Predicting the Course of Childhood Asthma

Summary and Comment |
March 3, 2010

Predicting the Course of Childhood Asthma

  1. David J. Amrol, MD

Asthma morbidity improves as children get older, but most school-age children with persistent asthma will have symptoms during adolescence.

  1. David J. Amrol, MD

Parents often ask, “Will my child outgrow asthma?” In 2000, the Childhood Asthma Management Program (CAMP) Research Group (JW Gen Med Oct 27 2000) reported that children aged 5 to 12 years with persistent asthma who were treated with inhaled corticosteroids for approximately 5 years had better asthma control than children who were treated with nedocromil or placebo. After active treatment was stopped, asthma control and lung function did not differ among groups. To describe the natural history of childhood asthma, the CAMP Research Group assessed outcomes in 909 (86%) of the original cohort after a washout period and another 4 years of treatment and follow-up by their personal physicians.

Based on reports of symptoms, exacerbations, and medication use, only 6% of children had remitting asthma (absence of any asthma activity at the last 4 encounters), while 39% had periodic asthma and 55% had persistent asthma. Prior use of inhaled corticosteroids during the CAMP trial had no effect on lung function or asthma remission during the 4-year follow-up period. Predictors of persistent asthma included atopy, low lung function, and increased airway hyperresponsiveness. Sensitization and exposure to indoor allergens were associated with three times the risk for persistent asthma. Asthma severity improved over time for all three asthma groups, but more-severe asthma at study enrollment was associated with more-severe asthma during adolescence.

Comment

Although asthma morbidity improves as children get older, most school-age children with persistent asthma still will have symptoms in adolescence. Even though inhaled corticosteroids are the best treatment for improving asthma symptoms, they seem to have no effect on the long-term lung function or the natural history of asthma.

David J. Amrol, MD, is an Assistant Professor of Clinical Internal Medicine and Director of the Division of Allergy and Immunology at the University of South Carolina School of Medicine in Columbia. Dr. Amrol is on the speakers’ bureau for AstraZeneca.

Citation(s):

Reader Comments (1)

Dr SV Kondekar

Hi there we all know that hyperreactive airways are a known feature of many asthma like illnesses. in my experience a good number of adenoids, sinusitis, tonsillitis, bronchitis,ASD,PH and chronic lung diseases do come with a component of hyper reactive airway disease apart from their baseline respiratory morbidity. Often the cases presenting with label of child hood asthma with onset less than 4 years of age or early infancy; are likely to have some respiratory or maturational insult with respiratory system. Some people even call these as secondary/atypical asthma, but in part these cases demostrate episodic or seasonal hyper reactivity reversible with bronchodilators. All such causes need to be saught for. These surely affect outcome in long term. For example if one has a case being referred as refractory asthma and one finds large adenoids or tonsils; these cases will surely respond better with tonsillo-adenoid resection and need for frequent or long term asthma medicines will almost disappear. To conclude, I would recommend a thorough check on all these issues before telling a patient that all is unpredicatable. Such situation has often diverted parents to seek non-allopathic remedies.

Competing interests: None declared

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