Asthma severity, allergy and lung function during young middle life in subjects with asthma in childhood

Abstract

The further course of asthma severity lung function, bronchial hyperresponsiveness (BHR) to cold air challenge (CACh), clinical allergies and allergic sensitization in young middle adulthood was studied in a cohort of 55 subjects with childhood asthma. All subjects (27 females) have attended all five previous and the current follow-up visit, undertaken at a mean age of 35 years. Twelve subjects (22%) reported no current asthma, 28 (51%) mild/intermittent, and 15 (27%) moderate/severe asthma. Asthma severity changed little in the individual subjects over the last 5-year period. Females continued to have higher asthma severity scores than the males, but the previously noted lower resting and post-bronchodilator % predicted FEV1 in females was not confirmed now. Pathological BHR to CACh tended to be more common among the males. Forty-four subjects were still allergic to animal danders and 35 to pollens. Sensitization rates (skin prick test or RAST) were similar to those recorded 5 years earlier and there was no clear evidence of tolerance developing. Five subjects have never shown evidence of allergy or sensitization. The extent of sensitization to animal danders showed statistically significant relationships to asthma severity and BHR to CACh. Social development and professional careers continued to be good.

Quality of life in adolescents with asthma, during the transition period from child to adult

“…An additional limitation is that our follow‐up rate was only 69%, which is in line with the rate of follow‐up in several others (26, 31) but lower than in other previous prospective studies (32). In investigations on patients living in a large metropolitan area, a higher number of dropouts is probably to be expected.…”

Peripheral airway involvement in asthma assessed by single-breath SF6and He washout

“…Participants included 55 adults (28 males, mean age 34.9 yrs) (table 1) with childhood asthma, who took part in an asthma follow-up study [22][23][24]. Forty-three subjects reported asthma symptoms over the last year, 17 had persistent asthma symptoms or medicated regularly, and nine took asthma medication continuously [24].…”

“…Intraacinar airways can be assessed by the use of a more sophisticated N 2 phase-III slope analysis of the N 2 MBW [11,12] or by a single-breath washout (SBW) with test gases of different diffusivity, such as helium (He) and sulphur hexafluoride (SF 6 ) [20,21]. In the present study, a He/SF 6 SBW test was used to extend the previous observations on peripheral airway dysfunction in asthma [11][12][13] in an attempt to assess how deep into the acinar region the airways response to CACh reaches.CACh was performed in all 55 adult subjects participating in a long-term prospective follow-up study of childhood asthma [22]. At a previous follow-up visit [23,24], performed 5 yrs earlier, 24 out of 53 subjects tested showed pathological bronchial hyperresponsiveness (BHR) to CACh, and 11 of these 24 subjects had a fall in forced expiratory volume in one second (FEV1) of o20%.…”

“…CACh was performed in all 55 adult subjects participating in a long-term prospective follow-up study of childhood asthma [22]. At a previous follow-up visit [23,24], performed 5 yrs earlier, 24 out of 53 subjects tested showed pathological bronchial hyperresponsiveness (BHR) to CACh, and 11 of these 24 subjects had a fall in forced expiratory volume in one second (FEV1) of o20%.…”

TH17 cells mediate pulmonary collateral priming

“…However, in the context of allergic responses this beneficial effect can have deleterious consequences as any lung inflammation, regardless of its origin (allergic, viral, environmental) or polarization will increase the risk of de-novo sensitization towards unrelated, harmless antigens. Ultimately this process leads to polysensitization, a subtype of allergic disease with a much worse clinical course which is immensely more difficult to treat53–55 and thus needs to become a focus of future research directions.…”