Predictors of remitting, periodic, and persistent childhood asthma

• Published in: Journal of allergy and clinical immunology Vol. 125; no. 2; pp. 359 - 366.e3
• Main Authors: Covar, Ronina A., MD, Strunk, Robert, MD, Zeiger, Robert S., MD, PhD, Wilson, Laura A., ScM, Liu, Andrew H., MD, Weiss, Scott, MD, MSc, Tonascia, James, PhD, Spahn, Joseph D., MD, Szefler, Stanley J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2010; Elsevier; Elsevier Limited
• Subjects: Adolescent; Age; Allergies; Allergy and Immunology; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - epidemiology; Biological and medical sciences; Budesonide - therapeutic use; Child; Child, Preschool; Chronic obstructive pulmonary disease, asthma; Clinical trials; Double-Blind Method; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Male; Medical sciences; natural history; Nedocromil - therapeutic use; persistent asthma; Pneumology; Remission; Respiratory Function Tests; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Skin; Treatment Outcome; Variables; persistent asthma; OR; Childhood Asthma Management Program; Forced vital capacity; AHR; natural history; Airway hyperresponsiveness; FVC; Emergency department; Remission; Odds ratio; CAMP; ED; Human; Lung disease; Immunopathology; Respiratory disease; Prediction; Asthma; Immunology; Bronchus disease; Obstructive pulmonary disease; Predictive factor; Child; Natural history
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2009.10.037

Background The course of mild to moderate persistent asthma in children is not clearly established. Objective To determine the rate and predictors for remitting, periodic, and persistent asthma in adolescence. Methods The Childhood Asthma Management Program (CAMP) was a 4.3-year randomized, double-masked, multicenter trial in children with mild to moderate persistent asthma that compared continuous therapy with either budesonide or nedocromil, each to placebo, followed by a 4-year observational follow-up period. Asthma activity during the observation period included remitting (no asthma activity in the last year), persistent (asthma activity in every quarter), and periodic asthma (neither remitting nor persistent). Results Asthma was identified as remitting in 6%, periodic in 39%, and persistent in 55% of the 909 participants, with no effect noted from earlier anti-inflammatory treatment during the CAMP trial. Within all 3 asthma activity categories, improvements in airway hyperresponsiveness, eosinophilia, and asthma morbidity were observed over time. Features at entry into CAMP associated with remitting versus persistent asthma were lack of allergen sensitization and exposure to indoor allergens (odds ratio [OR], 3.23; P < .001), milder asthma (OR, 2.01; P = .03), older age (OR, 1.23; P = .01), less airway hyperresponsiveness (higher log methacholine FEV1 PC20 (OR, 1.39; P = .03), higher prebronchodilator FEV1 percent predicted (OR, 1.05; P = .02), and lower forced vital capacity percent predicted (OR, 0.96; P = .04). Conclusion Remission of asthma in adolescence is infrequent and not affected by 4 years of anti-inflammatory controller therapy. Factors such as sensitization and exposure, low lung function, and airway greater hyperresponsiveness decrease the likelihood of remitting asthma.