Predicting asthma outcomes

Abstract

This review addresses predictors of remission or persistence of wheezing and asthma from early childhood through adulthood. Early childhood wheezing is common, but predicting who will remit or have persistent childhood asthma remains difficult. By adding parental history of asthma and selected infant biomarkers to the history of recurrent wheezing, the Asthma Predictive Index and its subsequent modifications provide better predictions of persistence than simply the observation of recurrent wheeze. Sensitization, especially to multiple allergens, increases the likelihood of development of classic childhood asthma. Remission is more likely in male subjects and those with milder disease (less frequent and less severe symptoms), less atopic sensitization, a lesser degree of airway hyperresponsiveness, and no concomitant allergic disease. Conversely, persistence is linked strongly to allergic sensitization, greater frequency and severity of symptoms, abnormal lung function, and a greater degree of airway hyperresponsiveness. A genetic risk score might predict persistence more accurately than family history. Remission of established adult asthma is substantially less common than remission during childhood and adolescence. Loss of lung function can begin early in life and tracks through childhood and adolescence. Despite therapy which controls symptoms and exacerbations, the outcomes of asthma appear largely resistant to pharmacologic therapy.

Physiology of the lung in idiopathic pulmonary fibrosis

“…In such a context, measurements of lung compliance, blood gas analysis while breathing 100% oxygen, assessment of pulmonary haemodynamics and exploration of the ventilatory drive, as well as exercise testing with quantification of dead space ventilation, may provide useful information when relevant comorbidities such as heart failure or anaemia have been ruled out. This aspect may be of particular importance for the definition of clinical-physiological disease phenotypes, analogous with other fields such as severe asthma [141]. Future studies will inform us about the respective roles of select physiological tests in the general IPF care strategy.…”

Determinants of persistent asthma in young adults

“…The understanding of determinants that affect the course of diagnosed asthma, e.g. avoidance of environmental or occupational exposures [12], is therefore important for tertiary prevention, since asthma persistence is associated with frequent and severe symptoms with development of impaired lung function [13]. …”

Prescribing of asthma drugs for children 2004–2015

“…Atopic sensitisation is a key factor in order to assess whether children with chronic obstructive lower airway symptoms in fact have asthma and should start treatment with inhaled steroids (7). The prevalence of atopic asthma is higher in older children than in younger children (2), and we would thus expect that the proportion of children treated with inhaled steroids would increase with age, as found for example in the UK (6).…”