Clinical assessment of asthma progression in children and adults

• Published in: Journal of allergy and clinical immunology Vol. 121; no. 3; pp. 548 - 557
• Main Authors: Spahn, Joseph D., Covar, Ronina
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2008; Elsevier; Elsevier Limited
• Subjects: Accreditation; Adult; Age; Allergies; Allergy and Immunology; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - genetics; Asthma - physiopathology; Asthma progression; Biological and medical sciences; birth cohort studies; Child; Child development; Colds; Disease; Disease Progression; early intervention; Families & family life; Family medical history; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; lung function decline; Medical sciences; natural history of asthma; Preschool education; relapse; remission; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Studies; OR; birth cohort studies; relapse; early intervention; FP; lung function decline; BHR; BDP; natural history of asthma; FVC; RSV; SPT; remission; Asthma progression; API; CAMP; COPD; H6CS; Harvard Six Cities Study; Forced vital capacity; Asthma Predictive Index; Fluticasone propionate; Chronic obstructive pulmonary disease; Childhood Asthma Management Program; Skin prick test; Respiratory syncytial virus; Beclomethasone dipropionate; Bronchial hyperresponsiveness; Odds ratio; Human; Lung disease; Immunopathology; Relapse; Respiratory disease; Pathogenesis; Asthma; Lung function; Immunology; Cohort study; Bronchus disease; Adult; Birth cohort; Evolution; Early; Remission; Obstructive pulmonary disease; Child
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2008.01.012

Asthma is a heterogeneous disorder with a variable course, characterized by episodes of cough, wheezing and shortness of breath, reversible airflow limitation, and bronchial hyperresponsiveness. It begins early in life in many subjects with intermittent symptoms occurring with viral respiratory tract infections. Over time, and in genetically susceptible children (those with an atopic predisposition), the disease becomes more persistent with symptoms occurring in the absence of respiratory tract infections. Children with persistent wheezing are eventually diagnosed with asthma, with those at greatest risk having developed allergic sensitization early in life. Among children with asthma, some will have lifelong asthma with active symptoms and progressive loss of lung function over time, whereas other children will undergo asthma remission in adolescence. Once in remission, the disease may remain quiescent, or it may relapse in midadult life. This review focuses on studies that have enhanced our understanding of the progression of asthma from infancy to adulthood. Studies evaluating progressive loss of lung function, the best-studied measure of asthma progression, are also reviewed, followed by a brief discussion of whether asthma progression can be modified by inhaled glucocorticoid therapy.