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Early-life risk factors for development of asthma from 8 to 28 years of age: a prospective cohort study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-1630-3167
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
Martina Children’s Hospital, Stockholm, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0001-7222-6402
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2022 (English)In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 4, article id 00074-2022Article in journal (Refereed) Published
Abstract [en]

Background: The objective was to estimate the incidence rate of asthma from age 8 to 28 years and evaluate early-life risk factors for asthma onset at different ages.

Methods: In 1996, within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of 3430 schoolchildren (97% of invited) was recruited at age 8 years to a prospective study about asthma. The cohort was followed annually from age 8 to 19 years and at 28 years by questionnaire surveys (67% of the original cohort participated). Asthma was categorised as never-asthma, onset age ⩽8 years, onset age 9–13 years, onset age 14–19 years or onset age >19 years.

Results: Of the 3430 individuals in the cohort, 690 (20.1%) reported asthma in any survey. The average incidence rate was 10.0/1000 per year at ⩽8 years, 11.9/1000 per year at 9–13 years, 13.3/1000 per year at 14–19 years and 6.1/1000 per year at >19 years. The incidence was higher among boys until age 10 years, but from age 15 years, it became higher among girls. Family history of asthma, allergic sensitisation and breastfeeding <3 months were associated with asthma onset throughout the study. Low birthweight, maternal smoking during pregnancy, severe respiratory infection, rhinoconjunctivitis and eczema were associated with asthma onset ⩽8 and 9–13 years.

Conclusions: The incidence of asthma was high during childhood and the teenage period, and decreased substantially during young adulthood. Early-life factors were associated with asthma onset throughout childhood but had also a lasting effect on asthma incidence until adulthood.

Place, publisher, year, edition, pages
European Respiratory Society , 2022. Vol. 8, no 4, article id 00074-2022
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:umu:diva-203272DOI: 10.1183/23120541.00074-2022ISI: 000895755200002Scopus ID: 2-s2.0-85141716387OAI: oai:DiVA.org:umu-203272DiVA, id: diva2:1727809
Funder
Swedish Heart Lung FoundationVårdal FoundationSwedish Asthma and Allergy AssociationVisare NorrNorrbotten County CouncilRegion VästerbottenAvailable from: 2023-01-17 Created: 2023-01-17 Last updated: 2024-04-22Bibliographically approved
In thesis
1. Asthma epidemiology: prognosis of asthma with onset in childhood and in adulthood
Open this publication in new window or tab >>Asthma epidemiology: prognosis of asthma with onset in childhood and in adulthood
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Astmaepidemiologi : prognos av astma som debuterari barndom respektive vuxen ålder
Abstract [en]

Aim: to update the knowledge on the epidemiology of asthma with onset in childhood and adulthood as well as examine the importance of risk factors in early childhood and clinical characteristics on the incidence and prognosis of asthma.

Methods: The thesis is based on the epidemiological research program Obstructive Lung Disease in Northern Sweden (OLIN) studies. Pediatric cohort: recruited in 1996 (age 8y, n=3430, 97% of invited) and followed annually by questionnaire about asthma, allergy and risk factors until 19y and a postal questionnaire at 28y. Clinical examinations included skin prick tests (SPT at 8, 12 and 19y) and spirometry (19y). Adult cohort: 309 adults (age 20–60y) with asthma onset in the last 12 months were recruited 1995-99 and re-examined in 2012-14 (n=205). Structured interviews, spirometry and SPT were performed at recruitment and follow-up and bronchial hyperreactivity (BHR) at recruitment.

Results: The asthma incidence rate was 10-13/1000/year in childhood and adolescence and 6/1000/year in young adulthood. Several risk factors in early life were associated with asthma onset in childhood, adolescence and young adulthood, e.g. family history of asthma, <3 months breastfeeding, rhinoconjunctivitis and positive SPT at 8y, while low birthweight, maternal smoking during pregnancy, severe respiratory infections and eczema were associated with onset in childhood and adolescence. Among those with asthma at 8y, 62% still had asthma at 28y and this was associated with positive SPT, rhinoconjunctivitis, severe respiratory infection in childhood, and bronchial hyperreactivity (BHR) in adolescence. Coexistence of asthma, rhinitis and eczema increased by age, especially among those with a positive SPT. However, having all three conditions was uncommon. In the 15y follow-up adult onset asthma, 89% had persistent asthma. Better lung function at recruitment and less severe BHR was associated with remission. Remission rate of adult onset asthma was <1% per year.

Conclusion: The incidence of asthma was high during childhood and adolescence and then decreased in young adulthood. Factors in early life that were associated with incident asthma during childhood were still associated with the incidence in adult age. Among those with asthma onset by 8 years, 62%, still had asthma as young adults. The coexistence of asthma, rhinitis and eczema varied from 8 to 28y without following a specific pattern, only a small proportion reported having all three conditions. Remission of adult onset asthma was rare. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 74
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2291
Series
The Obstructive Lung disease in Northern Sweden studies (OLIN) ; 26
Keywords
Asthma, Relapse, Prognosis, Epidemiology, Remission
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health; Lung Medicine
Identifiers
urn:nbn:se:umu:diva-223661 (URN)978-91-8070-325-3 (ISBN)978-91-8070-326-0 (ISBN)
Public defence
2024-05-17, Aulan, Sunderby sjukhus, Sjukhusvägen 10, 09:00 (Swedish)
Opponent
Supervisors
Funder
Umeå UniversityNorrbotten County CouncilSwedish Asthma and Allergy AssociationVisare NorrVårdal FoundationSwedish Research Council
Available from: 2024-04-26 Created: 2024-04-22 Last updated: 2024-04-23Bibliographically approved

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Hedman, LinneaAlmqvist, LinneaAndersson, MartinBackman, HelenaRönmark, Eva

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