Bradley E. Chipps, MD, FCCP

Disclosures

July 13, 2004

Question

What percentage of children with asthma outgrow their condition? What is the "outgrowing" rate's relation to parameters such as age of onset and severity?

Timur Sumer, MD

Response from Bradley E. Chipps, MD, FCCP

There are multiple epidemiologic studies that address the chances of spontaneous remission of childhood asthma. An important study from the University of Arizona at Tucson that began in 1980 followed 1246 subjects for 24 years with a 78% retention rate.[1] At the beginning of the study, approximately 50% of the children had wheezing. Approximately 20% had transient wheezing, 15% had late-onset wheezing after 3 years of age, and approximately 14% had persistent wheezing. An asthma predictive index was used to predict the risk of children who are wheezing at 2-3 years of age of experiencing persistent wheezing in the school-age years. The study found that children who had 1 major criteria, eczema or a family history of asthma, or 2 of 3 minor criteria, wheezing other than with colds, persistent rhinitis, or eosinophilia, had a 75% chance of having active asthma between 6 and 13 years of age, whereas 68% of the patients with negative index did not have asthmatic symptoms during the school-age years.

A study from the Isle of Wight showed that of the children who began wheezing, persistent wheezing was seen in approximately 40% of the patients.[2] The patients who had more persistent wheezing were those with a family history of asthma and those who had positive skin tests at 4 years of age. A study from Dunedin, New Zealand followed a cohort of 613 children from 9 to 26 years of age.[3] A total of 51% of the patients reported wheezing during this time, and 27% of these patients had remission. The remainder had either persistent or relapsing wheezing. The factors that were associated with persistent or recurrent wheezing were house dust mite sensitivity, bronchial hyperresponsiveness to methacholine, female sex, smoking, and early age of onset.

It appears from the epidemiologic studies that the persistence of childhood asthma into adult life is primarily predictable by early onset of disease with more severe symptoms, atopy, and level of allergen exposure and cigarette smoking.

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