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Predicting asthma outcomes
1Department of Medicine, Faculty of Health Sciences, de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Insights
Predicting childhood asthma persistence is challenging. Factors like parental history and infant biomarkers improve prediction, while allergic sensitization strongly influences asthma development and persistence.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Genetics
Background:
- Early childhood wheezing is common, yet predicting its persistence into adulthood remains difficult.
- The Asthma Predictive Index (API) and its modifications enhance prediction accuracy by incorporating parental history and infant biomarkers.
Purpose of the Study:
- To review predictors of wheezing and asthma remission or persistence from childhood to adulthood.
- To identify factors influencing the development and trajectory of asthma.
Main Methods:
- Literature review of studies on childhood wheezing and asthma persistence.
- Analysis of factors including parental history, infant biomarkers, allergen sensitization, airway hyperresponsiveness, and lung function.
Main Results:
- Allergen sensitization, particularly to multiple allergens, increases the risk of developing classic childhood asthma.
- Remission is more likely in males with milder disease, less sensitization, and lower airway hyperresponsiveness.
- Persistence is strongly associated with allergic sensitization, severe symptoms, abnormal lung function, and high airway hyperresponsiveness.
- Genetic risk scores may offer more accurate persistence prediction than family history.
- Adult asthma remission is significantly less common than in childhood.
Conclusions:
- Asthma outcomes appear largely resistant to pharmacologic therapy, despite symptom control.
- Lung function decline can initiate early in life and persist through adolescence.
- Accurate prediction of asthma persistence requires a multifactorial approach, including genetic and immunological markers.
Abstract:
This review addresses predictors of remission or persistence of wheezing and asthma from early childhood through adulthood. Early childhood wheezing is common, but predicting who will remit or have persistent childhood asthma remains difficult. By adding parental history of asthma and selected infant biomarkers to the history of recurrent wheezing, the Asthma Predictive Index and its subsequent modifications provide better predictions of persistence than simply the observation of recurrent wheeze. Sensitization, especially to multiple allergens, increases the likelihood of development of classic childhood asthma. Remission is more likely in male subjects and those with milder disease (less frequent and less severe symptoms), less atopic sensitization, a lesser degree of airway hyperresponsiveness, and no concomitant allergic disease. Conversely, persistence is linked strongly to allergic sensitization, greater frequency and severity of symptoms, abnormal lung function, and a greater degree of airway hyperresponsiveness. A genetic risk score might predict persistence more accurately than family history. Remission of established adult asthma is substantially less common than remission during childhood and adolescence. Loss of lung function can begin early in life and tracks through childhood and adolescence. Despite therapy which controls symptoms and exacerbations, the outcomes of asthma appear largely resistant to pharmacologic therapy.
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