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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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“Nonatopic asthma is not uncommon in childhood(9) but is more prevalent in adults, especially among women.(5) Thus most asthma starts during the first decade of life, and as one goes through adolescence, it persists in some and improves in others.”
BackgroundInfluentialPathophysiological characterization of asthma transitions across adolescence
Arshad, S. H., Raza, A., Lau, L. C. K., Bawakid, K. O., Karmaus, W., Zhang, H., Ewart, S., Patil, V., Roberts, G. C., & Kurukulaaratchy, R. J. (2014) · Respiratory Research · doi:10.1186/s12931-014-0153-7 · Cited by 43
“The rate of asthma remission during adolescence has been variably reported to range from 30 to 65% [4-7].”
BackgroundLong-term exposure to indoor air pollution and wheezing symptoms in infants
Raaschou‐Nielsen, O., Hermansen, M. N., Loland, L., Buchvald, F. F., Pipper, C. B., Sørensen, M., Loft, S. H., & Bisgaard, H. F. (2009) · Indoor Air · doi:10.1111/j.1600-0668.2009.00635.x · Cited by 44
Question 3: Can we diagnose asthma in children under the age of 5 years?
Yang, C. L., Gaffin, J. M., & Radhakrishnan, D. (2018) · Paediatric Respiratory Reviews · doi:10.1016/j.prrv.2018.10.003 · Cited by 47
“Long term cohort studies have found that lung function trajectory is established in childhood [20,21] and that children with asthma are at risk for irreversible airways obstruction in adulthood with pathologic findings of airways remodeling developing between 12 months and 3 years of age [22,23].”
BackgroundLinking COPD epidemiology with pediatric asthma care: Implications for the patient and the physician
Melén, E., Guerra, S., Hallberg, J., Jarvis, D., & Stanojevic, S. (2019) · Pediatric Allergy and Immunology · doi:10.1111/pai.13054 · Cited by 44
Increased Impact of Air Pollution on Lung Function in Preterm versus Term Infants: The BILD Study
Decrue, F., Gorlanova, O., Salem, Y., Vienneau, D., de Hoogh, K., Gisler, A., Usemann, J., Korten, I., Nahum, U., Sinues, P., et al. (2021) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202102-0272oc · Cited by 44
Blume‐Peytavi, U., & Wahn, U. (2010) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2010.03942.x · Cited by 43
Comorbidities in childhood-onset and adult-onset asthma
Mendy, A., & Baye, T. M. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.05.005 · Cited by 42
Zhang, X., Morrison-Carpenter, T., Holt, J. B., & Callahan, D. B. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-1156 · Cited by 42
“, age and race status) risk factors [7-11,26-30]; however, the extent to which these risk factors contribute to increasing prevalence at the state level over time has not been analyzed or determined.”
BackgroundInfant lung function predicts asthma persistence and remission in young adults
Owens, L., Laing, I. A., Zhang, G., & Souëf, P. N. L. (2016) · Respirology · doi:10.1111/resp.12901 · Cited by 43
The burden of asthma in children: an Australian perspective
Poulos, L. M., Toelle, B. G., & Marks, G. B. (2005) · Paediatric Respiratory Reviews · doi:10.1016/j.prrv.2004.11.004 · Cited by 42
Silva, J. M., Câmara, A. A., Tobias, K. R. C., Macedo, I. S., Cardoso, M. R. A., Arruda, E., Chapman, M. D., Platts‐Mills, T. A. E., Arruda, L. K., & Ferriani, V. P. L. (2005) · Pediatric Allergy and Immunology · doi:10.1111/j.1399-3038.2005.00308.x · Cited by 42
“Pulmonary function was found to be decreased in individuals with persistent or relapsing symptoms, as compared to those without persistent wheezing (3).”
BackgroundA multi-center ring trial of allergen analysis using fluorescent multiplex array technology
King, E. M., Filep, S. C., Smith, B., Platts‐Mills, T. A. E., Hamilton, R. G., Schmechel, D., Sordillo, J. E., Milton, D. K., van Ree, R., Krop, E. J. M., et al. (2012) · Journal of Immunological Methods · doi:10.1016/j.jim.2012.09.015 · Cited by 42
“…essential role in multiple epidemiologic studies of asthma in the US, Europe and New Zealand (Eggleston et al., 1998; Phipatanakul et al., 2000; Arbes et al., 2003, 2004; Zock et al., 2006; Sears et al., 2003; Almqvist et al., 2003; Woodcock et al., 2004; Illi et al., 2006; Celedon et al., 2002).”
BackgroundRecurrent severe exacerbations in early life and reduced lung function at school age
O’Brian, A. L., Lemanske, R. F., Evans, M. D., Gangnon, R. E., Gern, J. E., & Jackson, D. J. (2012) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2011.11.046 · Cited by 42
“These findings have important potential implications because prior studies have shown that abnormalities in lung function present at school age persist at least into early adulthood.(2,3) The reductions in lung function present in this high-risk cohort are consistent with the effects of severe exacerbations on lung fu…”
ResultClinical practice guidelines: Medical follow-up of patients with asthma—Adults and adolescents
Roche, N., Morel, H., Martel, P., & Godard, P. (2005) · Respiratory Medicine · doi:10.1016/j.rmed.2005.03.011 · Cited by 42
Gestational age at birth and wheezing trajectories at 3–11 years
Leps, C., Carson, C., & QUIGLEY, M. A. (2018) · Archives of Disease in Childhood · doi:10.1136/archdischild-2017-314541 · Cited by 41
Bracken, S. J., Adami, A. J., Szczepanek, S. M., Ehsan, M., Natarajan, P., Guernsey, L. A., Shahriari, N., Rafti, E., Matson, A. P., Schramm, C. M., et al. (2015) · International Archives of Allergy and Immunology · doi:10.1159/000381058 · Cited by 41
Zhang, L., He, L., Gong, J. G., & Liu, C. (2016) · BioMed Research International · doi:10.1155/2016/9868704 · Cited by 42
“Incidence of IAO Asthma Twelve articles with the data of risk factors for IAO were retrieved [3–6, 8, 11, 33, 34, 36, 38, 39, 41].”
BackgroundMethodAsthma phenotypes in childhood
Deliu, M., Belgrave, D. C. M., Sperrin, M., Buchan, I. E., & Čustović, A. (2016) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2017.1257940 · Cited by 41
“Using similar subjective methods to characterize children, study groups from New Zealand [20] and Australia [29], observed that children who were categorized as persistent wheezers continued to wheeze into adulthood and had consistently lower lung function.”
MethodLong-Term Trajectories of Mild Asthma in Adulthood and Risk Factors of Progression
Chen, W., FitzGerald, J. M., Lynd, L. D., Sin, D. D., & Sadatsafavi, M. (2018) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2018.04.027 · Cited by 43
Soto‐Martínez, M. E., & Sly, P. D. (2009) · Chronic Respiratory Disease · doi:10.1177/1479972309345929 · Cited by 40
“Similar data are available from other longitudinal birth cohort studies.(42,45) Thus lung function growth in childhood is one determinant of lung function in adulthood, thus having a lifelong effect on respiratory disease risk.”
MethodPediatric Asthma: Natural History, Assessment, and Treatment
Herzog, R., & Cunningham–Rundles, S. (2011) · Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine · doi:10.1002/msj.20285 · Cited by 41
High Risk of Gastrointestinal Hemorrhage in Patients With Epilepsy: A Nationwide Cohort Study
Yeh, C.-C., Wang, H.-H., Chou, Y.-C., Hu, C., Chou, W.-H., Chen, T.-L., & Liao, C. (2013) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2013.06.024 · Cited by 40
Wheeze phenotypes in young children have different courses during the preschool period
Just, J., Saint-Pierre, P., Gouvis-Echraghi, R., Boutin, B., Panayotopoulos, V., Chebahi, N., Ousidhoum-Zidi, A., & Khau, C.-A. (2013) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2013.07.002 · Cited by 42
Cazzoletti, L., Corsico, A. G., Albicini, F., Vincenzo, E. M. G. D., Gini, E., Grosso, A., Ronzoni, V., Bugiani, M., Pirina, P., & Cerveri, I. (2014) · PLoS ONE · doi:10.1371/journal.pone.0086956 · Cited by 40
“However, other investigators used the same time frame [7,11,12,25], and a longer period could raise the problem of recall bias.”
BackgroundArshad, S. H., Hodgekiss, C., Holloway, J. W., Kurukulaaratchy, R. J., Karmaus, W., Zhang, H., & Roberts, G. C. (2019) · European Respiratory Journal · doi:10.1183/13993003.00477-2019 · Cited by 43
Matsunaga, K., Harada, M., Suizu, J., Oishi, K., Asami‐Noyama, M., & Hirano, T. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103078 · Cited by 41
The relationship between infant lung function and the risk of wheeze in the preschool years
Pike, K. C., Rose-Zerilli, M. J. J., Osvald, E. C., Inskip, H. M., Godfrey, K. M., Crozier, S., Roberts, G. C., CLOUGH, J. B., Holloway, J. W., Lucas, J. S., et al. (2010) · Pediatric Pulmonology · doi:10.1002/ppul.21327 · Cited by 40
Epidemiology of the Origins of Airflow Limitation in Asthma
Guerra, S., & Martinez, F. D. (2009) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200908-085dp · Cited by 40
“Prospective studies have shown that the degree of asthmarelated phenotypes, such as eosinophilic inflammation—assessed both in the airways and in blood—bronchial hyperresponsiveness, and bronchodilator response appear positively associated with subsequent low lung function and development of airflow limitation in subj…”
BackgroundResultŞekerel, B. E., Civelek, E., Karabulut, E., Yıldırım, S., Tuncer, A., & Adalıoğlu, G. (2006) · Allergy · doi:10.1111/j.1398-9995.2006.01082.x · Cited by 40
Allergic Asthma in the Era of Personalized Medicine
Papapostolou, N., & Makris, M. P. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12071162 · Cited by 39
“Although individuals with childhood asthma are expected to outgrow their asthma before adulthood, in about 30% of children with asthma the condition persists [22,23].”
BackgroundDiagnosing asthma in children: What is the role for methacholine bronchoprovocation testing?
Liem, J. J., Kozyrskyj, A. L., Cockroft, D. W., & Becker, A. B. (2008) · Pediatric Pulmonology · doi:10.1002/ppul.20801 · Cited by 39
Murphy, T. M., Wong, C. C. Y., Arseneault, L., Burrage, J., Macdonald, R., Hannon, E. J., Fisher, H. L., Ambler, A. P., Moffitt, T. E., Caspi, A., et al. (2015) · Clinical Epigenetics · doi:10.1186/s13148-015-0163-4 · Cited by 39
The 100 most influential publications in asthma from 1960 to 2017: A bibliometric analysis
Qu, Y., Zhang, C., Hu, Z., Li, S., Chen, K., Ning, Y., Shang, Y., & Bai, C. (2018) · Respiratory Medicine · doi:10.1016/j.rmed.2018.03.014 · Cited by 41
“The 100 articles are listed in Table 1 and are in descending order, according 85 to the number of citations that they have received [12-111].”
BackgroundAsthma across the lifespan: Time for a paradigm shift
Szefler, S. J. (2018) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2018.03.010 · Cited by 39
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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