The natural history of asthma

Area of Science:

• Pulmonology
• Allergology
• Epidemiology

Background:

• Asthma onset typically occurs in infancy, often linked to respiratory infections.
• The persistence of childhood asthma is strongly correlated with the frequency and severity of early wheezing episodes.
• Asthma incidence declines after infancy but remains a significant lifelong condition.

Purpose of the Study:

• To delineate the diverse natural histories and epidemiological patterns of asthma across different age groups and subtypes.
• To identify factors influencing asthma persistence, remission, and progression.
• To examine the impact of asthma on lung function decline and mortality in older adults.

Main Methods:

• Retrospective analysis of asthma onset, progression, and remission patterns.
• Categorization of asthma by age of onset (infancy, adolescence, adulthood) and type (allergic, occupational, intrinsic).
• Evaluation of lung function decline and mortality data in relation to asthma severity and comorbidities.

Main Results:

• Infantile asthma persistence is linked to severe, frequent wheezing; incidence decreases post-infancy.
• Allergic asthma often emerges in the second decade, with potential for remission, though severe cases and allergen exposure promote persistence.
• Adult-onset asthma is frequently intrinsic, potentially including the aspirin triad, and may worsen over time, with comorbidities like COPD contributing to lung function decline.

Conclusions:

• Asthma exhibits varied trajectories influenced by age of onset, type, and environmental factors.
• Effective management is crucial to mitigate long-term lung function decline and associated risks, especially in older adults with comorbidities.
• While overall mortality rates are similar to the general population, asthma patients face an elevated risk of death from respiratory diseases, including lung cancer.