Adult asthma severity in individuals with a history of childhood asthma

Limb, Susan L.; Brown, K. J.; Wood, Robert A.; Wise, Robert A.; Eggleston, Peyton A.; Tonascia, James; Hamilton, Robert G.; Adkinson, N. F.

doi:10.1016/j.jaci.2004.09.032

Cited by 56 publications

(70 citation statements)

References 15 publications

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“…The underlying mechanisms have yet to be fully elucidated. 32 Allergic sensitization to common inhalant allergens, 5,12,13 allergic rhinitis, atopic eczema, 8 and level of total serum IgE 34 have all been linked to persistence of childhood asthma. We found a consistently stronger inverse association between remission and allergic sensitization to furred animals compared with pollen.…”

Section: Figurementioning

confidence: 99%

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Remission and Persistence of Asthma Followed From 7 to 19 Years of Age

Andersson

Hedman²,

Bjerg

et al. 2013

Pediatrics

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BACKGROUND AND OBJECTIVE: To date, a limited number of population-based studies have prospectively evaluated the remission of childhood asthma. This work was intended to study the remission and persistence of childhood asthma and related factors. METHODS: In 1996, a questionnaire was distributed to the parents of all children aged 7 to 8 years in 3 municipalities in northern Sweden, and 3430 (97%) participated. After a validation study, 248 children were identified as having asthma; these children were reassessed annually until age 19 years when 205 (83%) remained. During the follow-up period lung function, bronchial challenge testing, and skin prick tests were performed. Remission was defined as no use of asthma medication and no wheeze during the past 12 months as reported at endpoint and in the 2 annual surveys preceding endpoint (ie, for ≥3 years). RESULTS: At age 19 years, 21% were in remission, 38% had periodic asthma, and 41% persistent asthma. Remission was more common among boys. Sensitization to furred animals and a more severe asthma (asthma score ≥2) at age 7 to 8 years were both inversely associated with remission, odds ratio 0.14 (95% confidence interval 0.04–0.55) and 0.19 (0.07–0.54), respectively. Among children with these 2 characteristics, 82% had persistent asthma during adolescence. Asthma heredity, damp housing, rural living, and smoking were not associated with remission. CONCLUSIONS: The probability of remission of childhood asthma from age 7- to 8-years to age 19 years was largely determined by sensitization status, particularly sensitization to animals, asthma severity, and female gender, factors all inversely related to remission.

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Section: Figurementioning

confidence: 99%

“…26,34 We used a cutoff of $2 in our asthma scoring to separate mild from more severe asthma. However, it is important to note that our cutoff does not necessarily correspond to the clinical definition of severe asthma.…”

Section: Figurementioning

confidence: 99%

Remission and Persistence of Asthma Followed From 7 to 19 Years of Age

Andersson

Hedman²,

Bjerg

et al. 2013

Pediatrics

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“…At 42 yrs of age, 90% of the original severe asthma group continued to have symptoms, and 45% had persistent asthma [48]. The risk of more severe asthma in adult life was increased by the presence of severe asthma and atopy in childhood (table 2) [47,48,51]. In the New South Wales Belmont cohort study, the subjects were recruited in 1982 at the age of 8-10 yrs and reassessed 15-17 yrs later [50].…”

Section: Prognosis Of Problematic Severe Asthma In Childhoodmentioning

confidence: 99%

Problematic severe asthma in children, not one problem but many: a GA2LEN initiative

Hedlin

Bush²,

Carlsen³

et al. 2010

European Respiratory Journal

146

130

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Although most children with asthma are easy to treat with low doses of safe medications, many remain symptomatic despite every therapeutic effort. The nomenclature regarding this group is confusing, and studies are difficult to compare due to the proliferation of terms describing poorly defined clinical entities.In this review of severe asthma in children, the term problematic severe asthma is used to describe children with any combination of chronic symptoms, acute severe exacerbations and persistent airflow limitation despite the prescription of multiple therapies.The approach to problematic severe asthma may vary with the age of the child, but, in general, three steps need to be taken in order to separate difficult-to-treat from severe therapy-resistant asthma. First, confirmation that the problem is really due to asthma requires a complete diagnostic re-evaluation. Secondly, the paediatrician needs to systematically exclude comorbidity, as well as personal or family psychosocial disorders. The third step is to re-evaluate medication adherence, inhaler technique and the child's environment.There is a clear need for a common international approach, since there is currently no uniform agreement regarding how best to approach children with problematic severe asthma. An essential first step is proper attention to basic care.

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“…Asthma affects ϳ10% of the U.S. population and is considered a leading cause of young children hospitalization (1). Allergic asthma has origins in early life (2,3) and is commonly characterized by airway hyperresponsiveness (AHR) 4 to bronchoconstrictors, reversible airflow obstruction, and allergic airway inflammation with eosinophilia (4). Although the exact interrelation between AHR and allergic inflammation is still debated (5,6), there exists evidence that two major Th2 cytokines, IL-4 and IL-13, are critically involved in most aspects of allergic asthma (7,8).…”

Section: Targeting Of Cd25 and Glucocorticoid-induced Tnf Receptor Famentioning

confidence: 99%

Targeting of CD25 and Glucocorticoid-Induced TNF Receptor Family-Related Gene-Expressing T Cells Differentially Modulates Asthma Risk in Offspring of Asthmatic and Normal Mother Mice

Hubeau¹,

Apostolou

Kobzik

2007

The Journal of Immunology

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Immunological mechanisms leading to increased asthma susceptibility in early life remain obscure. In this study, we examined the effects of neonatal Ab treatments targeting T cell populations on the development of an asthma syndrome. We used a model of increased asthma susceptibility where offspring of asthmatic BALB/c mother mice are more prone (than normal pups) to develop the disease. Neonatal pretreatment of naive pups with mAb directed against the IL-2Rα chain (CD25), the costimulatory molecule glucocorticoid-induced TNFR family related gene, and the inhibitory molecule CTLA-4 elicited contrasting effects in offspring depending on the mother’s asthma status. Specifically, neonatal CD25high T cell depletion stimulated asthma susceptibility in normal offspring whereas it ameliorated the condition of pups born of asthmatic mothers. Conversely, glucocorticoid-induced TNFR family related gene ligation as a primary signal reduced the spleen cellularity and largely abrogated asthma susceptibility in asthma-prone offspring, without inducing disease in normal pups. Striking changes in Th1/Th2 cytokine levels, especially IL-4, followed mAb pretreatment and were consistent with the impact on asthma susceptibility. These results point to major differences in neonatal T cell population and responsiveness related to maternal asthma history. Interventions that temporarily remove and/or inactivate specific T cell subsets may therefore prove useful to attenuate early life asthma susceptibility and prevent the development of Th2-driven allergic airway disease.

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Adult asthma severity in individuals with a history of childhood asthma

Cited by 56 publications

References 15 publications

Remission and Persistence of Asthma Followed From 7 to 19 Years of Age

Remission and Persistence of Asthma Followed From 7 to 19 Years of Age

Problematic severe asthma in children, not one problem but many: a GA2LEN initiative

Targeting of CD25 and Glucocorticoid-Induced TNF Receptor Family-Related Gene-Expressing T Cells Differentially Modulates Asthma Risk in Offspring of Asthmatic and Normal Mother Mice

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