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Natural history of childhood asthma. 20-year follow-up
Insights
Long-term follow-up of childhood asthma reveals that 52% of patients achieve symptom remission. Prognosis is influenced by early asthma severity and family history, not age or sex.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Epidemiology
Background:
- Childhood asthma presents significant long-term health challenges.
- Effective long-term follow-up is crucial for understanding asthma prognosis.
- Previous studies often lacked comprehensive long-term data.
Purpose of the Study:
- To assess the long-term prognosis of childhood asthma.
- To identify factors influencing asthma remission and relapse.
- To evaluate the effectiveness of different follow-up methodologies.
Main Methods:
- A retrospective cohort study comparing hospital-based and group practice follow-up.
- Analysis of 267 asthmatic children followed for over 20 years.
- Assessment of symptom status, remission periods, and mortality.
Main Results:
- A 91% follow-up rate was achieved in a group practice cohort over 20 years, compared to 50% in a hospital cohort.
- 52% of patients achieved near or complete symptom freedom.
- Asthma severity at onset, breastfeeding, and family history of atopy were significant prognostic factors.
Conclusions:
- Personalized, long-term follow-up significantly improves patient data retention.
- Childhood asthma prognosis is multifactorial, with early-life factors playing a key role.
- Short-term follow-up may underestimate long-term remission rates due to relapses.
Abstract:
Of 417 asthmatic children seen in hospital from 1941 to 1947, only 208 (50%) were still attending the hospital and were available for long-term follow-up, whereas a 91% follow-up was achieved from a personal follow-up of 267 asthmatic children seen in an East London group practice from 1948 to 1952 and followed for more than 20 years to December 1972. 125 patients (52%) were almost or completely symptom free; 51 (21%) had never had any symptom-free period for longer than 6 months; a further 63 (27%) had a remission of symptoms for 3 years before relapsing. 7 patients died, 3 due to their asthma. The final prognosis was influenced by the severity of the asthma at onset, by breast feeding, by the presence of associated atopic disease, and by a positive family history of atopic disease in first-degree relatives. It was uninfluenced by the age of onset of the asthma, by the sex of the patients, or by skin testing results. Short-term follow-up of such patients will fail to include those patients whose asthma remits and subsequently relapses.