Adult asthma severity in individuals with a history of childhood asthma

doi:10.1016/j.jaci.2004.09.032

Journal of Allergy and Clinical Immunology

Volume 115, Issue 1, January 2005, Pages 61-66

https://doi.org/10.1016/j.jaci.2004.09.032 Get rights and content

Background

Childhood asthma can have a range of outcomes in adulthood.

Objective

To identify clinical features and exposures associated with persistence and severity of childhood asthma in adulthood.

Methods

Eighty-five of 121 subjects previously enrolled in a study of immunotherapy for childhood allergic asthma (age 5-12 years) were re-evaluated with allergy skin testing, spirometry, and interviews about asthma symptoms and medications. These young adults (age 17-30 years; 74% male) all had moderate to severe childhood asthma. Adult asthma severity was scored by using a modified version of National Heart, Lung, and Blood Institute severity categories.

Results

Thirteen (15.3%) of 85 adult subjects were in remission despite persistent childhood asthma. Another 19 subjects (22.4%) had only intermittent asthma. The remaining 53 had persistent asthma, of whom 12 (14.1%) had mild asthma, 25 (29.4%) had moderate asthma, and 16 (18.8%) had severe asthma. Subjects in remission, compared with subjects with intermittent or persistent asthma, had lower total serum IgE in childhood (412 ng/mL vs 1136 ng/mL vs 968 ng/mL; P = .02) and fewer positive allergy skin tests (7 vs 9 vs 10 from panel of 18; P = .02). Subjects in remission also had milder childhood asthma, indicated by lower average daily medication usage scores (1.6 vs 3.5 vs 4.4; P = .005) and lower percentage of days on inhaled corticosteroids (13.7% vs 24.7% vs 40.9%; P = .008). No significant association was found between current asthma severity and childhood immunotherapy (P = .46).

Conclusion

The prognosis of childhood allergic asthma in adulthood is largely determined early in life. The degree of atopy appears to be a critical determinant of asthma persistence.

Section snippets

Study participants

The Childhood Asthma Study (CAS) was a double-blind, randomized, placebo-controlled trial designed to study the role of immunotherapy as an adjunct treatment of childhood allergic asthma.⁴ The 121 original study members, age 5 to 12 years at randomization, had moderate to severe asthma on the basis of symptoms and medication usage and were diagnosed and treated by a physician for at least 1 year before enrollment. Evaluations performed during the original study included daily medication–symptom

Subjects

Eighty-five of the 121 subjects from the original CAS were enrolled. The enrolled group did not differ from those not re-evaluated in mean age at recall, gender, ethnicity, socioeconomic status, childhood lung function, asthma severity or medication use, immunotherapy status, and methacholine responsiveness at the end of the clinical trial, as described elsewhere.¹¹ The subjects evaluated in adulthood were predominantly male (73.8%), with a mean age of 24 years (range, 18-30 years). The ethnic

Discussion

In this study, we assessed the severity of current asthma in a cohort of young adults with a history of moderate to severe childhood allergic asthma. After an average follow-up interval of 10.8 years (range, 8-15.6 years), a subset (15.3%; N = 13) are in remission despite the severity of their childhood disease. Another group (22.4%; N = 19) have mild, intermittent symptoms, and the remaining ⅔ (62.4%; N = 53) continue to have mild, moderate, or severe persistent disease. Because the original cohort

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Although we found no associations between either mouse allergen sensitization or exposure and measures of fixed obstruction (postbronchodilator lung function indices), the association between mouse sensitization and lower prebronchodilator FEV1/FVC with increasing age is consistent with these previous studies and this relationship was similar, although not statistically significant, for postbronchodilator FEV1/FVC. Studies of other common indoor allergens, such as dust mite, dog, cat, or cockroach, have also described an association with sensitization and exposure and lower lung function,3,21 as well as persistent asthma and asthma severity, based on FEV1 and asthma medication use.25 Because childhood asthma severity and lung function are associated with worse outcomes in adulthood,3,6-9 reducing indoor allergen exposure has potential to improve long-term outcomes of asthma by altering the natural history of the disease.
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: Supported by the Philip Morris External Research Program and National Institutes of Health, National Center for Research Resources Grant 5M01RR02719 to the Johns Hopkins Bayview General Clinical Research Center.

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Asthma diagnosis and treatmentAdult asthma severity in individuals with a history of childhood asthma

Background

Objective

Methods

Results

Conclusion

Section snippets

Study participants

Subjects

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Pediatr

Airway responsiveness in childhood as a predictor of the outcome of asthma in adulthood

Am Rev Respir Dis

A longitudinal, population-based, cohort study of childhood asthma followed to adulthood

N Engl J Med

Longitudinal study of childhood wheezy bronchitis and asthma: outcome at age 42

BMJ

A controlled trial of immunotherapy for asthma in allergic children

N Engl J Med

Asthma diagnosis and treatment
Adult asthma severity in individuals with a history of childhood asthma