PURPOSE OF THE STUDY.
The goal of this study was to analyze the remission and persistence of childhood asthma in adolescents.
The study population included 205 subjects with asthma studied from age 7 to 8 years up until the study end-point age of 19 years.
Subjects with asthma were identified by distributing an extended International Study of Asthma and Allergies in Childhood questionnaire to the families of all children in the first and second grade in 3 municipalities in northern Sweden. The diagnosis of asthma was confirmed in 248 of the subjects identified according to the questionnaire by using structured interviews and clinical assessments. These subjects were then assessed for their status of asthma, family history of asthma, asthma medication use (including inhaled corticosteroids), asthma severity score, presence of physician-diagnosed rhinitis or eczema, and traffic exposure and home exposure to dampness by using annual questionnaires until 19 years of age. In addition, some patients underwent skin prick testing for 10 common allergens. Positive skin prick test results were validated in relation to serum-specific immunoglobulin E levels. Lung function testing was also performed in all patients in the asthma cohort, and some patients received methacholine bronchial challenge tests.
A total of 205 subjects remained in the study until the end-point age of 19 years. Of these patients, 21% had asthma that was in remission, 38% had periodic asthma, and 41% had persistent asthma. Remission was more common in boys. Sensitization to furred animals at baseline as identified by skin prick testing and serum-specific immunoglobulin E levels was inversely associated with remission (odds ratio: 0.14 [95% confidence interval: 0.04–0.55]), as was severe asthma (odds ratio: 0.19 [95% confidence interval: 0.07–0.54]). Eighty-two percent of children with these characteristics had persistence of asthma in adolescence.
Remission of asthma during adolescence is common. Female gender, sensitization to furred animals, and more severe asthma all inversely correlate with the chance of asthma going into remission.
The take-home message from this article is the importance of long-term clinical follow-up of patients with asthma, as large numbers of patients have persistent disease. Furthermore, the identification of the risk factors for disease persistence will allow better identification of at-risk patients and allow patient-specific care with medical interventions that are appropriate in intensity, well timed, and improve the long-term outcomes of patients without overburdening the system.
- Copyright © 2014 by the American Academy of Pediatrics