40) |
| Geographic factors | ||
| City of Makkah region | ||
| Taif | Reference | Reference |
| Makkah | 1.765 (1.150–2.710) | 1.46 (0.97–2.19) |
| Jeddah | 1.100 (0.698–1.734) | 2.08 (1.41–3.09) |
| Occupational/ environmental factors | ||
| Health care worker | ||
| No | Reference | Reference |
| Yes | 1.016 (0.855–1.795) | 0.95 (0.57–1.62) |
| Work/live near a factory | ||
| No | Reference | Reference |
| Yes | 0.95 (0.57–1.62) | 1.93 (1.34–2.78) |
aOR = adjusted odds ratio, BMI = body mass index, CI = confidence interval, cOR = crude odds ratio.
Body mass index was positively associated with asthma, with a cOR of 1.044 (95% CI: 1.004–1.085) and an aOR of 1.04 (95% CI: 1.01–1.07). Residents of Jeddah showed higher adjusted odds of asthma compared with those residing in Taif (aOR = 2.08, 95% CI: 1.41–3.09). Working or living near a factory was also associated with increased odds of asthma after adjustment (aOR = 1.93, 95% CI: 1.34–2.78). No significant associations were observed for marital status, education level, income, or healthcare worker status in the adjusted model (Table 2).
Among the 192 participants with BA, 76.6% reported using asthma medications, and 73.4% reported using air conditioners. Exposure to chemicals used in cleaning, farming, or hair styling was reported by 76.6% of patients, while 70.3% reported using firewood for heating or cooking. Nearly half of the asthma patients were smokers (46.0%), and 57.3% reported passive exposure to tobacco smoke. Pet ownership was reported by 50.5% of asthma patients (Table 3).
Table 3.
Personal and environmental factors among bronchial asthma patients (N = 192).
| Personal and environmental factors | Yes, N (%) | No, N (%) |
|---|---|---|
| Using asthma medications | 147 (76.6%) | 45 (23.4%) |
| Using air conditioner | 141 (73.4%) | 51 (26.6%) |
| Have cattle/poultry/horses | 54 (28.0%) | 138 (72.0%) |
| Using chemicals in cleaning, farming, or hair styling | 147 (76.6%) | 45 (23.4%) |
| Using firewood for heating/cooking | 135 (70.3%) | 57 (29.7%) |
| Smoking | 89 (46.0%) | 103 (54.0%) |
| Passive smokers (in contact with smokers) | 110 (57.3%) | 82 (42.7%) |
| Pet at home | 97 (50.5%) | 95 (49.5%) |
4. Discussion
Risk factors associated with BA in Saudi Arabia include high-altitude, dust, smoke, allergens, and family history of smoking.[4] Comorbidities such as obesity and gastroesophageal reflux disease also play a significant role in asthma control.[5] It is recommended that asthmatics receive proper education about triggers, avoid exposure to allergens, and adhere to regular treatment and clinic visits.[1]
In the current study, we focused on the Makkah region as it is characterized by the crowding of people in a special geographic area of mountains, desert fine sand, and a windy climate that precipitates asthma. Different areas in Saudi Arabia were recently studied, including Madinah,[4] Riyadh,[5] Abha,[6] and the Aseer region.[9] However, the Makkah region remains a special region due to the crowding of a lot of people in the Hajj and Omrah of all Muslims around the world, all year.
Al Ghamdi et al[9] study showed that residing near heavy truck traffic streets (as a proxy of outdoor pollution) was a significant factor associated with asthma in adults. There is now considerable evidence that traffic and outdoor pollution are important factors in new set asthma as well as exacerbating preexisting asthma. Particulate matters such as diesel exhaust particles, road dust, tire wear, brake wear, and gaseous emissions, including nitrogen oxides, are all implicated. This may be explained by the possible interaction of outdoor air pollutants with the respiratory tract and the immune system.[13]
The Makkah region consisted of 3 main cities: Taif, Makkah, and Jeddah. Taif was found to be higher prevalence of asthma patients than the other 2 cities, with a statistically highly significant difference (P = .0011) in this study. People in Taif live at a high altitude, and based on the findings of this study, they have a lower risk of becoming asthmatic compared to those who live in Makkah city or Jeddah, which are cities at sea level altitude. Adverse effects of high-altitude living were reported for asthmatic children in the tropics,[14] beneficial effects and treatment gains have been cited for adults living in high altitudes.[15] Al Ghamdi et al[9] reported that adult people live in a lower altitude had a higher risk for asthma than those living at a high altitude, which agrees with our findings.
A study on adults in the Aseer region reported 184 adults having wheeze in the past 12 months, giving a prevalence rate of BA of 19.2% (95% CI: 16.72–21.80), which was less than our study.[9] Also, a study investigating the prevalence of asthma among 16 to 18-year-old adolescents attending high schools in the city of Riyadh, utilizing the same ISAAC questionnaire tool, found a comparable prevalence of wheeze during the past 12 months of 18.5%.[16] Another study using the European Community Respiratory Health Survey questionnaire performed in Riyadh among Saudi patients aged 20 to 44 years found a prevalence of wheezing in the past 12 months of 18.2%.[17]
A systematic review reported a pooled weighted prevalence of 14.3% for asthma in KSA, with regional variation ranging from 3.1% in Al-Qassim to 33.7% in Al-Hofuf.[18,19] Rabigh is considered to have the second-highest prevalence of asthma in Saudi children, after Hofuf in the eastern region of KSA.[20] Findings from a large-scale study conducted in 5 countries in the region, including Saudi Arabia, revealed a rate of 44.2% for uncontrolled asthma.[21]
Our data showed that females had a higher risk of asthma compared with males; however, this difference was not statistically significant (P > .05). Alomary et al[19] found a significant difference of female predominance rather than males. This is consistent with the results of a SNAPSHOT program, conducted in 2016 to obtain updated information for the prevalence of asthma, which reported a higher prevalence of asthma in women than men among the adult general population of 5 Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia, and the United Arab Emirates).[22]
Other studies have reported sex-based differences in asthma prevalence worldwide.[23] Although multiple gestations and the role of sex hormones in asthma genesis can explain these differences, no single mechanism can explain the sex-based differences and the impact of sex hormones on the pathophysiology of asthma.[24]
In this study, patients who work near factories were more prone to asthma than those who live away from industrial areas, with a statistically highly significant difference. Similar studies reported occupational asthma caused by conditions attributable to work exposure, such as the cumulative effect of exposure to chemicals.[25,26]
Similarly, the prevalence of asthma/asthma symptoms in Rabigh, another city in the Makkah region, is expected to be currently increasing in association with the significant and rapidly developing industrialization, with many factories that have been established in the past 2 decades in Rabigh.[17] The 24-hour fine particulate matter (PM 2.5) indicative of air pollution of 37 ± 16.2 μg m–3 in Rabigh significantly exceeds the World Health Organization guideline of 20 μg m–3, which is alarming when worrying about poor air quality in Rabigh.[27] Additionally, a study shows that the risk for cardiac and respiratory illnesses is increased in response to fine particulate air pollution exposure in Rabigh City.[28]
We found in this study that the majority of patients use an air conditioner (73.4%). Alomary’s study[19] showed a positive association between heating the house when cold and current wheeze. Several studies have reported positive effects from using a heating system on asthma symptoms.[29] More studies are needed to explain the association between air conditioners/heating and asthma.
We found that 46% of asthma patients were smokers. Alomary et al[19] identified that ever using tobacco daily or less than daily is a statistically significant risk factor for developing asthma symptoms. The association between ever using tobacco and asthma has been well established in studies.[30,31]
We found that nearly half of the patients have domestic animals. Al Ghamdi et al[9] showed that having cats was significantly associated with asthma in adults. Although it has previously been reported worldwide that the presence of cats and dogs in and around the house is associated with an increased prevalence of asthma in children, this association was not clearly established for adults. Nonetheless, this concept has recently been challenged, and such an association has been demonstrated in some adult populations.[32] However, such a notion should be counterbalanced with studies that propose a protective effect of exposure to cats and dogs as pets in earlier childhood, a concept not far removed from the hygiene hypothesis with regard to infection.[33]
This study has several limitations. First, the cross-sectional design precludes causal inference between asthma and associated factors. Second, asthma diagnosis was self-reported, which may be subject to recall bias or misclassification. Finally, the study was conducted among healthcare center attendees, which may limit the generalizability of the findings to the broader population.
Future studies should employ longitudinal designs to better assess causal relationships between environmental exposures and asthma development. Additionally, objective clinical measures and region-specific environmental assessments are warranted to further clarify asthma risk factors across different geographic settings within the Makkah region.
5. Conclusion
Differences in altitude and environmental characteristics across cities in the Makkah region may contribute to variations in the prevalence of asthma. In this study, the prevalence of asthma among adults was higher than that reported among children in previous studies conducted in Taif. Several environmental and lifestyle factors, including the use of air conditioners, firewood for heating or cooking, exposure to chemicals, overweight or obesity, and living or working near factories, were associated with asthma among adults in the Makkah region. These findings highlight the importance of considering regional environmental and occupational factors when addressing asthma prevention and management in Saudi Arabia.
Acknowledgments
The authors would like to acknowledge the Deanship of Graduate Studies and Scientific Research, Taif University, for funding this work.
Author contributions
Conceptualization: Majed Ahmed Algarni.
Funding acquisition: Majed Ahmed Algarni.
Investigation: Nawwaf Ali Alzaidi, Mohammed S. Alharthi.
Methodology: Nawwaf Ali Alzaidi, Abdulaziz Ibrahim Alzarea.
Validation: Abdulaziz Ibrahim Alzarea, Mohammed S. Alharthi.
Formal analysis: Mohammad S. Alzahrani.
Software: Mohammad S. Alzahrani.
Writing – review & editing: Majed Ahmed Algarni, Abdulaziz Ibrahim Alzarea, Mohammed S. Alharthi, Mohammad S. Alzahrani.
Writing – original draft: Nawwaf Ali Alzaidi.
Abbreviations:
- aOR
- adjusted odds ratio
- BA
- bronchial asthma
- CI
- confidence interval
- cOR
- crude odds ratio
- ISAAC
- International Study of Asthma and Allergies in Childhood
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.
How to cite this article: Algarni MA, Alzaidi NA, Alzarea AI, Alharthi MS, Alzahrani MS. Prevalence and factors associated with self-reported asthma diagnosis in Makkah Region of Saudi Arabia. Medicine 2026;105:17(e48481).
Contributor Information
Nawwaf Ali Alzaidi, Email: nawaf.ali.h.alzaidi@gmail.ccom.
Abdulaziz Ibrahim Alzarea, Email: aizarea@ju.edu.sa.
Mohammed S. Alharthi, Email: Ms.harthi@tu.edu.sa.
Mohammad S. Alzahrani, Email: m.s.alzahrani@tu.edu.sa.
References
- [1].Hashem SA, Alzahrani MA, Alghamdi BS, et al. Prevalence and risk factors of bronchial asthma in children in Saudi Arabia: a systematic review. Uttar Pradesh J Zool. 2022;43:201–9. [Google Scholar]
- [2].Rutter CE, Mitchell EA, Asher MI, et al. Potential asthma risk factors do not account for global asthma symptom prevalence patterns and time trends in children and adolescents. World Allergy Organ J. 2024;17:100917. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Zhang L, Wang Y, Li Z, et al. Global, regional and national burden of asthma from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. BMJ Open Respir Res. 2025;12:e003144. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Alhazmi SM, Alharbi ES, Alghamdi AG, Altamimi MA, Alharbi S, Alghamdi F. Impact of asthma education program among bronchial asthma children in asthma control in Madinah City, Saudi Arabia, 2020-2021. Cureus. 2023;15:e40571. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Alfurayh MA, Alturaymi MA, Sharahili AI, Bin Dayel MA, Al-Eissa A, Alilaj MO. Bronchial asthma exacerbation in the emergency department in a Saudi pediatric population: an insight from a Tertiary Hospital in Riyadh, Saudi Arabia. Cureus. 2023;15:e33391. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [6].Ali AA, Ahmad AA, Ahmad AI, et al. Burden and risk factors associated with bronchial asthma among secondary school children in Abha City, Saudi Arabia. King Khalid Univ J Health Sci. 2023;8:30–6. [Google Scholar]
- [7].Al-Moamary MS, Alhaider SA, Alangari AA, et al. The Saudi initiative for asthma - 2021 update: guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med. 2021;16:4–56. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Syed FS, Al-Azemi MA, Zamreeq A, Nazrul Islam M, Ghulam A. Observed heatwaves characteristics and variability over Saudi Arabia. Meteorol Atmos Phys. 2024;136:13. [Google Scholar]
- [9].Al Ghamdi BR, Koshak EA, Ageely HM, Omer FM, Awadalla NJ, Mahfouz AA. Prevalence and factors associated with adult bronchial asthma in Aseer region, Southwestern Saudi Arabia. Ann Thorac Med. 2019;14:278–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Magzoub AA, Musa OA, Elsony AE, Alawad AO, Dawod OY. Validation of the modified international study of asthma and allergies in childhood questionnaire: is wheeze alone enough for determination of asthma symptoms prevalence? Int J Med Sci Public Health. 2017;6:1–9. [Google Scholar]
- [11].Pearce N, Sunyer J, Cheng S, et al. Comparison of asthma prevalence in the ISAAC and the ECRHS. ISAAC Steering Committee and the European Community Respiratory Health Survey. International Study of Asthma and Allergies in Childhood. Eur Respir J. 2000;16:420–6. [DOI] [PubMed] [Google Scholar]
- [12].Wandalsen NF, Gonzalez C, Wandalsen GF, Solé D. Evaluation of criteria for the diagnosis of asthma using an epidemiological questionnaire. J Bras Pneumol. 2009;35:199–205. [DOI] [PubMed] [Google Scholar]
- [13].Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383:1581–92. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Duenas-Meza E, Torres-Duque CA, Correa-Vera E, et al. High prevalence of house dust mite sensitization in children with severe asthma living at high altitude in a tropical country. Pediatr Pulmonol. 2018;53:1356–61. [DOI] [PubMed] [Google Scholar]
- [15].Rijssenbeek-Nouwens LH, Fieten KB, Bron AO, Hashimoto S, Bel EH, Weersink EJ. High-altitude treatment in atopic and nonatopic patients with severe asthma. Eur Respir J. 2012;40:1374–80. [DOI] [PubMed] [Google Scholar]
- [16].Al Ghobain MO, Al-Hajjaj MS, Al Moamary MS. Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire. BMC Public Health. 2012;12:239. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [17].Al Ghobain MO, Algazlan SS, Oreibi TM. Asthma prevalence among adults in Saudi Arabia. Saudi Med J. 2018;39:179–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Hussain SM, Farhana SA, Al Nasser SM. Time trends and regional variation in prevalence of asthma and associated factors in Saudi Arabia: a systematic review and meta-analysis. Biomed Res Int. 2018;2018:8102527. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [19].Alomary SA, Al Madani AJ, Althagafi WA, et al. Prevalence of asthma symptoms and associated risk factors among adults in Saudi Arabia: a national survey from Global Asthma Network Phase Ⅰ. World Allergy Organ J. 2022;15:100623. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [20].Alahmadi TS, Hegazi MA, Alsaedi H, et al. Prevalence and risk factors of asthma in children and adolescents in Rabigh, Western Saudi Arabia. Children (Basel). 2023;10:247. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Mungan D, Aydin O, Mahboub B, et al. Burden of disease associated with asthma among the adult general population of five Middle Eastern countries: Results of the SNAPSHOT program. Respir Med. 2018;139:55–64. [DOI] [PubMed] [Google Scholar]
- [22].Tarraf H, Aydin O, Mungan D, et al. Prevalence of asthma among the adult general population of five Middle Eastern countries: results of the SNAPSHOT program. BMC Pulm Med. 2018;18:68. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [23].Zein JG, Denson JL, Wechsler ME. Asthma over the adult life course: gender and hormonal influences. Clin Chest Med. 2019;40:149–61. [DOI] [PubMed] [Google Scholar]
- [24].Asthma and Allergy Foundation of America. Asthma overview. https://www.aafa.org/asthma.aspx. Accessed February 2021.
- [25].Lemmenes L. Asthma in the workplace. Nurs Clin North Am. 2013;48:159–64. [DOI] [PubMed] [Google Scholar]
- [26].Tarlo SM, Lemiere C. Occupational asthma. N Engl J Med. 2014;370:640–9. [DOI] [PubMed] [Google Scholar]
- [27].Nayebare SR, Aburizaiza OS, Khwaja HA, et al. Chemical characterization and source apportionment of PM2.5 in Rabigh, Saudi Arabia. Aerosol Air Qual Res. 2016;16:3114–29. [Google Scholar]
- [28].Nayebare SR, Aburizaiza OS, Siddique A, et al. Association of fine particulate air pollution with cardiopulmonary morbidity in Western Coast of Saudi Arabia. Saudi Med J. 2017;38:905–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [29].Miyake F, Odgerel CO, Mine Y, Kubo T, Ikaga T, Fujino Y. A prospective cohort study of bedroom warming with a heating system and its association with common infectious diseases in children during winter in Japan. J Epidemiol. 2021;31:165–71. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [30].Murrison LB, Brandt EB, Myers JB, Hershey GKK. Environmental exposures and mechanisms in allergy and asthma development. J Clin Invest. 2019;129:1504–15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [31].Osei AD, Mirbolouk M, Orimoloye OA, et al. The association between e-cigarette use and asthma among never combustible cigarette smokers: behavioral risk factor surveillance system (BRFSS) 2016 & 2017. BMC Pulm Med. 2019;19:180. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [32].Simoneti CS, Ferraz E, Menezes MB, Icuma TR, Vianna EO. Cat ownership is associated with increased asthma prevalence and dog ownership with decreased spirometry values. Braz J Med Biol Res. 2018;51:e7558. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [33].Salo PM, Zeldin DC. Does exposure to cats and dogs decrease the risk of allergic sensitization and disease? J Allergy Clin Immunol. 2009;124:751–2. [DOI] [PMC free article] [PubMed] [Google Scholar]