Adult asthma severity in individuals with a history of childhood asthma.
BACKGROUND
Childhood asthma can have a range of outcomes in adulthood.


OBJECTIVE
To identify clinical features and exposures associated with persistence and severity of childhood asthma in adulthood.


METHODS
Eighty-five of 121 subjects previously enrolled in a study of immunotherapy for childhood allergic asthma (age 5-12 years) were re-evaluated with allergy skin testing, spirometry, and interviews about asthma symptoms and medications. These young adults (age 17-30 years; 74% male) all had moderate to severe childhood asthma. Adult asthma severity was scored by using a modified version of National Heart, Lung, and Blood Institute severity categories.


RESULTS
Thirteen (15.3%) of 85 adult subjects were in remission despite persistent childhood asthma. Another 19 subjects (22.4%) had only intermittent asthma. The remaining 53 had persistent asthma, of whom 12 (14.1%) had mild asthma, 25 (29.4%) had moderate asthma, and 16 (18.8%) had severe asthma. Subjects in remission, compared with subjects with intermittent or persistent asthma, had lower total serum IgE in childhood (412 ng/mL vs 1136 ng/mL vs 968 ng/mL; P = .02) and fewer positive allergy skin tests (7 vs 9 vs 10 from panel of 18; P = .02). Subjects in remission also had milder childhood asthma, indicated by lower average daily medication usage scores (1.6 vs 3.5 vs 4.4; P = .005) and lower percentage of days on inhaled corticosteroids (13.7% vs 24.7% vs 40.9%; P = .008). No significant association was found between current asthma severity and childhood immunotherapy ( P = .46).


CONCLUSIONS
The prognosis of childhood allergic asthma in adulthood is largely determined early in life. The degree of atopy appears to be a critical determinant of asthma persistence.
Limb
Susan L
SL
Division of Allergy and Clinical Immunology, Bloomberg School of Public Health, Johns Hopkinds University, Baltimore, MD, USA.
Brown
Kathryn C
KC
Wood
Robert A
RA
Wise
Robert A
RA
Eggleston
Peyton A
PA
Tonascia
James
J
Hamilton
Robert G
RG
Adkinson
N Franklin
NF
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006889:Hydroxycorticosteroids / Q000627:therapeutic use; D007073:Immunoglobulin E / Q000097:blood; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D012882:Skin Tests
D018927:Anti-Asthmatic Agents; D006889:Hydroxycorticosteroids; D020024:Leukotriene Antagonists; D007073:Immunoglobulin E