The natural history of childhood asthma to adult life.

Abstract

Summary and conclusionsA randomly selected group of 331 children who had started to wheeze in childhood and a control group of 77 children were prospectively studied clinically and physiologically from 7 to 21 years of age. Most subjects improved during adolescence and about 55% of those whose wheezing had started before 7 years and stopped before adolescence remained wheeze free. Forty-five per cent of subjects who had apparently ceased to wheeze at 14 years had minor recurrences of wheezing between 14 and 21 years of age. Fewer than 20% of those with persistent symptoms in childhood had become totally wheeze free during adolescence, although there was amelioration in symptoms.Girls did less well during adolescence than boys, so that there was no longer an increased preponderance of boys with increasing severity of asthma. Normal growth was achieved in all grades despite the persistence of symptoms in many cases. At 21 years of age features of airways obstruction were often found during an interval phase, especially in those who had more persistent symptoms.

Asthma: from childhood to adulthood

“…Seven of these studies did not find a are asymptomatic subjects who have bronchial difference in outcome (1,28,47,50,(58)(59)(60), another responsiveness, but do not perceive induced bronone found women to have a better prognosis than chial obstruction during histamine provocation men (41), and two found female sex to be associ- (64). The same is true of asthmatic subjects, some ated with a poor outcome (32,55). reporting little discomfort with severe airway In the Melbourne study, which started in 1964, obstruction, whereas others experience marked 401 children were randomly selected from 30 000 (55) could not support this hypothesis.…”

“…Most patients with asthma have clinical and serologic evidence of atopy. The results of studies examining the relationship of allergy to the outcome of asthma from childhood to adulthood are conflicting: some investigators found no effect on the outcome (32,(75)(76)(77), whereas others did (39,41,48,56,78,79). The studies which have shown an effect all point to a negative association of atopy with the outcome of asthma.…”

“…Several studies have shown that onset of wheeze at an early age, usually defined as wheeze before the age of 2 years, correlates with a negative outcome (28,50,59). Other investigators, however, found no effect of age at onset of wheeze on the outcome of asthma (32,47,54), or even an association with a positive outcome (38,49,61). One reason for these contradictions is that most of the follow-up studies recruited their subjects at the age of 7 years or older (28,39,45,47,55,56,59) and are therefore susceptible to "recall bias", even if they were prospective in nature.…”

“…Research into a link between eczema as a risk factor for the progression of asthma is complicated by the fact that eczema is generally defined as imprecisely as asthma itself. A further problem is that many studies did not include a physical examination to establish the presence of eczema, but based their findings on questionnaires only (28,32,41,47,55). Because eczema is a disease that changes in severity within hours or days, it is difficult to determine its role in the persistence and severity of asthma.…”

“…The studies which have shown an effect all point to a negative association of atopy with the outcome of asthma. Within the group of atopic asthmatics, the most severe cases also tend to have the most extensive allergic features (hay fever, eczema) (32,41).…”