Remission of persistent childhood asthma: early predictors of adult outcomes

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Alberta L. Wang, Soma Datta, Scott T. Weiss, Kelan G. Tantisira

Abstract

Background

Few data exist on the predictors of asthma remission by early adulthood in North America.

Objective

The predictors of adult asthma remission were determined in a multiethnic population of mild-to-moderate persistent childhood asthmatics.

Methods

Asthma remission in early adulthood was measured using two definitions, a clinical and a strict definition. Both included normal lung function and the absence of symptoms, exacerbations, and medication use. The strict definition also included normal airways responsiveness. Predictors were identified from 23 baseline measures using multivariate logistic regression. The probability of remission was modeled using decision tree analysis.

Results

In 879 subjects, mean baseline age was 8.8 years (SD ± 2.1), 59.4% were males, and 68.7% were Caucasian. By adulthood, 229 (26.0%) of 879 participants were in clinical remission and 111 (15.0%) of 741 participants were in strict remission. The degree of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC) impairment was the largest predictor of asthma remission. Over half of boys and two-thirds of girls with baseline FEV₁/FVC ≥ 90% were in remission at adulthood. Decreased airways responsiveness was also a predictor for both remission definitions (clinical remission OR 1.23, 95% CI 1.09-1.39; strict remission OR 1.52, 95% CI 1.26-1.84). The combination of normal FEV₁/FVC, airways responsiveness, and serum eosinophil count at baseline yielded > 80% probability of remission by adulthood.

Conclusion

A considerable minority of persistent childhood asthmatics will develop disease remission by adulthood. Clinical prognostic indicators of asthma remission, including baseline lung function, can be seen from an early age.

Graphical abstract

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