Burden of Bronchial Asthma in School-Going Adolescents: A Narrative Review of Prevalence, Risk Factors, Severity and Functional Outcomes

Abstract

Background: Bronchial asthma is one of the most common chronic diseases affecting school-going adolescents worldwide and remains a significant cause of morbidity, impaired quality of life, and educational disruption. While prevalence estimates are widely reported, growing evidence suggests that asthma burden in adolescents is inadequately characterized when severity, control, academic participation, and health-related quality of life (HRQoL) are not assessed in an integrated manner.

Objective: This narrative review synthesizes studies published between 2015 and 2025 to summarize current evidence on the epidemiology, determinants, severity and control, academic impact, and HRQoL of bronchial asthma among school-going adolescents, with particular relevance to low- and middle-income settings.

Methods: A narrative review was conducted using PubMed-indexed literature. Eligible studies included peer-reviewed research involving adolescents (approximately 10-19 years) that reported asthma prevalence, risk factors, severity, control, academic outcomes, or HRQoL. Major international surveillance studies, systematic reviews, and observational cohorts were prioritized.

Results: Global Asthma Network data demonstrate substantial international variability in adolescent asthma prevalence and reveal that a considerable proportion of symptomatic adolescents experience severe symptoms and poor disease control. Indian evidence shows moderate pooled prevalence with marked heterogeneity across settings, alongside persistent under-diagnosis and treatment gaps. Modifiable determinants such as environmental tobacco smoke, indoor housing conditions, and ambient air pollution consistently contribute to morbidity. Importantly, poorly controlled asthma is associated with school absenteeism, reduced academic performance, and impaired HRQoL, particularly in emotional and activity-related domains.

Conclusion: Adolescent asthma represents a multidimensional burden extending beyond prevalence alone. Integrated assessment frameworks combining symptom-based prevalence, validated control measures, and HRQoL instruments are essential to identify high-risk adolescents and inform effective school-based and public health interventions.