TY - JOUR
T1 - Predictors of remitting, periodic, and persistent childhood asthma
AU - Covar, Ronina A.
AU - Strunk, Robert
AU - Zeiger, Robert S.
AU - Wilson, Laura A.
AU - Liu, Andrew H.
AU - Weiss, Scott
AU - Tonascia, James
AU - Spahn, Joseph D.
AU - Szefler, Stanley J.
N1 - Funding Information:
The Childhood Asthma Management Program is supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051 , M01RR0099718-24 , M01RR02719-14 , and RR00036 from the National Center for Research Resources.
PY - 2010/2
Y1 - 2010/2
N2 - Background: The course of mild to moderate persistent asthma in children is not clearly established. Objective: To determine the rate and predictors for remitting, periodic, and persistent asthma in adolescence. Methods: The Childhood Asthma Management Program (CAMP) was a 4.3-year randomized, double-masked, multicenter trial in children with mild to moderate persistent asthma that compared continuous therapy with either budesonide or nedocromil, each to placebo, followed by a 4-year observational follow-up period. Asthma activity during the observation period included remitting (no asthma activity in the last year), persistent (asthma activity in every quarter), and periodic asthma (neither remitting nor persistent). Results: Asthma was identified as remitting in 6%, periodic in 39%, and persistent in 55% of the 909 participants, with no effect noted from earlier anti-inflammatory treatment during the CAMP trial. Within all 3 asthma activity categories, improvements in airway hyperresponsiveness, eosinophilia, and asthma morbidity were observed over time. Features at entry into CAMP associated with remitting versus persistent asthma were lack of allergen sensitization and exposure to indoor allergens (odds ratio [OR], 3.23; P < .001), milder asthma (OR, 2.01; P = .03), older age (OR, 1.23; P = .01), less airway hyperresponsiveness (higher log methacholine FEV1 PC20 (OR, 1.39; P = .03), higher prebronchodilator FEV1 percent predicted (OR, 1.05; P = .02), and lower forced vital capacity percent predicted (OR, 0.96; P = .04). Conclusion: Remission of asthma in adolescence is infrequent and not affected by 4 years of anti-inflammatory controller therapy. Factors such as sensitization and exposure, low lung function, and airway greater hyperresponsiveness decrease the likelihood of remitting asthma.
AB - Background: The course of mild to moderate persistent asthma in children is not clearly established. Objective: To determine the rate and predictors for remitting, periodic, and persistent asthma in adolescence. Methods: The Childhood Asthma Management Program (CAMP) was a 4.3-year randomized, double-masked, multicenter trial in children with mild to moderate persistent asthma that compared continuous therapy with either budesonide or nedocromil, each to placebo, followed by a 4-year observational follow-up period. Asthma activity during the observation period included remitting (no asthma activity in the last year), persistent (asthma activity in every quarter), and periodic asthma (neither remitting nor persistent). Results: Asthma was identified as remitting in 6%, periodic in 39%, and persistent in 55% of the 909 participants, with no effect noted from earlier anti-inflammatory treatment during the CAMP trial. Within all 3 asthma activity categories, improvements in airway hyperresponsiveness, eosinophilia, and asthma morbidity were observed over time. Features at entry into CAMP associated with remitting versus persistent asthma were lack of allergen sensitization and exposure to indoor allergens (odds ratio [OR], 3.23; P < .001), milder asthma (OR, 2.01; P = .03), older age (OR, 1.23; P = .01), less airway hyperresponsiveness (higher log methacholine FEV1 PC20 (OR, 1.39; P = .03), higher prebronchodilator FEV1 percent predicted (OR, 1.05; P = .02), and lower forced vital capacity percent predicted (OR, 0.96; P = .04). Conclusion: Remission of asthma in adolescence is infrequent and not affected by 4 years of anti-inflammatory controller therapy. Factors such as sensitization and exposure, low lung function, and airway greater hyperresponsiveness decrease the likelihood of remitting asthma.
KW - Remission
KW - natural history
KW - persistent asthma
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U2 - 10.1016/j.jaci.2009.10.037
DO - 10.1016/j.jaci.2009.10.037
M3 - Article
C2 - 20159245
AN - SCOPUS:75849136559
SN - 0091-6749
VL - 125
SP - 359-366.e3
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 2
ER -