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Previous Volume 349:1414-1422 October 9, 2003 Number 15 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Martinez, F. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background 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.

Methods 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.

Results 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.

Conclusions 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.

Source Information

From the Departments of Medicine (M.R.S., J.M.G.), and Clinical Epidemiology and Biostatistics (A.R.W., E.M.W.), McMaster University, Hamilton, Ont., Canada; and the Department of Medicine (D.R.T., E.M.F., J.O.C.), the Department of Preventive and Social Medicine (G.P.H.), and the Dunedin Multidisciplinary Health and Development Research Unit (P.A.S., R.P.), University of Otago, Dunedin, New Zealand.

Address reprint requests to Dr. Sears at the Firestone Institute for Respiratory Health, McMaster University and St. Joseph's Healthcare, 50 Charlton Ave. E., Hamilton, ON L8N 4A6, Canada, or at searsm{at}mcmaster.ca.

Full Text of this Article

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Long-Term Follow-up of Asthma
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Extract | Full Text | PDF  
N Engl J Med 2004; 350:304, Jan 15, 2004. Correspondence

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