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Predicting the Course of Childhood Asthma
Asthma morbidity improves as children get older, but most school-age children with persistent asthma will have symptoms during adolescence.
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
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.
Published in Journal Watch Pediatrics and Adolescent Medicine March 3, 2010
Citation(s):
Covar RA et al. Predictors of remitting, periodic, and persistent childhood asthma. J Allergy Clin Immunol 2010 Feb; 125:359.e3.
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