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Natural history of asthma
Theresa Guilbert1, Marzena Krawiec
1Division of Pediatric Pulmonary Medicine, Arizona Respiratory Center, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA. guilbert@resp-sci.arizona.edu
Insights
Childhood asthma can be persistent, leading to lifelong severe symptoms and lung function loss, particularly in those with a family history. New research is needed to understand evolving asthma patterns and genetics in children.
Area of Science:
- Pediatric respiratory medicine
- Clinical immunology
- Epidemiology of chronic diseases
Background:
- Asthma in children presents variable natural histories, with some experiencing symptom remission while others develop persistent, severe disease.
- Persistent childhood asthma is often linked to a family history of asthma, increased airway reactivity, and atopy.
- Longitudinal studies have improved understanding of asthma's natural history in children, but critical questions remain.
Purpose of the Study:
- To review current understanding of childhood asthma natural history based on longitudinal studies.
- To highlight the need for new cohort studies investigating potential changes in asthma incidence, severity, and pathophysiology in recent birth cohorts.
- To emphasize the importance of genetic investigations for identifying distinct asthma phenotypes and guiding future therapeutic interventions.
Main Methods:
- Review of findings from existing longitudinal studies on childhood asthma.
- Discussion of epidemiological trends in asthma incidence and severity.
- Call for new prospective cohort studies and genetic research.
Main Results:
- Some children experience asthma remission, while others develop persistent disease with significant morbidity.
- Children with persistent asthma often exhibit early signs of airway hyperresponsiveness and atopy, alongside a positive family history.
- Increasing asthma incidence and severity suggest potential shifts in disease pathophysiology or environmental influences in recent generations.
Conclusions:
- Further longitudinal and genetic studies are crucial to understand the evolving landscape of childhood asthma.
- Identifying distinct asthma phenotypes early in life could enable personalized therapeutic strategies to mitigate symptom severity and lung function decline.
- Understanding the genetic basis of asthma is key to elucidating its complex phenotypic expressions.
Abstract:
For some children, asthma is a disease whose symptoms seem to remit with time. Numerous children, however, develop disease that is persistent throughout their lifetimes and is associated with more severe symptoms, increased airway reactivity, and loss of lung function. These children typically have a family history of asthma and demonstrate increased airways reactivity and atopy in childhood. A clearer picture of the natural history of asthma in the developing child has been derived from the results of several longitudinal studies. Although some questions have been clarified, several questions still remain. Now that the incidence and severity of asthma seem to be increasing, children born in the last 10 years may experience more severe disease or a different pathophysiology than those born 30 to 40 years ago. New cohort studies are needed to assess this possibility. Additional investigations into the genetics of asthma causation will help elucidate the different phenotypic expressions of this complex disease. Once these different phenotypic groups can be identified early in life, further studies can be performed to explore the impact of therapeutic intervention on the severity of asthma symptoms and loss of lung function.