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A Longitudinal, Population-Based, Cohort Study of Childhood Asthma Followed to Adulthood
Open accessAbstract
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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“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].”
In the citing paper
“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]
In the citing paper
“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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Inoue, T., Murayama, N., 豊島, 協., Kameda, M., Takamatsu, I., & Doi, S. (2004) · Allergology International · doi:10.1111/j.1440-1592.2004.00350.x · Cited by 3
Transition from childhood to adult asthma
Lau, S. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61419-1 · Cited by 3
Delacourt, C., Dubus, J. ‐., & Jacques de, B. L. I. C. (2009) · Revue des Maladies Respiratoires · doi:10.1016/s0761-8425(09)71592-x · Cited by 2
Campos, H. S. (2004) · Boletim de Pneumologia Sanitária · doi:10.5123/s0103-460x2004000100006 · Cited by 3
STATISTICAL MODELING OF LONGITUDINAL SURVEY DATA WITH BINARY OUTCOMES
Ghosh, S. (2007) · University Library - University of Saskatchewan (University of Saskatchewan) · Cited by 3
Barnes, N., & Bush, A. (2011) · Thorax · doi:10.1136/thx.2011.161323 · Cited by 3
Section 3, Component 3: Control of Environmental Factors and Comorbid Conditions that affect asthma
Program, P., & theDiagnosis, T. E. P. O. (2007) · Cited by 3
Choi, J., Ambalavanan, A., Zhang, Y., Dai, R., Simons, E., Sbihi, H., Anand, S. S., Paré, G., Lefebvre, D. L., Turvey, S. E., et al. (2020) · doi:10.22541/au.159986525.53189546/v2 · Cited by 3
OECD (2009) · Panorama de la santé · doi:10.1787/health_glance-2009-76-fr · Cited by 3
The Lifelong Burden of Severe Childhood Asthma
Carr, T. F. (2024) · CHEST Journal · doi:10.1016/j.chest.2024.07.137 · Cited by 4
Characteristics of Older Individuals with Asthma Being Treated with Biologics
Aetou, M., Kiskinov, Y., Ratsimba, S. F. N., Barth, M., Pizarro, C., Bergs, I., Spießhoefer, J., Skowasch, D., & Dreher, M. (2025) · Journal of Asthma and Allergy · doi:10.2147/jaa.s510469 · Cited by 2
Qin, J., Liu, F., Wang, T., Fu, Z., Lin, Y. L., Wang, X., Zhao, J., & Liu, S. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1388951 · Cited by 2
“Studies have shown that the level of airway reactivity in early infancy (1 month old) is strongly correlated with asthma in childhood (6 years old) (2, 3), and increased airway reactivity in childhood is an independent risk factor for asthma in adulthood (4, 5).”
Tang, R., Zhang, X., Yin, P., Wang, L., You, J., Zhou, M., Ng, M., & Li, J. (2025) · Chinese Medical Journal · doi:10.1097/cm9.0000000000003910 · Cited by 2
“[3] Therefore, understanding the current trends and prevalence of childhood asthma is critical for anticipating the future disease burden.”
L’asthme de la femme au fil du temps : l’adolescence
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Molecular Biology of Allergens: Structure and Immune Recognition
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Young men with asthma : Prognosis and effect on work ability
Lindström, I., Karjalainen, A., Karjalainen, J., Lauerma, A., Lindholm, H. J., Luukkonen, R. A., Pallasaho, P., & Suojalehto, H. (2012) · STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) · Cited by 2
SENSITIZATION FEATURES IN ADULTS WITH REMISSION OF ATOPIC BRONCHIAL ASTHMA
Zhorina, Y. V., Сергеевна, А. О., & Ignatova, G. L. (2020) · Современные проблемы науки и образования · doi:10.17513/spno.29650 · Cited by 2
Clinical and complete remission of asthma among schoolchildren
Oluwole, O., Rennie, D., & Lawson, J. A. (2020) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2020.05.012 · Cited by 2
Metadata
- 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)
- 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
- 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
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › 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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