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No remission in 60% of those with childhood-onset asthma: a population-based cohort followed from 8 to 28 years of age
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0001-7222-6402
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-0553-8067
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-2358-8754
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2024 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 224, article id 107581Article in journal (Refereed) Published
Abstract [en]

Background: Although remission occur, childhood-onset asthma may persist until adulthood. Since few longitudinal population-based studies have followed a cohort from childhood until adulthood, the knowledge on predictors of persistence of asthma is sparse.

Aim: To estimate persistence of asthma from 8 to 28 years and its associated factors. Methods: Within the OLIN (Obstructive Lung Disease in Northern Sweden) studies, a cohort was recruited in 1996 (age 8y, n = 3430) and followed annually with questionnaires about asthma and risk factors until 19y. Clinical examinations included skin prick tests (at 8, 12 and 19y) and lung function tests (17 and 19y) whereof a subsample performed bronchial hyperreactivity test. We identified n = 248 with asthma at 8y whereof 170 (69%) participated in a follow-up at 28y (73% of possible to invite).

Results: Of the 170 participants at 28y, 105 (61.8%) had persistent asthma (women: 49/76, 64.5%; men: 56/94, 59.6%, p = 0.513). Factors collected at recruitment: allergic sensitization (OR7.8, 95%CI 3.0–20.2), severe respiratory infection (OR2.6, 95%CI 1.1–6.3) and higher asthma severity score (OR1.6, 95%CI 1.1–2.4) were associated with asthma at 28y after adjustment for sex, family history of asthma, breastfeeding <3 months and eczema. Replacing allergic sensitization with rhinoconjunctivitis in the model yielded OR3.4 (95%CI 1.5–8.0). Bronchial hyperreactivity at age 17y associated with asthma at 28y (OR9.0, 95%CI 1.7–47.0).

Conclusions: Among children with asthma onset by 8y, 62% still had asthma at age 28 years. Persistent asthma was associated with allergic sensitization, rhinoconjunctivitis, severe respiratory infection, a more severe asthma and bronchial hyperreactivity.

Place, publisher, year, edition, pages
Saunders Elsevier, 2024. Vol. 224, article id 107581
Keywords [en]
Asthma, Epidemiology, Longitudinal, Relapse, Remission, Risk factors
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:umu:diva-222239DOI: 10.1016/j.rmed.2024.107581PubMedID: 38417585Scopus ID: 2-s2.0-85186384579OAI: oai:DiVA.org:umu-222239DiVA, id: diva2:1845284
Funder
Vårdal FoundationNorrbotten County CouncilVästerbotten County CouncilSwedish Asthma and Allergy AssociationAstraZenecaUmeå UniversitySwedish Heart Lung FoundationAvailable from: 2024-03-18 Created: 2024-03-18 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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Almqvist, LinneaAndersson, MartinBackman, HelenaRönmark, EvaHedman, Linnea

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