Asthama, Rhinitis, Other Respiratory Diseases
Early life risk factors for adult asthma: A birth cohort study of subjects at risk,☆☆,

https://doi.org/10.1067/mai.2001.119151Get rights and content

Abstract

Background: Prediction of adult asthma is important, and early prevention strategies should be targeted at those most at risk. Identifying high-risk children at an early age, however, is currently difficult. Objective: We sought to determine those factors present in early life that predict an increased risk of adult asthma. Methods: A prospective cohort study of subjects at risk of asthma and atopy was undertaken in Poole, England. One hundred babies of atopic parents were recruited at birth. During the first 5 years of life, subjects were recalled annually, all respiratory events were reported, and skin prick tests and total serum IgE measurements were performed. At 11 and 22 years, bronchial hyperresponsiveness was also measured. Seventy-three subjects were followed up at 5 years, 67 at 11 years, and 63 at 22 years. Results: Twenty-three (37%) adult subjects reported wheezing within the previous 12 months. Fifteen (25%) of these subjects showed signs of bronchial hyperresponsiveness and were regarded as asthmatic. Wheezing before the age of 2 years occurred in 28% and was not significantly related to adult asthma (odds ratio, 0.3; 95% CI, 0.03-1.7; P = .19). A positive skin prick test response to hen's egg, cow's milk, or both in the first year was independently predictive of adult asthma (odds ratio, 10.7; 95% CI, 2.1-55.1; P = .001; sensitivity, 57%; specificity, 89%). Conclusion: Prediction of adult asthma remains difficult. In this study of subjects at risk of atopy, skin sensitivity to hen's egg or cow's milk in the first year was predictive of adult asthma. (J Allergy Clin Immunol 2001;108:720-5.)

Section snippets

Methods

One hundred subjects were enrolled before birth over a 12-month period from 1976 to 1977. All babies were born in Poole Hospital and were selected on the basis of one or both parents having a history of asthma, hay fever, or both. Informed consent was obtained, and the local ethical committee approved all stages of the study.

The cohort was studied every 3 months for the first year, annually thereafter until the age of 5 years, and again at 11 years. This study reports on the latest follow-up of

Results

One hundred children were recruited at birth. Nineteen children dropped out within the first 2 years, and information on these subjects is limited. Seventy-three subjects remained in the study at 5 years, and 67 remained at 11 years. At 22 years, 60 subjects were recalled for study, and a further 3 subjects returned questionnaires only. The early life characteristics of the 63 subjects who were studied at 22 years were compared with those of the 18 subjects who were lost to follow-up after

Discussion

In this birth cohort study of 63 subjects with atopic parents, 25% of the subjects had asthma in adult life. Wheezing before the age of 2 years did not predict adult asthma, but wheezing between the 10th and 11th birthday was highly predictive. A positive skin prick test response to hen's egg, cow's milk, or both in the first year of life was independently predictive of adult asthma. Total serum IgE levels were significantly related to adult asthma by the age of 11 years. We studied a number of

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    Supported as part of the NHS National Research and Development Programme on Asthma Management.

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    The views and opinions expressed herein do not necessarily reflect those of the Department of Health.

    Reprint requests: Helen Rhodes, MB, ChB, Room EG228, Mail Point 43, Southampton General Hospital, Tremona Rd, Southampton, UK, SO16 6YD.

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