A longitudinal, population-based, cohort study of childhood asthma followed to adulthood.
BACKGROUND
The outcome of childhood asthma in adults has been described in high-risk cohorts, but few population-based studies have reported the risk factors for persistence and relapse.


METHODS
We assessed children born from April 1972 through March 1973 in Dunedin, New Zealand, repeatedly from 9 to 26 years of age with questionnaires, pulmonary-function tests, bronchial-challenge testing, and allergy testing.


RESULTS
By the age of 26 years, 51.4 percent of 613 study members with complete respiratory data had reported wheezing at more than one assessment. Eighty-nine study members (14.5 percent) had wheezing that persisted from childhood to 26 years of age, whereas 168 (27.4 percent) had remission, but 76 (12.4 percent) subsequently relapsed by the age of 26. Sensitization to house dust mites predicted the persistence of wheezing (odds ratio, 2.41; P=0.001) and relapse (odds ratio, 2.18; P=0.01), as did airway hyperresponsiveness (odds ratio for persistence, 3.00; P<0.001; odds ratio for relapse, 3.03; P<0.001). Female sex predicted the persistence of wheezing (odds ratio, 1.71; P=0.03), as did smoking at the age of 21 years (odds ratio, 1.84; P=0.01). The earlier the age at onset, the greater the risk of relapse (odds ratio, 0.89 per year of increase in the age at onset; P<0.001). Pulmonary function was consistently lower in those with persistent wheezing than in those without persistent wheezing.


CONCLUSIONS
In an unselected birth cohort, more than one in four children had wheezing that persisted from childhood to adulthood or that relapsed after remission. The factors predicting persistence or relapse were sensitization to house dust mites, airway hyperresponsiveness, female sex, smoking, and early age at onset. These findings, together with persistently low lung function, suggest that outcomes in adult asthma may be determined primarily in early childhood.
Sears
Malcolm R
MR
Firestone Institute for Respiratory Health, Department of Medicine, McMaster University and St. Joseph's Healthcare, Hamilton, Ont., Canada. searsm@mcmaster.ca
Greene
Justina M
JM
Willan
Andrew R
AR
Wiecek
Elizabeth M
EM
Taylor
D Robin
DR
Flannery
Erin M
EM
Cowan
Jan O
JO
Herbison
G Peter
GP
Silva
Phil A
PA
Poulton
Richie
R
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001249:Asthma / Q000145:classification / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009520:New Zealand; D039981:Pyroglyphidae / Q000276:immunology; D012008:Recurrence; D012129:Respiratory Function Tests; D012135:Respiratory Sounds / Q000276:immunology / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires