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Published on: April 13, 2010
Prospective study of disease persistence and lung function trajectories of childhood asthma
Man Fung Tang1,2, Agnes Sze Yin Leung1, Noelle Anne Ngai1
1Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Insights
Many children outgrow asthma, but female sex, inhaled corticosteroid use, frequent exacerbations, and lower baseline lung function predict persistent asthma into adulthood. Persistent asthma is linked to poorer lung function growth.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Longitudinal Cohort Studies
Background:
- Childhood asthma often resolves by adulthood, but predictors of persistent disease remain unclear.
- Understanding asthma persistence is crucial for long-term management and predicting adult respiratory health.
Purpose of the Study:
- To identify predictors of persistent asthma in childhood.
- To characterize lung function trajectories in children with persistent versus resolved asthma.
Main Methods:
- Prospective follow-up of 181 Chinese children with asthma (aged 6-15) for over 12 years.
- Annual spirometry and medication data collection; asthma resolution defined as ≥2 years symptom and drug-free.
- Logistic regression and generalized estimating equations used to analyze predictors and lung function changes.
Main Results:
- One-third of children outgrew their asthma.
- Female sex (OR 3.36), ever using inhaled corticosteroids (ICS) (OR 3.19), and frequent asthma exacerbations (AE) (OR 3.05) predicted persistent asthma.
- Lower baseline FEV1% (OR 0.96) was associated with persistence; persistent asthma patients showed poorer lung function growth.
Conclusions:
- Female sex, prior ICS use, frequent AE, and reduced baseline lung function are key predictors of persistent childhood asthma.
- Children with persistent asthma exhibit diminished lung function growth into adulthood, highlighting the need for early intervention.
Background:
A proportion of asthmatic children outgrow their disease by adulthood, but there are limited data on predictors for asthma persistence. This prospective study characterized the trajectory of spirometric indices and identified predictors for the persistence of childhood asthma.
Methods:
Chinese asthmatic children aged 6-15 years from pediatric allergy clinic underwent annual visits for ≥5 years and until their adulthood. Pre-bronchodilator spirometry and anti-asthma medications were recorded at baseline and then at least annually. Asthma resolution was defined when patients were free from asthma symptoms and use of anti-asthma drugs for ≥2 years. Logistic regression was used to identify predictors for asthma persistence. Generalized estimating equation was used to analyze longitudinal changes in lung function parameters in relation to asthma persistence.
Results:
181 asthmatic children aged [mean (SD)] 10.0 (2.7) years were followed for [mean (SD)] 12.5 (2.8) years. One third of them outgrew asthma during follow-up. Female was 3.36 times more likely to have persistent asthma. Inhaled corticosteroid (ICS) treatment ever and frequent asthma exacerbation (AE) predicted asthma persistence with respective odds ratios of 3.19 (95% confidence interval [CI] 1.44-7.09) and 3.05 (95% CI 1.39-6.68). Persistent asthma was inversely associated with baseline forced expiratory volume in 1-second (FEV1 %) with an odds ratio of 0.96 (95% CI 0.93-1.00). Throughout follow-up, patients with persistent asthma had generally lower forced expiratory indices than those with asthma resolution. Children with persistent asthma experienced poorer lung function growth.
Conclusions:
Female, ICS ever, and frequent AE predicted persistent asthma. Patients with persistent asthma had lower forced expiratory indices and poorer lung function growth into adulthood.
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