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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