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. 2004 Nov;59(11):925–929. doi: 10.1136/thx.2003.016246

Childhood factors associated with asthma remission after 30 year follow up

J Vonk 1, D Postma 1, H Boezen 1, M Grol 1, J Schouten 1, G Koeter 1, J Gerritsen 1
PMCID: PMC1746857  PMID: 15516465

Abstract

Background: Factors contributing to either "complete" or "clinical" remission of asthma are important to know since there is no cure for the disease.

Methods: A cohort of 119 allergic asthmatic children was examined three times with a mean follow up of 30 years. They were aged 5–14 years at visit 1 (1966–9), 21–33 years at visit 2 (1983–6), and 32–42 years at visit 3 (1995–6). Complete remission of asthma at visit 3 was defined as no asthma symptoms, no use of inhaled corticosteroids, normal lung function (FEV1 >90% predicted), and no bronchial hyperresponsiveness (PC10 >16 mg/ml). Clinical remission was defined as no asthma symptoms and no use of inhaled corticosteroids.

Results: 22% of the group was in complete remission of asthma at visit 3 and a further 30% was in clinical remission (total 52%); 57% of subjects in clinical remission had bronchial hyperresponsiveness and/or a low lung function. Logistic regression analyses showed that a higher FEV1 in childhood and more improvement in FEV1 from age 5–14 to 21–33 were associated with both complete and clinical asthma remission at age 32–42.

Conclusions: Complete remission of asthma was present in a small subset of asthmatics while half the subjects showed clinical remission. Both complete and clinical remission were associated with a higher lung function level in childhood and a higher subsequent increase in FEV1. These results support the view that defining remission only on the basis of symptoms and medication use will overlook subjects with subclinical active disease and possibly associated airway remodelling.

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Selected References

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  1. Agertoft L., Pedersen S. Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med. 1994 May;88(5):373–381. doi: 10.1016/0954-6111(94)90044-2. [DOI] [PubMed] [Google Scholar]
  2. Boulet L. P., Turcotte H., Brochu A. Persistence of airway obstruction and hyperresponsiveness in subjects with asthma remission. Chest. 1994 Apr;105(4):1024–1031. doi: 10.1378/chest.105.4.1024. [DOI] [PubMed] [Google Scholar]
  3. Bronnimann S., Burrows B. A prospective study of the natural history of asthma. Remission and relapse rates. Chest. 1986 Oct;90(4):480–484. doi: 10.1378/chest.90.4.480. [DOI] [PubMed] [Google Scholar]
  4. Burney P. G., Luczynska C., Chinn S., Jarvis D. The European Community Respiratory Health Survey. Eur Respir J. 1994 May;7(5):954–960. doi: 10.1183/09031936.94.07050954. [DOI] [PubMed] [Google Scholar]
  5. Burrows B., Sears M. R., Flannery E. M., Herbison G. P., Holdaway M. D., Silva P. A. Relation of the course of bronchial responsiveness from age 9 to age 15 to allergy. Am J Respir Crit Care Med. 1995 Oct;152(4 Pt 1):1302–1308. doi: 10.1164/ajrccm.152.4.7551386. [DOI] [PubMed] [Google Scholar]
  6. Chalmers G. W., Macleod K. J., Little S. A., Thomson L. J., McSharry C. P., Thomson N. C. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax. 2002 Mar;57(3):226–230. doi: 10.1136/thorax.57.3.226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cockcroft D. W., Berscheid B. A. Standardization of inhalation provocation tests. Dose vs concentration of histamine. Chest. 1982 Nov;82(5):572–575. doi: 10.1378/chest.82.5.572. [DOI] [PubMed] [Google Scholar]
  8. Gerritsen J., Koëter G. H., Postma D. S., Schouten J. P., Knol K. Prognosis of asthma from childhood to adulthood. Am Rev Respir Dis. 1989 Nov;140(5):1325–1330. doi: 10.1164/ajrccm/140.5.1325. [DOI] [PubMed] [Google Scholar]
  9. Godden D. J., Ross S., Abdalla M., McMurray D., Douglas A., Oldman D., Friend J. A., Legge J. S., Douglas J. G. Outcome of wheeze in childhood. Symptoms and pulmonary function 25 years later. Am J Respir Crit Care Med. 1994 Jan;149(1):106–112. doi: 10.1164/ajrccm.149.1.8111567. [DOI] [PubMed] [Google Scholar]
  10. Grol M. H., Gerritsen J., Vonk J. M., Schouten J. P., Koëter G. H., Rijcken B., Postma D. S. Risk factors for growth and decline of lung function in asthmatic individuals up to age 42 years. A 30-year follow-up study. Am J Respir Crit Care Med. 1999 Dec;160(6):1830–1837. doi: 10.1164/ajrccm.160.6.9812100. [DOI] [PubMed] [Google Scholar]
  11. Grol M. H., Postma D. S., Vonk J. M., Schouten J. P., Rijcken B., Koëter G. H., Gerritsen J. Risk factors from childhood to adulthood for bronchial responsiveness at age 32-42 yr. Am J Respir Crit Care Med. 1999 Jul;160(1):150–156. doi: 10.1164/ajrccm.160.1.9707103. [DOI] [PubMed] [Google Scholar]
  12. Kerrebijn K. F., Hoogeveen-Schroot H. C., van der Wal M. C. Chronic nonspecific respiratory disease in children, a five year follow-up study. Acta Paediatr Scand Suppl. 1977;(261):3–72. [PubMed] [Google Scholar]
  13. Kokkonen J., Linna O. The state of childhood asthma in young adulthood. Eur Respir J. 1993 May;6(5):657–661. [PubMed] [Google Scholar]
  14. Martin A. J., McLennan L. A., Landau L. I., Phelan P. D. The natural history of childhood asthma to adult life. Br Med J. 1980 Jun 14;280(6229):1397–1400. doi: 10.1136/bmj.280.6229.1397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Panhuysen C. I., Vonk J. M., Koëter G. H., Schouten J. P., van Altena R., Bleecker E. R., Postma D. S. Adult patients may outgrow their asthma: a 25-year follow-up study. Am J Respir Crit Care Med. 1997 Apr;155(4):1267–1272. doi: 10.1164/ajrccm.155.4.9105065. [DOI] [PubMed] [Google Scholar]
  16. Phelan Peter D., Robertson Colin F., Olinsky Anthony. The Melbourne Asthma Study: 1964-1999. J Allergy Clin Immunol. 2002 Feb;109(2):189–194. doi: 10.1067/mai.2002.120951. [DOI] [PubMed] [Google Scholar]
  17. Quanjer P. H., Tammeling G. J., Cotes J. E., Pedersen O. F., Peslin R., Yernault J. C. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:5–40. [PubMed] [Google Scholar]
  18. Rijcken B., Schouten J. P., Weiss S. T., Meinesz A. F., de Vries K., van der Lende R. The distribution of bronchial responsiveness to histamine in symptomatic and in asymptomatic subjects. A population-based analysis of various indices of responsiveness. Am Rev Respir Dis. 1989 Sep;140(3):615–623. doi: 10.1164/ajrccm/140.3.615. [DOI] [PubMed] [Google Scholar]
  19. Roorda R. J., Gerritsen J., Van Aalderen W. M., Schouten J. P., Veltman J. C., Weiss S. T., Knol K. Risk factors for the persistence of respiratory symptoms in childhood asthma. Am Rev Respir Dis. 1993 Dec;148(6 Pt 1):1490–1495. doi: 10.1164/ajrccm/148.6_Pt_1.1490. [DOI] [PubMed] [Google Scholar]
  20. Sears M. R., Burrows B., Flannery E. M., Herbison G. P., Hewitt C. J., Holdaway M. D. Relation between airway responsiveness and serum IgE in children with asthma and in apparently normal children. N Engl J Med. 1991 Oct 10;325(15):1067–1071. doi: 10.1056/NEJM199110103251504. [DOI] [PubMed] [Google Scholar]
  21. Sears Malcolm R., Greene Justina M., Willan Andrew R., Wiecek Elizabeth M., Taylor D. Robin, Flannery Erin M., Cowan Jan O., Herbison G. Peter, Silva Phil A., Poulton Richie. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med. 2003 Oct 9;349(15):1414–1422. doi: 10.1056/NEJMoa022363. [DOI] [PubMed] [Google Scholar]
  22. Selroos O., Pietinalho A., Löfroos A. B., Riska H. Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest. 1995 Nov;108(5):1228–1234. doi: 10.1378/chest.108.5.1228. [DOI] [PubMed] [Google Scholar]
  23. Ulrik C. S., Backer V. Longitudinal determinants of bronchial responsiveness to inhaled histamine. Chest. 1998 Apr;113(4):973–979. doi: 10.1378/chest.113.4.973. [DOI] [PubMed] [Google Scholar]
  24. Van Lookeren Campagne, Knol K., De Vries K. House dust provocation in children. Scand J Respir Dis. 1969;50(1):76–85. [PubMed] [Google Scholar]
  25. Warke T. J., Fitch P. S., Brown V., Taylor R., Lyons J. D. M., Ennis M., Shields M. D. Outgrown asthma does not mean no airways inflammation. Eur Respir J. 2002 Feb;19(2):284–287. doi: 10.1183/09031936.02.00882002. [DOI] [PubMed] [Google Scholar]
  26. de VRIES, GOEI J. T., BOOY-NOORD H., ORIE N. G. Changes during 24 hours in the lung function and histamine hyperreactivity of the bronchial tree in asthmatic and bronchitic patients. Int Arch Allergy Appl Immunol. 1962;20:93–101. doi: 10.1159/000229248. [DOI] [PubMed] [Google Scholar]
  27. van den Toorn L. M., Overbeek S. E., de Jongste J. C., Leman K., Hoogsteden H. C., Prins J. B. Airway inflammation is present during clinical remission of atopic asthma. Am J Respir Crit Care Med. 2001 Dec 1;164(11):2107–2113. doi: 10.1164/ajrccm.164.11.2006165. [DOI] [PubMed] [Google Scholar]
  28. van der Lende R., Orie N. G. The MRC-ECCS questionnaire on respiratory symptoms (use in epidemiology). Scand J Respir Dis. 1972;53(4):218–226. [PubMed] [Google Scholar]

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