Prognosis after Puberty for 442 Asthmatic Children Examined and Treated on Specific Allergologic Principles

Abstract

Summary By means of questionnaires and/or personal inquiry information has been procured on the 503 asthmatic patients seen in the Clinic who were over 15 years of age in 1960. Useful data were obtained for 98,4 % of the series under review. Four hundred and forty‐two of these patients had been treated in the clinic on the lines stated. At the follow‐up 36.8% had been quite symptom‐free the past year or more. Nine point four per cent had occasionally experienced dyspnoea, and some of these also a cough, while 53.8% continued to have asthmatic symptoms. None had died from asthma. The fairly poor result was due partly to the relatively great number of severe cases (42 %) in the series, and partly to the fact that far too many had not been submitted to treatment till after a long period of illness; 37 % after not less than 5 years of illness and 16 % after at least 10 years of illness. It is shown that the chance of obtaining freedom from symptoms is greatest for the patients submitted to early treatment. The prognosis is, moreover, poorest in cases of severe asthma and a familial predisposition to atopic illness; further, in cases with other associated atopic illness and with increasing numbers of manifest allergies, as well as in cases with complicating pollen and/or mold fungus allergy. Finally, a markedly increased tendency towards freedom from symptoms has been demonstrated during the years of puberty. A final evaluation of specific allergologic treatment of asthma in childhood will probably require prolonged experiments of treatment, using the double‐blind technique.

Clinical assessment of asthma progression in children and adults

“…Most studies include the absence of respiratory symptoms and asthma medication use, whereas others also include normal lung function and/or absence of bronchial hyperresponsiveness (BHR). Studies of children with asthma from more than 25 years ago, and before the use of currently available medications, [6][7][8][9] reported remission rates ranging from 22% to 55%, whereas rates from recent hospital-based cohorts of children with asthma range from 28% to 57% at follow-up 20 years later. 10,11 Vonk et al 33 followed a cohort of 119 children with asthma over a period of 30 years with the main purpose to identify factors contributing to asthma remission in adulthood.…”

“…31,32 ADOLESCENCE AND ASTHMA REMISSION Remission rates ranging from 10% to 70% have been reported in unselected population-based or preselected cohorts. [6][7][8][9][10][11][12] The variability in reported remission rates stems largely from the various definitions used to define remission, because there is no universally accepted definition for what constitutes remission. Most studies include the absence of respiratory symptoms and asthma medication use, whereas others also include normal lung function and/or absence of bronchial hyperresponsiveness (BHR).…”

“…[2][3][4][5] It is also clear that many children with asthma will undergo remission in adolescence. [6][7][8][9][10][11][12] During adolescence, some boys undergo asthma remission because of enhanced lung and airway growth, whereas new-onset asthma can occur in girls with an increased body mass index. 13 In adulthood, asthma relapses in some whose disease remitted in adolescence, 14 whereas others who did not have respiratory symptoms as children will develop asthma.…”

Spätprognose bei Asthma bronchiale im Kindesalter

“…Wertvoll für die Beurteilung der Spätprognose erscheinen insbesondere die Arbeiten von Flensborg [6] und Ryssing [17] (1945 und 1959) sowie diejenigen von von Harnack [7, 8] (1957 und 1960). Die erstgenannten Untersuchungen über das Schicksal von 298 Asthmakindern aus Kopen hagen zeigten ohne Desensibilisierungsbehandlung nach 5-18 Jahren zu 54,7% Fortdauern der Asthmaatacken und bei weiteren 17,8% Dyspnoe, während 13 Jahre später beim gleichen Krankengut katamnestisch immer noch bei 55,3% Asthma-Symptome bestanden (zusätzlich 7,4% Dyspnoe).…”

“…Noch beklemmender wird die Situation in Kopenhagen durch erneute Erhebungen von Ryssing und F lensborg [17] an 442 Asthmakindern nach der Pubertät, die im Gegensatz zu der vorausgehenden Gruppe nach spezifisch allergologischen Prinzipien behandelt wurden. Auch hier blieben wiederum 53,8% Asthmatiker (9,4% zeigten Dyspnoe), nur bei 36,8% ver schwanden die Symptome (auf Zeit?).…”