Purpose of the Study. The purpose of the study was to evaluate the parameters and characteristics that could predict the persistence of respiratory symptoms in asthmatic children.
Study Population. A total of 279 children aged 1.7 to 20 years with asthma who had uniform therapy for a mean of 3 years.
Methods. A retrospective review was performed on records of children with asthma who were regularly followed by the outpatient clinic of Marmara University Hospital Pediatric Allergy and Immunology Department. Data were collected on the parameters at the initial encounter, including age at referral and at onset of respiratory symptoms, duration of symptoms, frequency of asthma episodes, sleep disturbances attributable to disease at referral, initial therapy, serum total immunoglobulin E (IgE) and specific allergen IgE levels/prick skin tests and lung function at onset. At the end of the study, the total number of episodes of asthma during follow-up, frequency of sleep disturbances in past 12 months, total serum IgE and lung function testing were recorded.
Results. The 279 patients had a mean age of 6.2 years at referral and 8.9 years at the end of follow-up. A total of 122 girls and 157 boys were studied. A total of 85/279 (30%) of patients had experienced no respiratory symptoms in the past 12 months at the conclusion of the follow-up. No significant differences were found between those with and without current respiratory symptoms with respect to age, sex, age at onset of symptoms, duration of follow-up, age at referral, therapeutic choice, severity of asthma, and duration of symptoms at the initial referral. The patients with current respiratory symptoms had significantly higher total serum IgE levels and a higher number of positive specific allergen IgE levels/prick skin tests than those subjects without current respiratory symptoms (P = .0027, P = .011, respectively). Initial FEV1, FEF25%–75%, and FEV1/FVC were significantly lower in those with current respiratory symptoms (P = .005; P = .003; and P = .011, respectively). However, there was no significant difference between lung functions in both groups at the end of follow-up.
Conclusion. Risk factors for persistence of respiratory symptoms in this study population were low initial FEV1, FEV1/FVC, and FEF25%–75% and allergen sensitivities.
Reviewer’s Comments. This study took a slightly different look at risk factors for persistence of respiratory symptoms in childhood asthma. During the study period patients received uniform treatment with inhaled budesonide. The author may have wanted to see if treatment would modify the risk factors, or in some way change the course of the patients’ asthma, but unfortunately this intent was not made clear. The study, however, shows once again that elevated IgE to specific allergens is an important risk factor in persistent asthma. Lung function measurements were similar for both groups at the end of the study. This may indicate that though treatment with corticosteroids may improve lung function, those patients with low initial measurements will not be “cured” by our current therapies.
- Copyright © 2002 by the American Academy of Pediatrics