Prognosis of childhood asthma

The major identifiable risk factors contributing to both the expression and persistence of asthma are considered below (1):

• family history of atopy - asthma is linked to both parental and sibling atopy (strongest association is with maternal atopy). A maternal history of asthma and/or rhinitis is a significant risk factor for late childhood onset asthma (and recurrent wheezing throughout childhood)
• co-existence of atopic disease - markers of allergic disease at presentation (including eosinophil counts, skin prick tests) are related to the persistence and severity of current asthma through childhood - no evidence that these markers are related to the outcome of respiratory symptoms and severity of asthma in adulthood
• effect of sex - male sex is a risk factor for asthma in prepubertal children (male children are more likely to "grow out" of their asthma in the transition to adulthood). Female sex is a risk factor for persistence of asthma in the transition from childhood to adulthood
• bronchiolitis in infancy - viral associated wheeze often is followed by wheeze in early childhood; as the child's age advances this association weakens and by 35-40 years ventilatory function and bronchial reactivity is similar to those who had no symptoms in childhood
• parental smoking - wheezing illness in early childhood is associated with maternal smoking; there is, however, no identifiable association between parental smoking and respiratory symptoms in adulthood
• birthweight and prematurity - there is no consistent relationship between adult asthma and birthweight. Wheezing is more common in children whoe were born prematurely
• age at presentation - the earlier the onset of wheeze, the better the prognosis. The majority of children who present before the age of two years become asymptomatic by mid childhood (6-11 years). Note though that coexistent atopy is a risk factor for the persistence of asthma independent of age of presentation

Reference:

1. Thorax 2003;58 (Suppl I).