Asthma from childhood to adulthood Ernst Eber

1. Asthma from childhood to adulthoodErnst Eber Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Austria

2. Prevalence of asthma 300 million people suffer from asthma worldwide No data available

3. ISAAC Lancet 1998

4. Wheezing in preschool children Martinez FD Pediatr Pulmonol 1997 based on: N Engl J Med 1995

5. Wheezing in preschool children Martinez FD Pediatr Pulmonol 1997 based on: N Engl J Med 1995

6. Wheezing in preschool children Landau LI Pediatr Pulmonol 1996

7. Asthma is not one disease • Different phenotypes of childhood asthma • - Virus associated wheeze • - Post-bronchiolitis wheeze • - Atopy associated wheeze • Asthma in more than 50% begins<3 years

8. Childhood asthma „... there is a belief among general practitioners and paediatricians that children grow out of asthma.“ „... it is often not the asthma that is outgrown but the paediatrician.“ Issues in Adolescent Asthma.Thorax 1996; 51 (Supplement 1)

9. Outcome of asthma and wheezing in the first 6 years of life Morgan WJ et al. Am J Respir Crit Care Med 2005

10. Outcome of asthma and wheezing in the first 6 years of life Morgan WJ et al. Am J Respir Crit Care Med 2005

11. Outcome of asthma and wheezing in the first 6 years of life Morgan WJ et al. Am J Respir Crit Care Med 2005

12. Outcome of asthma and wheezing in the first 6 years of life „... our study strongly suggests that both lung function characteristics in early infancy and events occurring during the first 6 years of life determine the expression of asthma and the level of lung function that will be achieved during childhood and into early adult life.“ Morgan WJ et al. Am J Respir Crit Care Med 2005

13. The Melbourne Asthma Study: 1964-1999 • 1964: Children at age 7 yrs with a history of wheezing randomly selected; further group selected from the same birth cohort at age 10 • Subjects followed prospectively at 7-yr intervals; last review 1999 (average age 42 yrs) • 87% of the original cohort participated in the 1999 review Phelan PD et al. J Allergy Clin Immunol 2002

14. The Melbourne Asthma Study: 1964-1999 Oswald H et al. Pediatr Pulmonol 1997

15. The Melbourne Asthma Study: 1964-1999 • The majority of children who had only a few episodes of wheezing associated with symptoms of a respiratory infection had a benign course, with many ceasing to wheeze by adult life. Most who continued with symptoms into adult life were little troubled by them. • Children with asthma mostly continued with significant wheezing into adult life, and the more troubled they were in childhood, the more likely symptoms continued. Phelan PD et al. J Allergy Clin Immunol 2002

16. The Melbourne Asthma Study: 1964-1999 • There was a loss in lung function by the age of 14 years in those with severe asthma, the loss did not progress in adult life. • There was no significant loss of lung function in those with milder symptoms. Phelan PD et al. J Allergy Clin Immunol 2002

17. A longitudinal, population-based cohort study of childhood asthma followed to adulthood 14.5% 15.0% 12.4% 9.5% 21.2% 27.4% Sears MR et al. N Engl J Med 2003

18. A longitudinal, population-based cohort study of childhood asthma followed to adulthood Sears MR et al. N Engl J Med 2003

19. A longitudinal, population-based cohort study of childhood asthma followed to adulthood • More than 1 in 4 children had wheezing that persisted from childhood to adulthood or that relapsed after remission. • The factors predicting persistence or relapse were sensitization to HDM, AHR, 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. Sears MR et al. N Engl J Med 2003

20. A clinical index to define risk of asthma in young children with recurrent wheezing Castro-Rodriguez JA et al. Am J Respir Crit Care Med 2000

21. A clinical index to define risk of asthma in young children with recurrent wheezing Castro-Rodriguez JA et al. Am J Respir Crit Care Med 2000

22. Risk factors for onset of asthmaA 12-year prospective follow-up study Thepresence of AHR and concomitant atopic manifestations in childhood increase the risk of developing asthma in adulthood, and should be recognized as markers of prognostic significance, whereas the absence of these manifestations predicts a very low risk of future asthma. Porsbjerg C et al. Chest 2006

23. Asthma from childhood to adulthood Airway inflammation and airway remodelling are present in children and adolescents with clinical remission of their asthma. (Eosinophils, T cells, mast cells and IL-5 in bronchial biopsy tissue; eosinophils in BALF; eosinophils, ECP, TNF-α and GM-CSF in induced sputum; FeNO; BR to AMP and MCh) van den Toorn et al. Am J Respir Crit Care Med 2000 & 2001; Warke et al. Eur Respir J 2002; Obase et al. Allergy 2003

24. Childhood factors associated with asthma remission after 30 years follow up Cohort of 119 allergic asthmatic children visit 1: 5-14 yrs, visit 2: 21-33 yrs, visit 3: 32-42 yrs Clinical remission: no asthma symptoms, no use of ICS Complete remission: no asthma symptoms, no use of ICS, normal lung function, no BHR Vonk JM et al. Thorax 2004

25. Childhood factors associated with asthma remission after 30 years follow up Complete remission at visit 3: 22% Clinical remission at visit 3: 30% Both complete and clinical remission were associated with a higher lung function level in childhood and a higher subsequent increase in FEV1. Vonk JM et al. Thorax 2004

26. Asthma from childhood to adulthood Summary I In the vast majority of cases asthma has its onset in childhood. In a proportion of asthmatic children, asthma remits in adolescence or early adulthood and the severity of asthma tracks significantly with age.

27. Asthma from childhood to adulthood Summary II Complete remission of childhood asthma may be the exception rather than the rule.  Patients with asthma in clinical remission should be monitored with periodic assessment of lung function, bronchial responsiveness, and other markers of inflammation.

28. İlginiz için teşekkür ederim!