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Cited by 1,460Asthma and respiratory diseasesOccupational exposure and asthmaAllergic Rhinitis and Sensitization

A longitudinal, population-based, cohort study of childhood asthma followed to adulthood

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Sears, Malcolm R., Greene, Justina M., Willan, Andrew R., Wiecek, Elizabeth M., Taylor, D. Robin, Flannery, Erin M., Cowan, Jan O., Herbison, G. Peter +2 more·2003·New England Journal of Medicine
DOI 10.1056/nejmoa022363
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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.

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Crossref · 10.1056/nejmoa022363

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  • House dust mite (HDM) is the most prevalent cause of allergic sensitization and a risk factor for persistent asthma in human subjects.

    “Among many factors, house dust mite (HDM) is the most prevalent cause of allergic sensitization [4, 6], and a risk factor for persistent asthma in human subjects [7, 8].”

    From Picroside II Attenuates Airway Inflammation by Downregulating the Transcription Factor GATA3 and Th2-Related Cytokines in a Mouse Model of HDM-Induced Allergic Asthma (2016) · cites this paper as [8]

  • Some studies suggest the effects of persistent wheeze and relapsed wheeze on lung function are established from mid-childhood, without further decline in tracking of FEV1 over time.

    “The majority of studies have shown that persistent wheeze is related to reduced lung function development throughout adolescence (31, 45, 152, 153), while some suggest the effects of persistent wheeze and relapsed wheeze on lung function are established from mid-childhood, without further decline in tracking of FEV1 over time (154, 155).”

    From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [154]

  • A number of studies have reported that childhood asthma itself has no impact on adult lung function decline.

    “While a number of studies have reported that childhood asthma itself has no impact on adult lung function decline (154, 157, 158, 160), a study that collected childhood asthma status retrospectively has reported that it is associated with greater lung function decline, which may be related to recall bias (161).”

    From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [154]

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Authors
Sears, M. R., Greene, J. M., Willan, A. R., Wiecek, E. M., Taylor, D. R., Flannery, E. M., Cowan, J. O., Herbison, G. P., Silva, P. A., & Poulton, R.
Affiliations
  • St. Joseph’s Healthcare Hamilton (CA)
  • McMaster University (CA)
  • University of Otago (NZ)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2003-10-09
Volume
349
Issue
15
Pages
1414-1422
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa022363
OpenAlex
W2104537618
Cited by
1,460
References
28
Citations by year
2026: 21 · 2025: 29 · 2024: 39 · 2023: 42 · 2022: 41 · 2021: 56 · 2020: 51 · 2019: 62 · 2018: 54 · 2017: 38 · 2016: 53 · 2015: 72 · 2014: 86 · 2013: 59 · 2012: 70
FWCI
40.25
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
  • Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
Keywords
childhood asthma, adult asthma, asthma persistence, asthma relapse, wheezing, house dust mite sensitization, airway hyperresponsiveness, sex differences, smoking, age at asthma onset, lung function, Dunedin birth cohort
MeSH terms
Adolescent, Adult, Asthma, Child, Child, Preschool, Environmental Exposure, Female, Humans, Longitudinal Studies, Male, New Zealand, Surveys and Questionnaires, Recurrence, Respiratory Function Tests, Respiratory Sounds, Risk Factors, Sex Factors, Smoking, Cohort Studies, Bronchial Hyperreactivity, Age of Onset, Disease Progression, Pyroglyphidae

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