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Prognosis of asthma in children: a cohort study into adulthood
1Department of Pediatrics, Central Hospital, Skövde, Sweden.
Insights
This 15-year asthma study found that while most childhood asthma symptoms improved by adulthood, persistent allergies were common. Early onset and severe childhood asthma predicted a poorer long-term outlook.
Area of Science:
- Pediatric Pulmonology
- Allergology
- Longitudinal Cohort Studies
Background:
- Childhood asthma often persists into adulthood, impacting quality of life.
- Understanding the long-term natural history of asthma is crucial for effective management.
- Allergic sensitization is a key factor in pediatric asthma, but its persistence requires further investigation.
Purpose of the Study:
- To prospectively investigate the 15-year evolution of asthma in a cohort of children.
- To assess the persistence of asthma symptoms, allergic sensitization, and spirometric function into adulthood.
- To identify predictors of asthma outcome in relation to clinical, allergic, and environmental factors.
Main Methods:
- Prospective follow-up of 56 children with asthma for 15 years, from median age 9 to 24.
- Data collection included symptom frequency, medication use, hospital admissions, spirometry, skin prick tests, RAST, and living conditions.
- Statistical analysis of changes in asthma parameters and correlation with baseline characteristics.
Main Results:
- Significant improvement in asthma severity parameters was observed by adulthood (median age >20).
- Approximately 90% of subjects maintained clinical allergies and reactivity to pollens/danders into adulthood.
- Early onset and severe childhood asthma (wheezing, abnormal spirometry) were associated with poorer long-term outcomes.
Conclusions:
- Childhood asthma often shows improvement by adulthood, but allergic sensitization frequently persists.
- Early-onset and severe childhood asthma are indicators of a less favorable long-term prognosis.
- Despite persistent allergies, the social prognosis for individuals with a history of childhood asthma is generally excellent.
Abstract:
Fifty-six children with asthma, randomly selected from a hospital clinic, were followed prospectively for 15 years from a median age of 9-24 years of age. Four follow-ups were performed and included scoring of the frequency of wheezing, the need for medication, admissions to hospital, spirometry, skin prick tests and RAST to common inhaled allergens, and evaluation of living conditions. One patient died of asthma. The remaining 55 reported for all follow-ups. After the second follow-up at a median age of 13 years, all parameters of severity of asthma showed improvement, which was significant at the last follow-up when all subjects were more than 20 years of age. Only 16% of the subjects had been free from wheezing and medication the year prior to the last follow-up. Approximately 90% of the children had clinical allergies and positive allergy tests to pollens and danders and the majority of children retained both the allergies and the reactivity into adulthood. Reactivity to moulds and mites was less frequent (40% and 31%, respectively) and seemed to decrease in adulthood. Approximately 10% of the subjects developed neither clinical allergies nor reactivity in allergy tests. Children with atopic eczema usually retained their eczema as adults. Frequent wheezing and abnormal spirometry in childhood and early onset of asthma were associated with poorer outcome. The social prognosis was excellent.