Follow−up of asthma from childhood to adulthood: Influence of potential childhood risk factors on the outcome of pulmonary function and bronchial responsiveness in adulthood,☆☆,,★★

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Abstract

The outcome of asthma in 406 children, aged 8 to 12 years, was studied. Follow−up in adulthood was 86%, with a mean age of 24.7 years and a mean interval of follow−up of 14.8 years. The predictive value of gender and various childhood variables on the adult level of pulmonary function (forced expiratory volume in 1 second [FEV1]) and bronchial responsiveness in adulthood was assessed. An increase in mean percent predicted FEV1 from childhood to adulthood was found, both in subjects with (76%) and without (24%) current respiratory symptoms. The only childhood variable predictive of adult level of FEV1 was the level of percent predicted FEV1 (p < 0.01). The proportion of subjects with a histamine provocative concentration causing a 10% decrease in FEV1 less than or equal to 16 mg/ml decreased significantly in adulthood. The degree of bronchial responsiveness had increased slightly in adults with symptoms (p = 0.87), whereas it had decreased significantly in subjects without symptoms (p < 0.01). Female subjects were significantly more responsive in adulthood than male subjects (p = 0.047). The childhood degree of bronchial responsiveness significantly predicted the presence of bronchial responsiveness in adulthood (p = 0.02). We conclude that childhood percent predicted FEV1 is relevant to predict the outcome of the adult pulmonary function level, whereas female gender and the childhood degree of bronchial responsiveness are important for the prediction of adult degree of bronchial responsiveness among children with asthma (J ALLERGY CLIN IMMUNOL 1994; 93:575−84.)

Section snippets

Study design

This study on the outcome of childhood asthma was designed as a survey of a cohort of children with asthma, who were referred to the outpatient clinic of the Department of Pediatric Pulmonology at the University Hospital of Groningen over a period of 5 consecutive years and who were followed up longitudinally and reinvestigated in adulthood.

Childhood data were collected in the outpatient department at the first visit. In adulthood subjects were seen in the same season of the year as that of the

Population characteristics

The childhood data for the subjects who participated in the second survey (n = 348) were compared with the data for the children who were lost to follow−up (Table I).

Childhood data were not traceable in 11 of the 58 subjects who were lost to follow−up, which is the reason that they did not participate in the second survey. No significant differences were found between the remaining 47 subjects who were not reexamined and 348 children who were reexamined.

The childhood data for subjects who fully

DISCUSSION

In this study of children with asthma diagnosed on the basis of clinical symptoms, we have examined the outcome of level of FEV1 and degree of histamine PC10 in adulthood. The cohort of children that was studied is likely to be representative of children with asthma who are treated in our outpatient department. We do realize that children who are referred to a pediatrician or pediatric pulmonologist may in some way be a “negative” sample of the general population of children with asthma. The

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    From aDepartment of Pediatrics, Division of Pediatric Pulmonology, University Hospital Groningen;bDepartment of Epidemiology, University of Groningen; cChanning Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston; and dPulmonary and Critical Care Division, Department of Medicine, Beth Israel Hospital, Harvard Medical School, Boston.

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    Supported by the Netherlands Asthma Foundation (grant 87.38)

    Reprint requests: Ruurd Jan Roorda, MD, PhD, Department of Pediatric Pulmonology, “De Weezenlanden” Hospital, P.O. Box 10500, 8000 GM Zwolle, The Netherlands.

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