A study published in this week's Asthma Special Issue of The Lancet has shown that asthma with onset in early adulthood has its origins in early childhood. The study is written by Dr Debra Stern and Professor Fernando D Martinez, Arizona Respiratory Center, Tucson, Arizona, USA, and colleagues.
The researchers used data from the Tucson Children's Respiratory Study, which enrolled 1246 babies, of which 849 had follow-up data at 22 years. Of the 181 cases of active asthma at 22 years, 49 (27%) were newly diagnosed, of which 35 (71%) were women. Men were twice as likely as women to have had asthma remission by age 22 years.
Factors independently associated with chronic asthma at 22 years included wheezing onset at six years (7.4 times increased risk); persistent wheezing in early life (14 times increased risk); sensitisation to Alternaria alernata* (3.6 times increased risk); low airway function at age six years (twice the risk); and bronchial hyper-responsiveness at six years (4.5 times the risk).
Furthermore, increased risk of newly diagnosed asthma at age 22 years was associated with bronchial hyper-responsiveness at six years (by seven times), low airway function at six years (by nearly three times), wheezing onset at 6 years (by 4.6 times) and persistent wheezing (by four times).
The authors conclude: "In over 70% of people with current asthma and 63% of those with newly diagnosed asthma at age 22 years, episodes of wheezing had happened in the first three years of life or were reported by parents at age six years…Our findings support our previous proposition that most forms of asthma have their origins in early life, but we now extend that proposition to asthma diagnosed in early adult life."
In an accompanying Comment, Dr Susanne Lau, Charité University Medicine, Berlin, Germany, says: "These findings identify a population at risk of chronic obstructive airway disease in early adulthood, and they already showed a predisposition during preschool years. Whether therapeutic approaches at early preschool age can affect progression of the disease is yet to be established."
Dr Debra Stern, Arizona Respiratory Center, Tucson, Arizona, USA T) +1 520 626-4226 E) ocean@arc.arizona.edu
Dr Susanne Lau, Charité University Medicine, Berlin, Germany T) +49-30-450 666254 E) Susanne.lau@charite.de
Note to editors:
*Alternaria alernata is a common allergen in humans, growing indoors and often causing asthma or hypersensitivity reactions
Full Article and Comment: http://press.thelancet.com/asthmachildhood.pdf
Journal
The Lancet