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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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“Female sex has also been reported to be a predictor for persistent asthma from childhood to adulthood [32, 33], which is why it seems that the increasing prevalence of asthma among adults is mainly driven by women, i.e. by lower remission rate of childhood asthma and higher incidence rate of…”
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“This subtype is not commonly associated with a family history of atopic disease or allergic sensitization (5).”
BackgroundMaternal positive skin prick test results and asthma prediction after early childhood wheezing
Elizur, A., Pollack, N., Boslaugh, S., Kannai, Y., & Katz, Y. (2007) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)60732-6 · Cited by 10
Takaku, Y., Nakagome, K., Kobayashi, T., Yamaguchi, T., Nishihara, F., Soma, T., Hagiwara, K., Kanazawa, M., & Nagata, M. (2010) · International Archives of Allergy and Immunology · doi:10.1159/000312124 · Cited by 10
“reported that lower IgE levels and fewer positive allergy skin tests in addition to milder symptoms were factors predictive of remission of moderate-severe asthma. Searset al. [”
BackgroundPredicting the Long-Term Course of Asthma in Wheezing Infants Is Still a Challenge
Amat, F., Vial‐Dupuy, A., Pereira, B., Petit, I., Labbé, A., & Just, J. (2011) · ISRN Allergy · doi:10.5402/2011/493624 · Cited by 10
“Other long-term follow-up studies have reported similar findings [13, 14].”
BackgroundResultFactors Affecting Bronchial Hyperreactivity in Asthmatic Children
Harmancı, K., Bakırtaş, A., & Türktaş, İ. (2008) · Journal of Asthma · doi:10.1080/02770900802385992 · Cited by 10
Section 2, Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma
Program, P., & theDiagnosis, T. E. P. O. (2007) · Cited by 10
Cantani, A., & Micera, M. (2005) · PubMed · Cited by 10
Bjørke‐Monsen, A., Vollsæter, M., Ueland, P. M., Markestad, T., Øymar, K. A. A., & Halvorsen, T. (2016) · American Journal of Respiratory Cell and Molecular Biology · doi:10.1165/rcmb.2016-0210oc · Cited by 10
Multi-Method Molecular Characterisation of Human Dust-Mite-associated Allergic Asthma
Whittle, E., Leonard, M. O., Gant, T. W., & Tonge, D. P. (2019) · Scientific Reports · doi:10.1038/s41598-019-45257-1 · Cited by 11
Woodruff, P. G., Bhakta, N. R., & Fahy, J. V. (2015) · Elsevier eBooks · doi:10.1016/b978-1-4557-3383-5.00041-5 · Cited by 10
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Duan, C., Wang, M., Ma, X., Ding, M., Yu, H., & Han, Y. (2015) · Europe PMC (PubMed Central) · Cited by 10
Du bon usage des corticoïdes inhalés chez l’enfant asthmatique (nourrisson inclus)
(GRAPP), G. D. R. S. L. A. E. P.-P. (2004) · Revue des Maladies Respiratoires · doi:10.1016/s0761-8425(04)71624-1 · Cited by 10
Saglani, S., & Bush, A. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201505-0989ed · Cited by 10
Szefler, S. J. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.2501001 · Cited by 10
Preoperative Corticosteroids for Reactive Airway?
Bishop, M. J. (2004) · Anesthesiology · doi:10.1097/00000542-200405000-00002 · Cited by 10
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Age at asthma diagnosis and onset of symptoms among adults with allergic and non-allergic asthma
Pakkasela, J., Salmela, P., Juntunen, P., Karjalainen, J., & Lehtimäki, L. (2023) · European Clinical Respiratory Journal · doi:10.1080/20018525.2023.2269653 · Cited by 19
“However, some previous studies have suggested that asthma onset in adulthood is mostly a relapse of childhood asthma, but again, these studies focus on asthma onset in young adulthood before the age of 26 years [14,15].”
BackgroundRelationships between lung function, allergy, and wheezing in urban children
Konno-Yamamoto, A., Goswamy, V. P., Calatroni, A., Gergen, P. J., Johnson, M. B., Sorkness, R. L., Bacharier, L. B., O’Connor, G. T., Kattan, M., Wood, R. A., et al. (2024) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2024.02.025 · Cited by 10
Childhood Air Pollution Exposure Associated with Self-reported Bronchitic Symptoms in Adulthood
Garcia, E., Birnhak, Z., West, S., Howland, S., Lurmann, F., Pavlovic, N., McConnell, R., Farzan, S. F., Bastain, T. M., Habre, R., et al. (2024) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202308-1484oc · Cited by 9
Con: clinical remission in asthma – not yet there
Eggert, L. E., Rhoads, S., Wechsler, M. E., & Akuthota, P. (2025) · European Respiratory Review · doi:10.1183/16000617.0182-2024 · Cited by 9
“Furthermore, the potential for spontaneous remission, a rarity in most chronic diseases, occurs in 22 – 27% of paediatric patients with asthma [6, 7] and 2 – 17% of adult patients [8].”
InfluentialProspective study of disease persistence and lung function trajectories of childhood asthma
Tang, M. F., Leung, A. S. Y., Ngai, N. A., Chan, O. M., Wong, G., & Leung, T. F. (2022) · Pediatric Allergy and Immunology · doi:10.1111/pai.13726 · Cited by 9
Pediatric subcutaneous allergen immunotherapy
Parashar, S., Pandya, A., & Portnoy, J. M. (2022) · Allergy and Asthma Proceedings · doi:10.2500/aap.2022.43.210114 · Cited by 9
Squillacioti, G., Fasola, S., Ghelli, F., Colombi, N., Pandolfo, A., Grutta, S. L., Viegi, G., & Bono, R. (2024) · Environmental Research · doi:10.1016/j.envres.2024.118166 · Cited by 11
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Characteristics of Adults With Severe Asthma in Childhood
Savran, O., Bønnelykke, K., & Ulrik, C. S. (2024) · CHEST Journal · doi:10.1016/j.chest.2024.06.005 · Cited by 9
Royer, C. M., Rudolph, K., & Barrett, E. G. (2012) · Immunology · doi:10.1111/imm.12043 · Cited by 9
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
About these checks
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