Adolescents with asthma: consequences of transition from paediatric to adult healthcare.
OBJECTIVE
A prospective follow-up of adolescents with asthma designed to identify risk factors for deterioration during and after transfer from paediatric to adult healthcare.


METHODS
Adolescents (n=150) with asthma being transferred from paediatric to adult healthcare were recruited consecutively and those with mild/moderate asthma assigned randomly to primary care or specialized care at an adult asthma clinic. Tests of pulmonary function, bronchial responsiveness and working capacity and skin prick tests were performed at the time of entry into the study and two and/or five years later.


RESULTS
Initially, 88.7% of the subjects demonstrated at least one positive skin prick test. During the five-year follow-up, FEV(1) improved, while FEV(1)/FVC remained unchanged. Bronchial hyperresponsiveness was present in 71% of the subjects at the time of inclusion and 59% five years later, while 20 developed hyperresponsiveness during this period. Poor adherence to treatment, female gender and inhalation of steroids exerted negative impacts on logPD(20). The risk for persistence of bronchial hyperresponsiveness was elevated by poor adherence and attenuated by regular exercise. The decline observed in working capacity demonstrated no correlation to the risk factors examined. Subjects with mild/moderate asthma who received primary or specialized care exhibited similar pulmonary function, responses to a histamine challenge and working capacities.


CONCLUSIONS
During a five-year follow-up of asthmatic adolescents leaving paediatric care, pulmonary function rarely deteriorated, but bronchial hyperresponsiveness persisted. Female gender and poor adherence to treatment exerted negative impact on bronchial hyperresponsiveness. Mild/moderate asthma was managed equally effectively with primary or specialized care.
Bergström
Sten-Erik
SE
Department of Allergeology and Pulmonology, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Stockholm, Sweden. sten-erik.bergstrom@ki.se
Sundell
Kerstin
K
Hedlin
Gunilla
G
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D001985:Bronchial Provocation Tests; D003266:Continuity of Patient Care / Q000458:organization & administration*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012737:Sex Factors; D012882:Skin Tests
D018927:Anti-Asthmatic Agents