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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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Bonato, M., Tinè, M., Bazzan, E., Biondini, D., Saetta, M. P., & Baraldo, S. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8081180 · Cited by 15
“This has been confirmed by the results of a number of studies [4,10,11,14,15], which have demonstrated that poor airway function shortly after birth (at 2–3 months of age) is a risk factor for asthma in teenagers and young adults (at 11, 16, and 22 years of age).”
ResultPfavayi, L. T., Sibanda, E., & Mutapi, F. (2020) · International Archives of Allergy and Immunology · doi:10.1159/000506009 · Cited by 16
Giampaolo, L. D., Cavallucci, E., Braga, M., Renzetti, A., Schiavone, C., Quecchia, C., Petrarca, C., & Gioacchino, M. D. (2011) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-011-0653-4 · Cited by 15
Inhaled corticosteroids and asthma prevention
Martínez, F. D. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69261-1 · Cited by 15
López-Silvarrey, A., Pértega-Díaz, S., Rueda-Esteban, S., Sánchez-Lastres, J. M., González, M. Á. S. J., Sampedro, M., Pérez-Castro, T. R., Garnelo, L., Bamonde, L., López-Silvarrey-Varela, J., et al. (2011) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2011.01.009 · Cited by 15
“Sibilancias alguna vez 38,9 37,1 41,7 43,5 36,9 39,8 35,3 43,4 (36,3-41,5) (35,4-38,7) (38,8-44,6) (40,2-46,7) (33,7-40,0) (36,6-42,9) (32,3-38,3) (40,3-46,6) Sibilancias recientesb 13,2 12,9 15,3 15,2 12,7 12,8 11,4 15,7 (11,4-15,0) (11,7-14,1) (13,1-17,4) (12,9-17,6) (10,5-14,9) (10,7-15,0) (9,4-13,4) (13,3-18,0) At…”
El‐Heneidy, A., Abdel‐Rahman, M. E., Mihala, G., ROSS, L. J., & Comans, T. A. (2018) · Nutrients · doi:10.3390/nu10111798 · Cited by 15
“Furthermore, long term follow up studies in different populations have concluded that asthma, like other common chronic diseases, originates in early years of life and that impaired respiratory function at early childhood is usually associated with asthma in adulthood [29,30,32,33].”
BackgroundElias, B. C., Silva, J. B., Mais, L. A., Warkentin, S., Konstantyner, T., & Solé, D. (2019) · Revista Paulista de Pediatria · doi:10.1590/1984-0462/;2019;37;4;00002 · Cited by 16
Blocking antibodies in allergen immunotherapy: the Yin and Yang
Hardy, C. L., Rolland, J. M., & O’Hehir, R. E. (2004) · Clinical & Experimental Allergy · doi:10.1111/j.1365-2222.2004.1943.x · Cited by 15
Persistent Airway Obstruction in Asthma
Lange, P. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201211-1966ed · Cited by 15
Molecular profiling of exhaled breath condensate in respiratory diseases
Malerba, M., Purghè, B., Ragnoli, B., Manfredi, M., & Baldanzi, G. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2537910 · Cited by 15
“Adding further complexity, some forms of asthma can undergo spontaneous remission, particularly during late childhood and adolescence [52–54].”
Holgate, S. T., Lemanske, R. F., O’Byrne, P. M., Kakumanu, S., & Busse, W. W. (2009) · Elsevier eBooks · doi:10.1016/b978-0-323-05659-5.00051-6 · Cited by 14
Type 2‐high airway inflammation in childhood asthma distinguishes a more severe phenotype
Skov, F. R., Sultan, T., Fischer‐Rasmussen, K., Chawes, B., Stokholm, J., Vahman, N., Bønnelykke, K., & Schoos, A. M. (2025) · Pediatric Allergy and Immunology · doi:10.1111/pai.70032 · Cited by 14
“26 These findings emphasize the role of early allergen sensitization and eosinophilic inflammation in shaping long-term pulmonary function outcomes, aligning with our observation of increased airway resistance and eosinophilia in children with T2-high asthma.”
Sanchez, M., Bousquet, J., Moual, N. L., Jacquemin, B., Clavel‐Chapelon, F., Humbert, M. J. C., Kauffmann, F., Tubert‐Bitter, P., & Varraso, R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065090 · Cited by 14
Ethnic Differences in the Effect of Asthma on Pulmonary Function in Children
Zhang, Y., McConnell, R., Gilliland, F. D., & Berhane, K. T. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200912-1863oc · Cited by 14
“The largest deficits in flows were associated with diagnosis at early age and did not vary between ethnic groups, results that were consistent with an earlier analysis of a sample of this cohort with shorter follow-up (38) and with other studies (82, 83).”
ResultLung effects of inhaled corticosteroids in a rhesus monkey model of childhood asthma
Plopper, C. G., Joad, J. P., Miller, L. A., Schelegle, E. S., Fanucchi, M. V., Winkle, L. S. V., Tyler, N. K., Avdalovic, M. V., Evans, M. J., Lasley, W. L., et al. (2012) · Clinical & Experimental Allergy · doi:10.1111/j.1365-2222.2012.04005.x · Cited by 13
Leung, T. F., Tang, M. F., Leung, A. S. Y., Tam, W., Sy, H. Y., & Wong, G. (2017) · Pediatric Allergy and Immunology · doi:10.1111/pai.12836 · Cited by 14
Dai, X., Dharmage, S. C., Abramson, M. J., Erbas, B., Bennett, C. M., Svanes, C., Hui, J., Axelrad, C., Lowe, A. J., & Lodge, C. (2020) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2020.03.027 · Cited by 14
Knihtilä, H. M., Stubbs, B. J., Carey, V. J., Laranjo, N., Chu, S. H., Kelly, R. S., Zeiger, R. S., Bacharier, L. B., O’Connor, G. T., Lasky-Su, J. A., et al. (2021) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2020.12.647 · Cited by 14
Accelerated decline in lung function in cigarette smokers is associated with TP53/MDM2 polymorphisms
Hancox, R. J., Poulton, R., Welch, D., Olova, N. N., McLachlan, C. R., Greene, J. M., Sears, M. R., Caspi, A., Moffitt, T. E., Robertson, S. P., et al. (2009) · Human Genetics · doi:10.1007/s00439-009-0704-z · Cited by 14
“The Dunedin Multidisciplinary Health and Development Study is described in detail elsewhere (Hancox et al. 2007; Rasmussen et al. 2002; Sears et al. 2003).”
BackgroundRhinovirus and the developing lung
Cox, D., & Souëf, P. N. L. (2014) · Paediatric Respiratory Reviews · doi:10.1016/j.prrv.2014.03.002 · Cited by 14
“Longitudinal data from birth cohorts have demonstrated an association between persistent asthma and lower lung function that tracks from early childhood to adulthood [79–82].”
Background¿Podemos modificar el remodelado bronquial en el asma?
Ramos‐Barbón, D. (2005) · Archivos de Bronconeumología · doi:10.1016/s0300-2896(05)70761-4 · Cited by 14
Bhatawadekar, S. A., Keller, G., Francisco, C. D. O., Inman, M. D., Fredberg, J. J., Tarlo, S. M., Stanbrook, M. B., Lyons, O. D., & Yadollahi, A. (2017) · Frontiers in Physiology · doi:10.3389/fphys.2017.01012 · Cited by 14
“Indeed reduced caliber of the intrathoracic airways is an independent predictor of airway reactivity in asthma (Sears et al., 2003) and in the general population (Britton et al.”
BackgroundOluwole, O., Rennie, D., Goodridge, D. M., Blackburn, D. F., Litzenberger, T., Penz, E. D., & Lawson, J. A. (2020) · Pediatric Pulmonology · doi:10.1002/ppul.24881 · Cited by 16
“Remission of childhood asthma occurs in more than half of children(6,7) while in those who do not remit, the disease may persist into adolescence(8) or adulthood.(9) Factors predicting these temporal changes in the course of the disease are unclear.”
BackgroundMethodLowe, L. A., Čustović, A., & Woodcock, A. A. (2003) · Current Allergy and Asthma Reports · doi:10.1007/s11882-003-0022-9 · Cited by 14
Sex influences on lung function and medication in childhood asthma
Hallberg, J., Anderson, M. P., Wickman, M. C., & Svartengren, M. (2006) · Acta Paediatrica · doi:10.1080/08035250600584794 · Cited by 14
Hartert, T. V., Kyvsgaard, J. N., Thaver, L., Suara-Istanbouli, A., Allinson, J. P., & Zar, H. J. (2025) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2025.04.012 · Cited by 16
Deciphering the Role of Bronchial Hyper-Responsiveness in Equine Pasture Asthma
Swiderski, C. E., Hunter, C. L., Bowser, J. E., Costa, L. R. R., Cooley, A. J., Claude, A. K., Eddy, A. L., & Bright, L. A. (2017) · Journal of Equine Veterinary Science · doi:10.1016/j.jevs.2017.03.219 · Cited by 13
Monitoring asthma in childhood
Carlsen, K. C. L., & Pijnenburg, M. W. H. (2015) · European Respiratory Review · doi:10.1183/16000617.00003714 · Cited by 13
Characterization of the duration from onset of asthma symptoms to asthma disease
Martyn, M., Weaver, A. L., Jacobson, R. M., & Juhn, Y. J. (2008) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)60059-2 · Cited by 12
New visions in respiratory allergy (asthma and allergic rhinitis): An iPAC summary and future trends
Papadopoulos, N. G., Borres, M. P., Gern, J. E., & Nieto, A. (2008) · Pediatric Allergy and Immunology · doi:10.1111/j.1399-3038.2008.00767.x · Cited by 13
“A considerable proportion of children with asthma will continue to wheeze in adulthood; risk factors include female sex, early onset, IgE sensitization and impaired lung function (26).”
BackgroundChildhood asthma and chronic obstructive pulmonary disease
Tai, A. (2015) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0000000000000146 · Cited by 14
“As to whether inhaled corticosteroids have any impact on lung function of asthmatic patients tracking into adult life, there is some evidence in the Dunedin cohort whereby patients who were receiving inhaled corticosteroids had lower lung function at age 18 and 26 years compared with those not receiving inhaled cortic…”
BackgroundResultPerimenstrual Asthma in Adolescents: A Shared Condition in Pediatric and Gynecological Endocrinology
Calcaterra, V., Nappi, R. E., Farolfi, A., Tiranini, L., Rossi, V., Regalbuto, C., & Zuccotti, G. (2022) · Children · doi:10.3390/children9020233 · Cited by 15
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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