Predicting asthma outcomes

• Published in: Journal of allergy and clinical immunology Vol. 136; no. 4; pp. 829 - 836
• Main Author: Sears, Malcolm R., MB, ChB
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; Elsevier Limited
• Subjects: Accreditation; Adult; Allergies; Allergy and Immunology; Animals; Asthma; Asthma - diagnosis; Biomarkers - metabolism; birth cohorts; Child; Colds; Copyright; Disclosure; Disease; Disease Progression; Family; Female; Humans; longitudinal phenotypes; lung function; Male; Medical History Taking; persistence; prediction; Prognosis; remission; Respiratory Sounds - diagnosis; Sex Factors; Studies; wheezing; BAMSE; aOR; University of Cincinnati Asthma Predictive Index; GRS; birth cohorts; Barn/Children, Allergy and Milieu in Stockholm, an Epidemiological study; wheezing; Asthma Predictive Index; Genetic risk score; lung function; PPV; Chronic obstructive pulmonary disease; Prevention and Incidence of Asthma and Mite Allergy; CAMP; mAPI; Adjusted odds ratio; OR; Childhood Asthma Management Program; ALSPAC; longitudinal phenotypes; Avon Longitudinal Study of Parents and Children; Asthma; ucAPI; PIAMA; remission; prediction; persistence; Odds ratio; API; Positive predictive value; Modified Asthma Predictive Index; COPD
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2015.04.048

This review addresses predictors of remission or persistence of wheezing and asthma from early childhood through adulthood. Early childhood wheezing is common, but predicting who will remit or have persistent childhood asthma remains difficult. By adding parental history of asthma and selected infant biomarkers to the history of recurrent wheezing, the Asthma Predictive Index and its subsequent modifications provide better predictions of persistence than simply the observation of recurrent wheeze. Sensitization, especially to multiple allergens, increases the likelihood of development of classic childhood asthma. Remission is more likely in male subjects and those with milder disease (less frequent and less severe symptoms), less atopic sensitization, a lesser degree of airway hyperresponsiveness, and no concomitant allergic disease. Conversely, persistence is linked strongly to allergic sensitization, greater frequency and severity of symptoms, abnormal lung function, and a greater degree of airway hyperresponsiveness. A genetic risk score might predict persistence more accurately than family history. Remission of established adult asthma is substantially less common than remission during childhood and adolescence. Loss of lung function can begin early in life and tracks through childhood and adolescence. Despite therapy which controls symptoms and exacerbations, the outcomes of asthma appear largely resistant to pharmacologic therapy.