11/10/03 Long-term follow-up of childhood asthmaSummaryMost previous studies have concluded that the prognosis for childhood asthma is good as the children become older in most, but certainly not all, cases. Several studies are now looking at possible predictors of which asthmatic children do well or not as they progress into adulthood. Horak et al have reported some of the findings in the Melbourne Epidemiologic Study of Childhood Asthma in which children at age 7 years (295 with asthma and 106 healthy controls were randomly selected in 1964). They were classified by the frequency and severity of asthmatic symptoms. The subjects were then followed sequentially starting at age 21 years until age 42 years. At the most recent evaluation, there was a participation rate of 87% with 15 fatalities (one reportedly due to asthma). It was found that the frequency and severity of asthmatic symptoms at age 42 years was significantly related to the severity of asthma at age 7 years. For example, 66% of those with mild "wheezy bronchitis" at age 7 had experienced no recent asthma and none had persistent asthma at age 42. In contrast, only 11% of those with severe asthma at age 7 no longer had asthma while 47% of this group had persistent asthma at age 42 years. Reference BMJ 2003; 326:422-23 Editor's Comments Many parents (and some physicians) are under the impression that childhood asthma is almost always "outgrown" as children enter adolescence. The findings in this study are of great interest and value because of the very high percentage of the original study group evaluated and the very long duration of the follow-up. It points out that asthma persists into middle age in a sizable percentage in those with severe asthma at age 7 years. The risk for persistent asthma decreases in those with less severe asthma at age 7 but there are still cases of at least intermittent asthma. It should be stressed that picking age 7 years for the initial evaluation this study by passed the very sizable number of young children who wheeze (generally with viral URI) in the first several years of life but do not manifest chronic asthma after age 3-5 years.
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