A Longitudinal, Population-Based, Cohort Study of Childhood Asthma Followed to Adulthood

TLDR

Childhood asthma outcomes into adulthood have been studied mainly in high‑risk cohorts, with few population‑based investigations of persistence and relapse. This study followed a population‑based birth cohort from age 9 to 26 to identify risk factors for persistent or relapsing wheezing. Among 613 participants, 51.4 % reported wheezing at multiple ages, with 14.5 % persisting, 27.4 % remitting, and 12.4 % relapsing; predictors of persistence or relapse were house‑dust mite sensitization, airway hyperresponsiveness, female sex, smoking, and early onset, and persistent wheezers had consistently lower lung function, indicating that adult asthma outcomes are largely set in early childhood.

Abstract

The outcome of childhood asthma in adults has been described in high-risk cohorts, but few population-based studies have reported the risk factors for persistence and relapse.We assessed children born from April 1972 through March 1973 in Dunedin, New Zealand, repeatedly from 9 to 26 years of age with questionnaires, pulmonary-function tests, bronchial-challenge testing, and allergy testing.By the age of 26 years, 51.4 percent of 613 study members with complete respiratory data had reported wheezing at more than one assessment. Eighty-nine study members (14.5 percent) had wheezing that persisted from childhood to 26 years of age, whereas 168 (27.4 percent) had remission, but 76 (12.4 percent) subsequently relapsed by the age of 26. Sensitization to house dust mites predicted the persistence of wheezing (odds ratio, 2.41; P=0.001) and relapse (odds ratio, 2.18; P=0.01), as did airway hyperresponsiveness (odds ratio for persistence, 3.00; P<0.001; odds ratio for relapse, 3.03; P<0.001). Female sex predicted the persistence of wheezing (odds ratio, 1.71; P=0.03), as did smoking at the age of 21 years (odds ratio, 1.84; P=0.01). The earlier the age at onset, the greater the risk of relapse (odds ratio, 0.89 per year of increase in the age at onset; P<0.001). Pulmonary function was consistently lower in those with persistent wheezing than in those without persistent wheezing.In an unselected birth cohort, more than one in four children had wheezing that persisted from childhood to adulthood or that relapsed after remission. The factors predicting persistence or relapse were sensitization to house dust mites, airway hyperresponsiveness, female sex, smoking, and early age at onset. These findings, together with persistently low lung function, suggest that outcomes in adult asthma may be determined primarily in early childhood.