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Clinical assessment of asthma progression in children and adults
1Division of Clinical Pharmacology, Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO 80206, USA. spahnj@njc.org
Insights
Asthma progression varies, often starting in childhood with viral infections and potentially persisting lifelong or entering remission. This review examines asthma
Area of Science:
- Pediatric Pulmonology
- Immunology
- Clinical Medicine
Background:
- Asthma is a chronic respiratory condition characterized by variable symptoms like wheezing and shortness of breath.
- Early-life allergic sensitization is a key risk factor for persistent childhood asthma.
- Asthma's course is heterogeneous, ranging from lifelong disease with lung function decline to adolescent remission.
Purpose of the Study:
- To review current understanding of asthma progression from infancy through adulthood.
- To examine studies on progressive lung function loss as a measure of asthma progression.
- To discuss the potential impact of inhaled glucocorticoids on asthma progression.
Main Methods:
- Literature review focusing on longitudinal studies of asthma.
- Analysis of research evaluating lung function decline in asthmatic individuals.
- Synthesis of evidence regarding therapeutic interventions for asthma progression.
Main Results:
- Asthma often begins in infancy, linked to viral infections and atopy.
- A subset of children experience persistent asthma with progressive lung function loss.
- Asthma remission can occur in adolescence, with potential for later relapse.
Conclusions:
- Understanding asthma's natural history is crucial for effective management.
- Progressive lung function loss is a significant indicator of severe asthma.
- Further research is needed to determine if inhaled glucocorticoids can modify asthma progression.
Abstract:
Asthma is a heterogeneous disorder with a variable course, characterized by episodes of cough, wheezing and shortness of breath, reversible airflow limitation, and bronchial hyperresponsiveness. It begins early in life in many subjects with intermittent symptoms occurring with viral respiratory tract infections. Over time, and in genetically susceptible children (those with an atopic predisposition), the disease becomes more persistent with symptoms occurring in the absence of respiratory tract infections. Children with persistent wheezing are eventually diagnosed with asthma, with those at greatest risk having developed allergic sensitization early in life. Among children with asthma, some will have lifelong asthma with active symptoms and progressive loss of lung function over time, whereas other children will undergo asthma remission in adolescence. Once in remission, the disease may remain quiescent, or it may relapse in midadult life. This review focuses on studies that have enhanced our understanding of the progression of asthma from infancy to adulthood. Studies evaluating progressive loss of lung function, the best-studied measure of asthma progression, are also reviewed, followed by a brief discussion of whether asthma progression can be modified by inhaled glucocorticoid therapy.
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