Outcome of asthma: longitudinal changes in lung function

Current knowledge about factors determining outcome of asthma is limited, but observations over the last few decades suggest that active asthma has a negative impact on the longitudinal changes in lung function. This review aims to give an overview of the present knowledge concerning longitudinal changes in lung function, including clinical markers for distinctly poor outcome with regard to lung function, in children and adults suffering from asthma. The majority of patients with asthma have a good prognosis. However, some patients with asthma, especially those with more severe disease, are at risk of impaired growth of lung function during childhood, a lower maximally attained level of lung function and excessive decline in lung function in adulthood, which may lead to life-threatening lung function impairment. Clinical markers of poorly controlled airway inflammation appear to have a negative impact on the longitudinal changes in lung function, and disease progression to nonreversible airflow obstruction may be observed in a minority of patients with asthma. Early intervention with anti-inflammatory therapy may improve the short-term outcome of asthma, but long-term controlled studies are clearly needed in order to verify whether or not treatment, especially with inhaled corticosteroids, according to the current international guidelines alters the natural history of asthma, i.e. disease progression with regard to changes in lung function and possible development of nonreversible airflow obstruction.