Risk factors for onset of asthma: a 12-year prospective follow-up study.

BACKGROUND Asthma development and prognosis have been studied extensively in at-risk populations, but knowledge of the natural history of asthma in the general population is limited. OBJECTIVE To describe the incidence and remission of asthma and its predictors, data from a 12-year follow-up study of a random population sample (n = 291; age range, 7 to 17 years) at enrollment, were analyzed. METHODS The sample was examined in 1986 and in 1998. A case history, including data on asthma, allergic diseases, and lifestyle factors, was obtained by questionnaire and interview. Airway hyperresponsiveness (AHR) to histamine, lung function, and skin-prick test reactivity to a standard panel of 10 aeroallergens were measured. RESULTS The point prevalence of asthma increased from 4.1% at the first survey to 11.7% at follow-up, at which point 19.6% of the sample had ever experienced asthma symptoms. Of the subjects with ever-asthma, 40% had remitted at follow-up. Asthma developed in 45 subjects (16.1%) during the follow-up period, which was predicted by the following factors: wheezing in childhood (odds ratio [OR], 3.61; 95% confidence interval [CI], 1.34 to 9.75), AHR (OR, 4.94; 95% CI, 2.42 to 10.08), allergic sensitization to house dust mites (OR, 3.23; 95% CI, 1.00 to 10.40), and dermatitis (OR, 2.94; 95% CI, 1.22 to 7.11). The simultaneous presence of more than one of these risk factors was associated with a high probability of developing asthma at follow-up (61.5%). In subjects without any risk factors, such as AHR, allergic sensitization, rhinitis, dermatitis or wheezing in childhood; paternal/maternal allergy, or asthma, asthma developed in only 4% during follow-up. CONCLUSION The presence 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.

[1]  W. Waters,et al.  Respiratory symptoms and bronchial reactivity: identification of a syndrome and its relation to asthma. , 1986, British medical journal.

[2]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[3]  R. Townley,et al.  Specificity and sensitivity of methacholine inhalation challenge in normal and asthmatic children. , 1984, The Journal of allergy and clinical immunology.

[4]  F. Hargreave,et al.  Bronchial reactivity to inhaled histamine: a method and clinical survey , 1977, Clinical allergy.

[5]  L. Boulet.  Asymptomatic airway hyperresponsiveness: a curiosity or an opportunity to prevent asthma? , 2003, American journal of respiratory and critical care medicine.

[6]  C. Ulrik.  Comparison of stayers, dropouts, and newcomers in a longitudinal population study of asthma and bronchial hyperresponsiveness: introduction of bias? , 1995, The Journal of asthma : official journal of the Association for the Care of Asthma.

[7]  C. Vancheri,et al.  Effect of immunotherapy on asthma progression, BHR and sputum eosinophils in allergic rhinitis , 2004, Allergy.

[8]  F. Speizer,et al.  The association of airways responsiveness to respiratory symptom prevalence and to pulmonary function in a random population sample. , 1987, Bulletin europeen de physiopathologie respiratoire.

[9]  C. Salome,et al.  Bronchial hyperresponsiveness in two populations of Australian schoolchildren. II. Relative importance of associated factors , 1987, Clinical allergy.

[10]  M. Sears,et al.  Parental and neonatal risk factors for atopy, airway hyper-responsiveness, and asthma. , 1996, Archives of disease in childhood.

[11]  M. Lebowitz,et al.  Antecedent features of children in whom asthma develops during the second decade of life. , 1993, The Journal of allergy and clinical immunology.

[12]  B. Toelle,et al.  Childhood factors that predict asthma in young adulthood , 2004, European Respiratory Journal.

[13]  A. Woolcock,et al.  Risk factors for onset and remission of atopy, wheeze, and airway hyperresponsiveness , 2002, Thorax.

[14]  S. Schraub,et al.  Sensitization to mite allergens is a risk factor for early and late onset of asthma and for persistence of asthmatic signs in children. , 1995, The Journal of allergy and clinical immunology.

[15]  J. Warner.  Bronchial hyperresponsiveness, atopy, airway inflammation, and asthma , 1998, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[16]  C. Salome,et al.  Longitudinal changes in atopy during a 4-year period: relation to bronchial hyperresponsiveness and respiratory symptoms in a population sample of Australian schoolchildren. , 1990, The Journal of allergy and clinical immunology.

[17]  F. Martinez,et al.  What have we learned from the Tucson Children's Respiratory Study? , 2002, Paediatric respiratory reviews.

[18]  A. Hjern,et al.  Trends in asthma, allergic rhinitis and eczema among Swedish conscripts from farming and non‐farming environments. A nationwide study over three decades , 2004, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[19]  C. Delacourt,et al.  Sensitization to inhalant allergens in wheezing infants is predictive of the development of infantile asthma , 1994, Allergy.

[20]  G. P. Herbison,et al.  Outcome in adulthood of asymptomatic airway hyperresponsiveness in childhood: A longitudinal population study , 2002, Pediatric pulmonology.

[21]  R. Townley,et al.  The presence of airway reactivity before the development of asthma. , 1990, The American review of respiratory disease.

[22]  D. Strachan,et al.  Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort , 1996, BMJ.

[23]  J. Kemp,et al.  Allergic Rhinitis and its Impact on Asthma (ARIA): In collaboration with the World Health Organization , 2002 .

[24]  J. Bousquet,et al.  Allergic rhinitis and its impact on asthma. , 2001, The Journal of allergy and clinical immunology.

[25]  G. Passalacqua,et al.  Bronchial hyperresponsiveness in children with atopic rhinitis: a 7‐year follow‐up , 2004, Allergy.

[26]  J. Bousquet,et al.  Executive Summary of the Workshop Report
7–10 December 1999, Geneva, Switzerland , 2002 .

[27]  S. Holgate,et al.  Associations between respiratory symptoms, bronchial response to methacholine, and atopy in two age groups of schoolchildren. , 1989, Archives of disease in childhood.

[28]  T. Cooper.  Department of Health, Education, and Welfare. , 1976, Military medicine.