Childhood factors associated with asthma remission after 30 year follow up

Abstract

Background: Factors contributing to either “complete” or “clinical” remission of asthma are important to know since there is no cure for the disease.

Methods: A cohort of 119 allergic asthmatic children was examined three times with a mean follow up of 30 years. They were aged 5–14 years at visit 1 (1966–9), 21–33 years at visit 2 (1983–6), and 32–42 years at visit 3 (1995–6). Complete remission of asthma at visit 3 was defined as no asthma symptoms, no use of inhaled corticosteroids, normal lung function (FEV₁ >90% predicted), and no bronchial hyperresponsiveness (PC₁₀ >16 mg/ml). Clinical remission was defined as no asthma symptoms and no use of inhaled corticosteroids.

Results: 22% of the group was in complete remission of asthma at visit 3 and a further 30% was in clinical remission (total 52%); 57% of subjects in clinical remission had bronchial hyperresponsiveness and/or a low lung function. Logistic regression analyses showed that a higher FEV₁ in childhood and more improvement in FEV₁ from age 5–14 to 21–33 were associated with both complete and clinical asthma remission at age 32–42.

Conclusions: Complete remission of asthma was present in a small subset of asthmatics while half the subjects showed clinical remission. Both complete and clinical remission were associated with a higher lung function level in childhood and a higher subsequent increase in FEV₁. These results support the view that defining remission only on the basis of symptoms and medication use will overlook subjects with subclinical active disease and possibly associated airway remodelling.