Reviews and feature articleNatural history of asthma: Persistence versus progression—does the beginning predict the end?
Section snippets
Wheezing before 3 years of age
Community-based longitudinal studies examining outcomes for early wheezers have provided insights into the development of asthma.2, 3, 4, 5, 6, 7 Although these study results differ to a certain extent, possibly because of different study populations and measured parameters, some general patterns have emerged.
Many children experience 1 or more wheezing episodes before the age of 3 years, often in association with a respiratory virus.8, 9 Some have asthma, but the majority do not. For example,
Airway remodeling and inflammation
There are currently no standard definitions for what constitutes disease persistence as opposed to disease progression in asthma or criteria on how and when progression should be measured or evaluated.29, 30 For the purpose of this review, disease persistence is defined as ongoing asthma symptoms, whereas disease progression is defined as a worsening of lung function, asthma symptoms, or both over time. All asthmatic patients have airway inflammation, with resultant altered airway function and
Diagnostic and therapeutic implications of current knowledge
Most children with asthma experience their first wheezing episode during their first 5 years of life,56 yet early identification of the children at greatest risk of asthma is a challenge for clinicians. Objective measures of disease activity are limited and difficult to perform in preschool children. Thus for very young children with recurrent wheezing, using a clinical index that incorporates risk elements, such as the modified API (Table I), might be the best indicator of probable asthma.
Areas of future research
Areas where further research is needed to address remaining questions include determining how wheezing patterns correlate with histopathologic findings and a better understanding of the characteristics and determinants of asthma progression. Study is needed of the contribution of the small airways to remodeling and disease progression, in addition to the relationships among remodeling, inflammation, and airway hyperresponsiveness and whether there exists any element of cause and effect.
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2020, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Measurement of lung function after treatment of asthma is clinically important because poor lung function is a prognostic factor for clinical outcomes in children with asthma.35 Patients displaying significant airflow obstruction, for instance, are twice as likely to develop an exacerbation and exhibit reduced FEV1 in adulthood than patients with normal lung function.13,35,36 Furthermore, in a small proportion of patients with asthma, irreversible airway obstruction may develop through abnormal development of lung function in childhood and an accelerated decline in lung function in adulthood.13,36
Predicting asthma outcomes
2015, Journal of Allergy and Clinical ImmunologyAsthma: Clinical Aspects and Mucosal Immunology
2015, Mucosal Immunology: Fourth EditionDevelopment of rhinitis may be an indicator for the persistence of childhood asthma
2014, International Journal of Pediatric OtorhinolaryngologyLong-Term Trajectories of Mild Asthma in Adulthood and Risk Factors of Progression
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Elizabeth Hillyer was supported by Merck & Co, Inc, Whitehouse Station, NJ.
Disclosure of potential conflict of interest: R. Covar has received research support from AstraZeneca and Ross Abbott Laboratories, Inc. E. V. Hillyer has received freelance writing work from Merck and Aerocrine. L. Bacharier has consulting arrangements with Schering-Plough and is on the speakers' bureau for AstraZeneca, Genentech, GlaxoSmithKline, and Merck. The rest of the authors have declared that they have no conflict of interest.
This article originated, in part, from a discussion at the National Respiratory Experts Forum, held June 15-17, 2006, in Chicago, IL. This was a scientific forum, sponsored by Merck, where specific topics and questions were explored for issues pertinent to the fields of asthma and respiratory medicine.