Predictors of remitting, periodic, and persistent childhood asthma.
BACKGROUND
The course of mild to moderate persistent asthma in children is not clearly established.


OBJECTIVE
To determine the rate and predictors for remitting, periodic, and persistent asthma in adolescence.


METHODS
The Childhood Asthma Management Program (CAMP) was a 4.3-year randomized, double-masked, multicenter trial in children with mild to moderate persistent asthma that compared continuous therapy with either budesonide or nedocromil, each to placebo, followed by a 4-year observational follow-up period. Asthma activity during the observation period included remitting (no asthma activity in the last year), persistent (asthma activity in every quarter), and periodic asthma (neither remitting nor persistent).


RESULTS
Asthma was identified as remitting in 6%, periodic in 39%, and persistent in 55% of the 909 participants, with no effect noted from earlier anti-inflammatory treatment during the CAMP trial. Within all 3 asthma activity categories, improvements in airway hyperresponsiveness, eosinophilia, and asthma morbidity were observed over time. Features at entry into CAMP associated with remitting versus persistent asthma were lack of allergen sensitization and exposure to indoor allergens (odds ratio [OR], 3.23; P < .001), milder asthma (OR, 2.01; P = .03), older age (OR, 1.23; P = .01), less airway hyperresponsiveness (higher log methacholine FEV(1) PC(20) (OR, 1.39; P = .03), higher prebronchodilator FEV(1) percent predicted (OR, 1.05; P = .02), and lower forced vital capacity percent predicted (OR, 0.96; P = .04).


CONCLUSIONS
Remission of asthma in adolescence is infrequent and not affected by 4 years of anti-inflammatory controller therapy. Factors such as sensitization and exposure, low lung function, and airway greater hyperresponsiveness decrease the likelihood of remitting asthma.
National Jewish Health, Denver, CO 80206, USA. covarr@njhealth.org
Ronina A
RA
Covar
Robert
R
Strunk
Robert S
RS
Zeiger
Laura A
LA
Wilson
Andrew H
AH
Liu
Scott
S
Weiss
James
J
Tonascia
Joseph D
JD
Spahn
Stanley J
SJ
Szefler
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D019819:Budesonide / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D017835:Nedocromil / Q000627:therapeutic use*; D012129:Respiratory Function Tests; D016896:Treatment Outcome
D018927:Anti-Asthmatic Agents; D017835:Nedocromil; D019819:Budesonide