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Asthma epidemiology: prognosis of asthma with onset in childhood and in adulthood
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0009-0003-7162-9041
2024 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Astmaepidemiologi : prognos av astma som debuterari barndom respektive vuxen ålder (Swedish)
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 [en]
Asthma, Relapse, Prognosis, Epidemiology, Remission
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health; Lung Medicine
Identifiers
URN: urn:nbn:se:umu:diva-223661ISBN: 978-91-8070-325-3 (print)ISBN: 978-91-8070-326-0 (electronic)OAI: oai:DiVA.org:umu-223661DiVA, id: diva2:1853297
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 CouncilAvailable from: 2024-04-26 Created: 2024-04-22 Last updated: 2024-04-23Bibliographically approved
List of papers
1. Early-life risk factors for development of asthma from 8 to 28 years of age: a prospective cohort study
Open this publication in new window or tab >>Early-life risk factors for development of asthma from 8 to 28 years of age: a prospective cohort study
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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
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-203272 (URN)10.1183/23120541.00074-2022 (DOI)000895755200002 ()2-s2.0-85141716387 (Scopus ID)
Funder
Swedish Heart Lung FoundationVårdal FoundationSwedish Asthma and Allergy AssociationVisare NorrNorrbotten County CouncilRegion Västerbotten
Available from: 2023-01-17 Created: 2023-01-17 Last updated: 2024-04-22Bibliographically approved
2. No remission in 60% of those with childhood-onset asthma: a population-based cohort followed from 8 to 28 years of age
Open this publication in new window or tab >>No remission in 60% of those with childhood-onset asthma: a population-based cohort followed from 8 to 28 years of age
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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
Keywords
Asthma, Epidemiology, Longitudinal, Relapse, Remission, Risk factors
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-222239 (URN)10.1016/j.rmed.2024.107581 (DOI)38417585 (PubMedID)2-s2.0-85186384579 (Scopus ID)
Funder
Vårdal FoundationNorrbotten County CouncilVästerbotten County CouncilSwedish Asthma and Allergy AssociationAstraZenecaUmeå UniversitySwedish Heart Lung Foundation
Available from: 2024-03-18 Created: 2024-03-18 Last updated: 2024-04-22Bibliographically approved
3. The coexistence of asthma, rhinitis and eczema from childhood to young adulthood
Open this publication in new window or tab >>The coexistence of asthma, rhinitis and eczema from childhood to young adulthood
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(English)Manuscript (preprint) (Other academic)
Keywords
Asthma, Rhinitis, Eczema
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health
Identifiers
urn:nbn:se:umu:diva-223660 (URN)
Available from: 2024-04-22 Created: 2024-04-22 Last updated: 2024-04-23
4. Remission of adult-onset asthma is rare: a 15-year follow-up study
Open this publication in new window or tab >>Remission of adult-onset asthma is rare: a 15-year follow-up study
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2020 (English)In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 4, article id 00620-2020Article in journal (Refereed) Published
Abstract [en]

Background: There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up.

Methods: A cohort of 309 adults aged 20-60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months.

Results: Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma.

Conclusion: Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.

Place, publisher, year, edition, pages
European Respiratory Society, 2020
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-179059 (URN)10.1183/23120541.00620-2020 (DOI)000603682700123 ()33263024 (PubMedID)2-s2.0-85098849252 (Scopus ID)
Available from: 2021-01-29 Created: 2021-01-29 Last updated: 2024-04-22Bibliographically approved

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